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Should I be managing my several medications?

Posted By Anthony Komaroff, M.D. On January 27, 2014 @ In Drugs and Supplements | Comments Disabled

DEAR DOCTOR K:

I’m in my 70s. Like many women my age, I’m on several medications. Should I be actively managing them? Or can I leave that to my doctor?

DEAR READER:

Many older adults are on a number of medications, prescribed to treat different health conditions. Yet each medication you take has the potential to interact — sometimes dangerously — with another. And if you see specialists for various health conditions, your medications may be prescribed by several different doctors.

If that’s the case, work with your primary care physician (PCP) to manage your medications. That means reviewing all of them with your PCP at every visit. Make sure to tell him or her about pills prescribed by specialists as well as over-the-counter drugs and supplements. Your doctor can make sure each drug is appropriate for you, and check that your medications don’t interact with one another.

At any medical visit, your doctor may suggest starting a new medication or changing the dose of one you already take. But time constraints may prevent your doctor from providing a detailed explanation of why, and what to expect. So you need to take the initiative.

My colleague Dr. Anne Fabiny is chief of geriatrics at Harvard-affiliated Cambridge Health Alliance and editor in chief of Harvard Women’s Health Watch. She recommends asking lots of questions.

First, make sure you understand why the doctor is suggesting the medication, and what it is going to do. Ask what adverse effects the drug might have, and which ones warrant a call to your doctor. Find out how long you’ll be on the medicine. And check back in with your doctor after a few weeks to let him or her know how you’re doing.

Here is a list of 10 questions to ask your doctor every time you get a new prescription:

10 Questions to ask every time you get a new prescription

  1. Why are you prescribing this drug?
  2. How is it supposed to treat my condition?
  3. Has it been tested and found to be safe and effective for people my age?
  4. What side effects might it have, and what should I do if I have any of them?
  5. At what dose are you starting me, and why?
  6. Will you eventually increase or lower the dose?
  7. Is there a lower-cost generic alternative to this drug available?
  8. Can you put me on a drug regimen that will be easier for me to take (for example, once a day instead of several times a day)?
  9. For how long do you want me to take this medicine?
  10. 10. What should I do when the medicine runs out? Will I need to refill the prescription, and if so, how can I get the new prescription from you?

If you’re thinking of stopping one of your medications, perhaps because of unpleasant side effects, let your doctor know first. You and your doctor can explore other options, such as lowering the dose or switching to a different drug.

When I was early in my training in internal medicine, I got my first lesson in how difficult it could be to make sure a patient was taking the right medicines. A patient of mine was getting medicines prescribed by several specialists — thirteen medications in all. At every visit I went over what I thought was the total list of her medicines, and she said I had it exactly right.

She was crippled by arthritis, so one day I made a home visit. She offered me some tea, and as we sat down at the dining room table I noticed a beautiful glass vase — full of pills. Her daughter told me that each morning she put her hand in the vase, grabbed a bunch of pills and swallowed them. She knew that she should take each pill as it was prescribed, but she felt “it would all work out OK in the end” the way she was doing it.

After she had gone into heart failure three times in three months, I (and her daughter) finally convinced her to take the medicines as prescribed. Her health improved.


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