You’ve probably been told to take your medications a certain way. And, that you can’t share prescribed medications with others. But, why all the fuss? If taking medication carries such risk, shouldn’t you just stop taking them? (Spoiler Alert: Never stop taking any prescribed medication without first discussing the benefits and risks of making a change with a regulated health professional.) It’s important to note that we can’t share medications because, in most cases, medications affect people differently… even another person who has the exact same disease condition. And, we can’t “double dose” most medications to achieve stronger results because in some cases they may work less effectively, and can even cause toxicity if the dose is too high.
On the flip side, medications are powerful tools when used appropriately. Inappropriate prescribing occurs when the expected risks of medication use outweigh the benefits. For many reasons, inappropriate prescribing is more common among older adults and those with complex disease conditions. Inappropriate prescribing also impacts your health, because the practice is associated with negative outcomes like: (1) increased side-effect burden, (2) worsening disease control, (3) hospitalization and (4) emergency room visits.
So, what might make some medications a “bad fit” for you?
Safe medication use occurs when the benefits of taking a medication outweigh potential harms. To accomplish this, the medication must be well-matched to the patient’s needs. Pharmacists and physicians typically work together to support safe medication use. Both professionals are trained to identify key risks when prescribing, and best practices for medication use to treat disease. They also should openly discuss their treatment decisions (with rationale) with patients. However, nursing professionals are also increasingly part of medication reviews and related conversations. Registered Nurses and Nurse Practitioners can thoroughly evaluate medication side-effects, medication impacts on daily life, and other factors like affordability and adherence. Combined with your physician and pharmacist review, an expert nurse may be the missing link in your annual care plan.
The “Top 5” Reasons Medications Need to be Reviewed by a Health Professional
5. Old medications get ‘grandfathered’ in
Over time, clinical guidelines change. What was once a “state-of-the-art” medication could still be the gold-standard treatment, or it could be associated with disease progression. Some patients get stuck taking old but risky medications simply because they are doing “well-enough” on the old medication. In one example, a patient with depression was prescribed a first-generation anti-depressant (phenelzine/Nardil®) many decades prior. After becoming ill from a cold, they suddenly experienced multiple unexplained symptoms, including: dry mouth, dizziness and high blood pressure. These side-effects all resolved after phenelzine was discontinued, and the patient switched to a newer anti-depressant with substantially less side-effects.
4. You improve, but medications don’t change
We sometimes keep “old medications” on board after disease conditions improve. This is best practice, but sometimes health professionals end up over-treating the condition at hand. For example, a patient with Type 2 Diabetes comes to see their nurse to complain about all the low blood sugars they get after taking dinner-time insulin. Over the past month, they started biking to work and started on a low-carb diet. The nurse recommends stopping their rapid-acting insulin with dinner and taking a lower dose of long-acting insulin. The patient continues to see great blood sugar control with no lows after adjusting therapy to accommodate for the hard-work of managing diabetes with lifestyle. In this case, the patient benefited from a reduced insulin dose.
3. We start treating side-effects
Sometimes we can start treating medication side-effects… which would stop if we simply switched to a different medication. For example, after starting on amitriptyline/Elavil® for arthritis pain, an older patient developed constipation, loss of bladder control and dry eyes. The clinical team quickly started laxatives, oxybutinin (for loss of bladder control) and eye drops. The patient was later admitted for a surgical procedure and had to hold non-essential medications for 3 days, at which point the side-effects completely resolved. Many medications were stopped after surgery, as it became clear that they were not needed.
2. You get older
Medications affect older adults differently. What once worked fantastically may now cause serious side-effects in older age. For example, after turning 70, a patient told their nurse that they think they have Alzheimer’s Disease. They recently started sleeping past lunch and had difficulty walking up stairs without falling. The patient also worried about feeling brain fog & confusion, which was unusual for them. They recently started taking dimenhydrinate/Gravol® to help them sleep. It always seemed to work like a charm. However, the medication’s anticholinergic effects now cause significant drowsiness for about a day after taking it (instead of just for a few hours). After stopping Gravol®. the patient felt significantly better.
1. You forget how to take medications properly
Although we assume prescribed medications are taken consistently, only one half (50%) of patients actually take long-term medications as originally prescribed (1). Most patients don’t want to take medication long-term, and we all must fit these medications into our daily life. For example, a patient was prescribed a salbutamol/Ventolin® inhaler as a child, and insists it doesn’t work and even causes a dry throat as an adult. So, they avoid takingVentolin® until a “severe” asthma attack comes on. This was perplexing to the nurse, who asked them to demonstrate how they use the inhaler. The patient promptly misted Ventolin® into their mouth and inhaled after a few seconds. It was clear at this point that none of the drug would even reach their lungs. After inhaler education was provided, the Ventolin® worked considerably better to control symptoms with no side-effects of a dry mouth/throat… and adherence to therapy improved.
Never adjust or stop prescribed medications without first speaking with a regulated health professional. If you have any questions or concerns about your medications, book an appointment to speak with a regulated health professional you trust in your local community. For example, you can speak with your family physician or pharmacist for advice. We offer a second opinion Medication Review & Annual Care Plan for medically-complex patients who are unsure about the “best” advice for them, or if they simply have questions.
(1) DiMatteo, M.R., Giordani, P.J., Lepper, H.S. & Croghan, T.W. (2002). Patient adherence and medical treatment outcomes: a meta-analysis. Medical Care. 40(9), 794-811. doi: 10.1097/01.MLR.0000024612.61915.2D