Having Trouble Taking All Your Medications?

Today I'd like to say a few words about medications. Often physicians need to prescribe multiple medications for the same patient. One is each morning, another twice a day, a couple are "as needed" and yet another is recommended at bedtime. One must be taken with food, and another is restricted to an "empty stomach". Before you know it, our patient is supposed to take a half a dozen pills per day- at different times, and with different restrictions- and then we wonder why they are "noncompliant"!

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.

Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

On Blood Thinners? READ THIS!

Typically when there is a drug recall, it is not too serious. The last several that I have noted were voluntary recalls by the manufacturers, and there were no adverse patient outcomes even reported. This one, however, could have immediate and disastrous consequences.
Warfarin (Coumadin) is a blood thinning agent that many people take to prevent blood clots. We use it in the treatment of atrial fibrillation, pulmonary embolisms and deep vein thrombosis (clots in your legs that can go to your lungs) as well as with patients who have artificial heart valves. Patients who take this drug must have their blood drawn regularly to make sure that they have proper drug levels in their system. Too much warfarin can cause bleeding- from a nuisance of easy bruising or bleeding gums, all the way to a serious bleeding event in your brain- a stroke.
The FDA and Usher-Smith Laboratories have issues a recall on Warfarin Sodium Tablets (Jantoven), 3mge. A bottle of the drug was found to have 10mg pills mislabeled as 3mg, which means the patient could potentially receive three times their appropriate dose. While there has only been one bottle identified so far with this risky error, they have appropriately recalled the entire batch.
The 10mg pills are white, and easy to tell apart from the 3mg ones, which are tan. There are also different markings on the pills, but most of us do not routinely check the fine print.
With concern for patient safety, the company has admirably voluntarily recalled their other products from that same packaging line over a six month period, including these medications: Amantadine, Amlodipine, Androxy, Baclofen, Bethanechol, Jantoven® and Oxybutynin.
BOTTOM LINE: Check your prescriptions if you are on any of these medications to be sure you've got the correct dose, but more importantly, BE AWARE of the color and shape of your prescription medications, and QUESTION the pharmacy when you notice a change! Most of the time it will be a change in brand- likely to a different generic- but ASK and BE SURE!

Did U 4Get? Medication Reminders

Ah, texting- the new language of our youth! As we embrace technology, I believe there will be many beneficial uses of the tiny screens upon which our culture is becoming increasingly dependent. There are multiple "apps" out there, for example, that help people track behavioral changes such as exercise, or count days without junk food (or soda, or alcohol, or cigarettes or candy bars!) In my practice, I have seen these simple electronic tools really help my patients improve their health.

Along those lines, there is an interesting study recently published in the medical journal Obstetrics and Gynecology, entitled Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. This was a small, short study with just less than one hundred young, high school female graduates followed over three months. The women were randomized to receive a daily text message reminding them to take their birth control pill, and their compliance was both self-recorded and externally monitored.

The results surprised me, frankly. I would have thought simply participating in such a study, none-the-less receiving a DAILY reminder would have yielded near perfect compliance. Unfortunately, what was seen was that BOTH groups missed a significant number of pills each month (4.9+/-3.0 for the text-message group and 4.6+/-3.5 for the control group.) It's possible the difference in the groups was small because women in both groups used additional reminders such as alarms on their cell phones.

The other disappointment is that the girls' self-reporting of missed pills was markedly below their true number of missed pills, which strongly suggests that they could be underestimating their true risk of becoming pregnant if they are sexually active.

BOTTOM LINE: While technology may be able to help us towards healthy lifestyles, daily text medication reminders may not be an effective tool (at least in this setting.) Physicians need to emphasize (and patients need to implement!) strict compliance with oral contraceptive pills.

What IS this Pill?

Have you ever found a pill-perhaps on the floor of your bathroom, or in your teenager's room or in your car-and wondered what the heck type of pill it is? Or perhaps your mail order prescription arrives, and the pill doesn't look anything like the size, shape or color of the last prescription for the same drug, and you wonder if the pharmacy put the right "generic" equivalent in the bottle. What can you easily do at home to help identify the drug?

It turns out that there are multiple websites that can help you to identify what pill you are holding. My current favorite (which means that it worked the best the last time I tried to identify a stray pill) is http://www.drugs.com/imprints.php All you need to do is to enter in the color(s), shape, and any letters or numbers that you see printed or imbedded on the pill. The site then shows you any matches, including a picture that you can compare with the pill you are holding- voila!

So, if you tossed a bunch of different medications into one container for your last trip and now need to sort them out, or simply have found a stray pill, here is a beautiful use of the information highway. Click on the link above (or google "pill identifier" to pull up multiple sites) and save yourself a trip to the pharmacy!

BOTTOM LINE: Reliable websites are available to help you identify "stray" pills, whether they are over the counter or prescription.

Medications, medications, medications!

Okay, it's obviously a play off of "location...location", but hey, if it gets your attention, then I've done my job! I want to say a few words about medications. First of all, to physicians. Many times we need to prescribe multiple medications for our patients. One is daily, another twice a day, and yet another may be before meals and bedtime. Before you know it, our patient is supposed to take a half a dozen pills per day (and then we wonder why they are "noncompliant"!)

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.
Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!