Take two tablets: the how, why and when of responsible pill taking

"The doctor knows what he's doing," we think as he scribbles a script for us.
"The pharmacist trained for years to do this job," we muse as we hand the script over to
the person in the white coat at the back of the store.

This is perfectly true. However, that does not mean we should hand over total responsibility for our health to them. How can your doctor know that you take an aspirin a day for headaches - unless you tell him? How can your pharmacist guess that you drink two whiskeys at night? And yet both of these factors could seriously alter the effectiveness of the medication that you take.

As part of the Government Employees Medical Scheme's (GEMS) ongoing effort to educate our members and future members on a range of healthcare topics, we would like to provide you with some information on the responsible and effective use of medication.

• Read the literature!

All too often individuals do not even know the names of the medications they are taking. "It's that little yellow pill, sort of square, you know," they explain to the pharmacist. Amazingly often, the pharmacist can actually identify it. But it would help him to help you if you kept a record of what you are taking, what it was prescribed for, and the exact dosage - 25 milligrams three times a day, for instance.

When you buy over-the-counter medication, the kind you do not need a prescription for, do read the insert before you buy it. The insert will tell you about likely side effects and if certain people - for instance, pregnant women - should avoid taking it. Ask the pharmacist if you have any doubts at all about using an unfamiliar medicine. The side effects can sound scary, but do bear in mind that, unless indicated otherwise, in most cases they only appear in a very small percentage of individuals. When you read the insert, look out for warnings such as the medication it should not be taken with. It is therefore a good idea to familiarise yourself with the generic term given to the active substances in the medication that you take.

Valium, for instance, is officially known as Diazepam; Voltaren is actually Diclophenac.  It is also wise to learn what family of drugs your specific medication belongs to: is it an amphetamine, an anti-inflammatory, a beta-blocker? Some inserts will simply say, "should not be taken with anti-inflammatories".

• Drug interactions:

There are some nasty stories about real harm being caused when children, in particular, are given more than one drug, and the drugs interact with one another. Pharmacists and doctors alike are very careful to avoid harmful interactions, so they are very rare; nevertheless, it is a warning to consumers to be on the alert for the possibility of drug interactions.
 
You may, for example, see a doctor that you do not know while on holiday and omit to tell him about that old familiar medicine you take every day, because it is such a habit that you hardly even think of it as drug taking. If he prescribes something that clashes with your regular medicine, you could become ill as a result. It is well worth remembering something that the well-known South African healthcare professional and radio personality Professor Harry Seftel once said: "All drugs are just poisons that have beneficial side effects!"

• Some possible interactions to look out for:

Antibiotics can render birth control pills ineffective; so do not rely on ‘The Pill' alone when you are on a course of antibiotics. Alcohol and antibiotics also do not mix very well! Be wary of taking more than one drug at a time that depresses the central nervous system such as medication like sleeping pills, narcotics, and anti-histamines. The result could be dangerous over-sedation.

Do not drink alcohol when you take these medications, either. Anticoagulants, often prescribed for heart patients should not be taken in combination with drugs like aspirin and antibiotics - the two together can increase the tendency to bleed. Amphetamines and decongestants (like many medicines taken for flu or sinus conditions) can cause a dangerous rise in blood pressure when taken at the same time as monoxamine oxidase inhibitors (a type of anti-depressant, commonly referred to as MAOIs). MAOIs also do not mix well with cheese, red wine, beer - and chocolate!

Changes in your own physical condition could have an impact on any long-term drugs you take. If you fall pregnant, for instance, your doctor may need to change your regular medication to protect your baby. If you contract another illness, you should tell the doctor treating you if you are on any regular medication.

• Safekeeping

Always store medication in a safe place - that means well away from any food or the prying fingers of little children. Make sure they are tightly sealed, and store them in a cool, dry place.  Never use drugs that are past their use-by date, which you will find stamped on the packaging. If drugs have deteriorated or are getting old, return them to the pharmacy for disposal. If you put them in the dustbin, they could cause harm to others, such as dogs rooting in the garbage bags or kids playing around dumps.

Never take tablets that are chipped, cracked or discoloured. Do not use liquids or creams if the smell, taste or colour has changed. Also never, ever take any medication that comes out of a tube, blister pack or bottle that is in any way damaged.

• How to take your medication safely

Some drugs, like painkillers or medicine for migraines, are only meant to be taken as and when they are needed, and they should not be taken "just in case". Others have to be taken regularly to have the desired effect, even if you feel well. When your doctor says of antibiotics, "Finish the course", he means it. You may start to feel better long before all the pills have been used up, but the bacteria that caused your illness may not have been destroyed completely. If you stop taking the drug before the course is finished, the bacteria may rebound and re-grow, and you could be worse off than you were to start with.

Blood pressure medication, or anti-hypertensives as they are known, are notoriously easy to forget. High blood pressure is rightly known as the ‘silent killer', because it often causes no symptoms. If you need medication to control your blood pressure, you should take it every day, no matter how well you feel. The consequences of stopping are potentially enormous - stroke, heart disease, kidney disease, even blindness. Follow instructions about when to take your medication religiously. The body metabolises things differently at different times of day, so if the doctor says to take your pill in the morning, that's when it should be taken as it will be more effective at that time. Even if he prescribes something that is, technically, not a drug, you should still take it at the specified time. A magnesium supplement, for instance, can help you to sleep, so it is best taken at night. A Vitamin B supplement can give you an energy boost, so take it in the morning.

Ask your doctor what he means by his cryptic notes: if he says, "Take three times a day," does that mean morning, noon and night - or does it mean every eight hours, in which case you would have to set the alarm for your midnight dose. And do ask him if your drugs should be taken with or without food. Some medicines can irritate the stomach, and should therefore always be taken with food. Anti-inflammatories usually fall into this group.

Others can make you feel woozy if taken on an empty stomach. On the other hand, some drugs are most effective if taken on an empty stomach, as they absorb into the bloodstream rapidly without food to dampen the effect.

Finally, check with your doctor or pharmacist before you stop taking a long course of drugs - anti-depressants, for example. A lot of long-term medications should ideally be tapered off to prevent rebound effects or other reactions.

Sources
www.healthline.com/galecontent/drug-interactions
www.medicinenet.com - cholesterol az list › statins index
drug reactions (ADRs). Drug Interactions (DIs); Drug use without priory.com/pharmol/practitioner.htm
drugs.about.com/od/medicationabcs/a/drug_interact.htm
www.thewellproject.org/en_US/...and.../Drug_Interactions.jsp