Rx Fix: How to balance multiple medications
According to the National Institutes of Health, people over the age of 65 take more prescription and over-the-counter medicines than any other group. Because older people tend to have more chronic illnesses, such as heart disease, arthritis and diabetes, it is also more likely that they are taking multiple medications at the same time.
To make sure that the medicines work properly together – and to avoid dangerous combinations – it is important to work with your doctor and pharmacist to manage them wisely.
Make sure your doctor and pharmacist are aware of all the medicines you are taking, as well as any over-the-counter drugs (including pain relievers, cold medicines and antacids), vitamins and dietary supplements. Foods, beverages and supplements can interact with medications. Here’s what to look out for:
Food and Beverage Interactions
Alcohol: If you are taking any sort of medication, it's recommended that you avoid alcohol, which can increase or decrease the effect of many drugs.
Grapefruit juice: Grapefruit juice is often mentioned as a product that can interact negatively with drugs, but the actual number of drugs the juice can interact with is less well-known. Grapefruit juice shouldn't be taken with certain blood pressure-lowering drugs or cyclosporine for the prevention of organ transplant rejection.
Grapefruit juice can cause higher levels of those medicines in your body, making it more likely that you will have side effects from the medicine. The juice can also interact to cause higher blood levels of the anti-anxiety medicine Buspar (buspirone); the anti-malaria drugs Quinerva or Quinite (quinine); and Halcion (triazolam), a medication used to treat insomnia.
Licorice: This would appear to be a fairly harmless snack food. However, for someone taking Lanoxin (digoxin), some forms of licorice may increase the risk for Lanoxin toxicity. Lanoxin is used to treat congestive heart failure and abnormal heart rhythms. Licorice may also reduce the effects of blood pressure drugs or diuretic (urine-producing) drugs, including Hydrodiuril (hydrochlorothiazide) and Aldactone (spironolactone).
Chocolate: MAO inhibitors are just one category of drugs that shouldn't be consumed with excessive amounts of chocolate. The caffeine in chocolate can also interact with stimulant drugs such as Ritalin (methylphenidate), increasing their effect, or by decreasing the effect of sedative-hypnotics such as Ambien (zolpidem).
Vitamins and Dietary Supplement Interactions
St. John's Wort (Hypericum perforatum): This herb is considered an inducer of liver enzymes, which means it can reduce the concentration of medications in the blood. St. John's Wort can reduce the blood level of medications such as Lanoxin, the cholesterol-lowering drugs Mevacor and Altocor (lovastatin), and the erectile dysfunction drug Viagra (sildenafil).
Vitamin E: Taking vitamin E with a blood-thinning medication such as Coumadin can increase anti-clotting activity and may cause an increased risk of bleeding.
Ginseng: This herb can interfere with the bleeding effects of Coumadin. In addition, ginseng can enhance the bleeding effects of heparin, aspirin, and nonsteroidal anti-inflammatory drugs such as ibuprofen, naproxen, and ketoprofen. Combining ginseng with MAO inhibitors such as Nardil or Parnate may cause headache, trouble sleeping, nervousness, and hyperactivity.
Ginkgo Biloba: High doses of the herb Ginkgo biloba could decrease the effectiveness of anticonvulsant therapy in patients taking the following medications to control seizures: Tegretol, Equetro or Carbatrol (carbamazepine), and Depakote (valproic acid).
Follow these tips to safely manage multiple medicines:
- Keep a checklist of all your medicines including the dose, when you need to take them and any special notes, such as whether you should take the medicine with food.
- Review your medicine record with your doctor regularly, in case there is new information that might be important to you.
- Have all of your prescriptions filled at one pharmacy so that your pharmacist is aware of all your medications as well.
- Keep your prescriptions in their original containers so you can identify them easily, and always read the labels carefully, including any special warnings.
- Whenever a new medicine is prescribed, learn as much as you can about it. Ask your doctor about how you can tell if the medicine is working and whether you need to watch for side effects. Also make sure you understand how much of the medicine you should take and how often. Never increase or decrease the dosage without consulting your doctor or pharmacist first. Also ask about any special storage instructions, such as if the medicine needs to be refrigerated.
- Never stop taking a prescription medicine unless your doctor says it is okay, even if you feel better.
- Make sure you get your prescriptions refilled before you run out and be aware of any expiration dates.
To find a physician near you, please call 877-904-4YOU or visit www.TheChristHospital.com.