This post was contributed to ConsumerSafety.org by Jennifer MacCormack.
Medications can get complicated, especially if your medical care involves more than one doctor and pharmacy. You're told to "ask your doctor" about medications all the time, but you never hear anything about asking your pharmacist. That's unfortunate, because pharmacists are well trained in their profession, and are an excellent source of information about medication, both prescription and over the counter.
Make use of that little consultation window at the pharmacy, and be a proactive patient. The more you know, the safer you'll be. Take the time to ask your pharmacist some important questions before you walk away with a new medication.
Is this medication safe to take along with my other medications?
If you listen closely to the voice-overs in drug ads on TV you'll hear things like "don't take this if you take nitrates for a heart condition," or "don't take this if you use an MAOI for depression." That's because mixing those medications can cause dips or spikes in your blood pressure. Drug interactions are incredibly common, and with a quarter of Americans taking three or more prescriptions at a time, they're a big source of risk to our health and safety.
Many medications are perfectly safe on their own, but can cause serious side effects when paired with other drugs, so it's important that your health care providers are always aware of your current medication list. That way, they can compare the medications on your current list with any new prescriptions, and catch any potentially dangerous combinations. For example, some types of antidepressant and anti-anxiety medications can cause drowsiness. So do some allergy and prescription pain medications. Stacking those drugs on top of each other may make it dangerous to drive, or even make it difficult to stay awake at all. And if you take a prescription sleep aid for insomnia, it may be dangerous to take it while you're on other drowsiness-inducing medications, as the combination could slow your breathing and heart rate too far.
Other examples include OTC medications like aspirin or NSAIDs which are natural blood thinners. Taking these in conjunction with prescription anticoagulants can amplify the effects of these drugs, increasing the risks of severe internal bleeding. This can make normally insignificant injuries life-threatening, a fact that spawned four Xarelto lawsuit trials in 2017 and resulted in an award of over $28 million. Xarelto isn't the only popular anticoagulant that has spent time in front of a jury. A $650 million fund was established to settle thousands of Pradaxa lawsuit claims in 2014 for similar safety concerns.
If you're taking hormonal birth control, some antibiotics can alter hormones in your body, making the birth control ineffective. This isn't the case with all antibiotics, so it's important to ask your pharmacist whether you should add extra barrier methods (like condoms) to your routine while you're taking your medication.
What about supplements and over-the-counter medications?
Just because they're not prescription drugs doesn't mean that over-the-counter (OTC) medications don't come with their own risks and interactions. Any medication containing acetaminophen should be avoided if you're taking a prescription pain medication that contains some, such as Vicodin. In fact, so many over-the-counter medications contain acetaminophen that the FDA has asked that manufacturers include a special section on their packaging, warning of the high risk of liver damage from exceeding the safe dose of acetaminophen.
Supplements, vitamins, and herbal remedies all contain active ingredients that can interact with prescription medications, so they need to be included on any list of medications that you give to your doctor or pharmacist. Even herbal teas, if you drink enough of them, can be a possible source of problems. It's better to list everything and let the professionals decide what's safe.
Do I need to change my diet while I am taking this?
Some foods can affect the absorption, metabolism, and excretion of medications, so ask your pharmacist whether there are any food restrictions associated with the medication you're prescribed. Many medications, such as replacement thyroid hormones, won't be properly absorbed if taken with a large amount of calcium. Grapefruit can alter drug metabolism. Some antidepressants can't be taken with red wine or aged cheese. Some clotting medications are dependent on Vitamin K, which is contained in leafy greens like spinach and kale. Your diet might be affecting how your medication works.
What side effects are common? And which are dangerous?
Just because a side effect is listed on a medication's information sheet doesn't mean you're guaranteed to experience it, but it can be good to know what to expect when you start a new drug. Does it generally cause drowsiness? Insomnia? Loss of appetite? Nausea or diarrhea? Knowing what might happen can help you to be prepared for it.
It's also important to know when you should contact a doctor about the side effects you might have. Blurred vision? Headaches? Hives? What symptoms are signs of an allergy or a serious problem that means you should stop the drug and call your doctor?
What do I do if I miss a dose?
It's easy to forget to take a pill. But depending on when you finally remember that you forgot it, how do you know whether to skip that dose and wait for the next one, or double up? That's something that a pharmacist can tell you. Equally important, especially for parents, is to know what to do if some of the dose of medication didn't get swallowed. Or if the patient vomited soon after taking a dose. Ask the pharmacist what to do, because the answer is different depending on the medication.