Mind Your Meds

Some chronic conditions require dozens of drugs. These 5 tips will help you take them safely and effectively. – Amy Paturel

Kimmi Erwin of San Diego, CA, battled tremors, stiff muscles, and impaired balance for eight years before doctors finally diagnosed her with Parkinson’s disease. That was last July, and now the 55-year-old takes 17 pills each day to manage her various symptoms.

“I can’t type. I can’t write. I can’t even put on mascara,” she says. That’s a tough pill to swallow for a woman who raised five daughters and seven grandchildren. “I want to be healthy so I can enjoy them.”

Erwin’s new pill regimen puts her in good company. Nearly 50 percent of people aged 55 and older take a prescription medicine. And almost 40 percent of Americans over the age of 65 report taking five or more prescription drugs in a single month, according to a 2014 survey by the US Centers for Disease Control and Prevention. Add over-the-counter (OTC) drugs and dietary supplements to the mix, and many seniors find themselves juggling between 10 and 20 pills a day.

“Taking multiple drugs, especially at high doses, can carry signficant risks and side effects,” says Orrin Devinsky, MD, a professor of neurology, neurosurgery, and psychiatry at New York University (NYU) Langone Medical Center, director of the NYU Comprehensive Epilepsy Center, and a Fellow of the American Academy of Neurology (FAAN). What’s worse, he says, the more meds you take, the more likely you are to make mistakes.

According to the Network for Excellence in Health Innovation, 50 percent of patients either forget to take their medications, overuse them, or take them improperly. That’s no small issue when medication misuse can lead to unnecessary sickness, seizures, and even death.

Protect yourself using these five expert-approved strategies.

1. MAKE A LIST
Create a list of all the pills you take. Include the brand and generic names (including prescriptions, OTC products, and supplements) and why you take them (to help avoid duplicate prescriptions), and any important dosing instructions (take with food at bedtime, for example).

Supplements, OTC medications, and even standard vitamins are not always innocuous. “Some products can increase the effects of your medication, while others may decrease it,” says Stephen Silberstein, MD, FAAN, professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia, PA. Read about each medicine and understand the potential side effects. For example, taking high doses of OTC non-steroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal bleeding, headaches, and ulcers. St. John’s wort can interfere with birth control pills. Aspirin and gingko biloba can thin the blood, and mixing either with a prescription blood thinner, such as warfarin, could increase the risk of stroke or bleeding, according to a report published by the US Food and Drug Administration.

2. VISIT YOUR DOC REGULARLY
“It’s very important to make regular contact with your physician, ideally with a neurologist, to assess both the effectiveness of the medication and the ongoing need for certain medications,” says Dr. Devinsky. Your body metabolizes drugs differently as you get older, so if your doctor prescribed a medicine decades ago, it may no longer be necessary. In fact, it could be causing other problems, such as dizziness and falls.

“In Parkinson’s disease, for example, a patient who previously tolerated dopamine agonists like pramipexole or ropinirole may develop side effects like hallucinations as he or she ages,” says Melissa J. Armstrong, MD, an assistant professor of neurology in the Division of Movement Disorders at the University of Maryland School of Medicine. Plus, some medications, including antiseizure drugs, require regular blood testing to ensure accurate dosing and to measure the drug’s impact on liver enzymes, metabolites, and electrolytes.

3. GET ORGANIZED
Despite their best efforts, more than half of seniors fail to take their prescription drugs correctly, according to a 2009 survey of Medicare recipients. For those with memory problems, keeping track of prescriptions and adverse drug interactions is even more difficult. To manage drug regimens that span from breakfast to bedtime, try using large pill boxes with separate compartments for each day. If you’re tech-savvy, experiment with iPhone apps, beepers, or computer programs to help you keep track.

The trick, say experts, is to create a system that works for you. For example, Kimmi Erwin marks up her pill bottles with black magic marker. “Pill boxes are too difficult to open, and too hard to fill with shaking hands,” she says.

4. EDUCATE YOURSELF
Know which prescription medications you’re taking and why, and understand how drugs interact with other medications, foods, alcohol, and even vitamins.

You should also know what to expect from a medication, says John Corboy, MD, FAAN, a professor of neurology and co-director of the Rocky Mountain Multiple Sclerosis (MS) center at the University of Colorado School of Medicine. If, for example, you’re taking something for a urinary tract infection, you can expect symptoms to subside gradually. Not so for drugs prescribed for a chronic condition like MS. “We often tell people to expect nothing. We just hope the condition doesn’t worsen and there are no side effects,” he says. “Symptomatic therapies to treat pain, spasticity, or bladder problems each have their own side effects. Someone may end up taking two to three medications, all of which might be sedating, for example.”

5. TAKE NOTES
“Since there’s often a long time between physician visits—sometimes as much as six to nine months—people may not remember the problems or benefits they received from a medication when it was started,” says Dr. Armstrong. She suggests patients take brief notes between visits to document both the positive and negative effects of a new medication.

Dr. Corboy asks his migraine patients to keep diaries of what they were doing or eating when a migraine occured, since certain foods and activities are known to trigger migraines. The diaries help patients and doctors better understand the source of the headaches.

Mobile apps are another convenient way to track symptoms. http://Seizuretracker.com, for example, allows epilepsy patients to write down their symptoms, medication schedules, and even capture a seizure on video in real time.

GOT A NEW PRESCRIPTION?

10 QUESTIONS TO ASK YOUR NEUROLOGIST OR PHARMACIST

  1.  Why do I need this medication?
  2.  Are there lifestyle changes I can make or alternative treatment strategies or therapies I can use instead of taking this drug?
  3. What are the risks and benefits?
  4. What are the potential side effects?
  5.  What should I expect from this medication?
  6.  What should I do if I miss a dose, or if I double-dose?
  7. How should I take this medication (with food or without, how many times daily, etc.)?
  8. Are there any foods, drugs, or activities I should avoid while taking this medication?
  9. How long will I be on this drug?
  10. How can I contact you if I’m having trouble with a medication?

QUICK TIPS TO STAY SAFE

  • Streamline Your Drug Regimen. Ideally, you should be taking the fewest medications possible at the lowest effective dose, says Orrin Devinsky, MD, director of the New York University Epilepsy Center and a Fellow of the American Academy of Neurology (FAAN). If, for example, you’re taking one drug to control the side effects of another, it may be time to talk to your doctor about alternatives.
  • Consider Extended-Release Versions. If you have to take some pills more than once a day, ask your physician if there’s an extended-release version of the drug that would reduce the number of times you have to take it, suggests Joseph Sirven, MD, FAAN, a professor of neurology at the Mayo Clinic in Phoenix, AZ, and a member of the Neurology Now editorial advisory board. “This is important given that several chronic neurological conditions such as epilepsy cause memory problems,” he says.
  • Quiz Your Physician. Ask your doctor what you should expect from a medication, how long side effects might last, what to do when they occur, and when to call the office. And always consult your doctor first before discontinuing a medication. For tips on getting the conversation started, see “10 Questions to Ask Your Neurologist,”.
  • Stay Current. Every six months (or less), bag up your prescriptions, supplements, and OTC items, and take them to your physician to reassess your medications.
  • Ask About Alternatives. When Kimmi Erwin began taking a new Parkinson’s medication, she felt like she was on speed. “I couldn’t sleep. I couldn’t eat. And I was still shaking all the time,” she says. After talking to her doctor about the side effects, her doctor switched her to a new drug.
  • Set a Schedule. Take prescriptions at the same time each day, and tie your medication schedule to daily activities like brushing your teeth, suggests Dr. Devinsky. And be sure to store medicines in a cool, dry, dark place—not the bathroom medicine chest. The moist, warm environment could cause medicines (and vitamins) to break down more quickly.
  • Download “My Medicine List.” The list, which was developed by the American Society of Health-System Pharmacists (ASHP) and the ASHP Foundation, can be downloaded at http://bit.ly/safemedication. Fill it out online and print several copies for loved ones, physicians, and yourself. Keep one on the refrigerator door and a second one in your wallet.

http://journals.lww.com/neurologynow/Fulltext/2015/11010/Mind_Your_Meds__Some_chronic_conditions_require.14.aspx

© 2015 American Academy of Neurology