Picture this…a friend says she wants to set you up on a blind date. After rolling your eyes, you’ll likely have several questions for her. What does he look like?How did they meet? How long has she known him? 
What kind of job does he have? Does he have any kids? Any baby momma drama or crazy exes? Is HE crazy? And if he’s so great, why doesn’t she want him?!
You ask those questions because you want to make sure you’ll be safe with him. Or maybe you don’t want to invest time in someone you know won’t complement your lifestyle. You want to know he will potentially help make your life better in some way.
If you ask lots of questions before you’ll agree to coffee or dinner with a blind date, don’t you think you should do the same before blindly taking a new medication? Something that you will ingest, and will quite literally run through your bloodstream, thereby potentially affecting every organ it touches?
I encourage you to ask questions at the doctor’s office and/or pharmacy prior to starting any new medication. The more you know prior to taking a medication, the better prepared you are to know what to expect from it. Additionally, it is almost always easier to ask questions while you already have the provider’s attention, versus trying to call the office/pharmacy after you’ve left or having to make another trip back.
The following are some questions you may consider asking your provider the next time s/he recommends a new medication for you:
- How will the medicine help me? How does the medication work in my body?
- How long does it take for the medication to work? Will I feel it working? Do I need to take it all, or should I stop when I feel better? There are some diseases that don’t necessarily exhibit symptoms. As a result, we don’t necessarily “feel” ourselves getting sick. An example would be hypertension (high blood pressure). Most of us don’t “feel” our blood pressure rising, unless it’s really extreme. As a result, we don’t necessarily feel the effects of the medications used to treat that disease. This does not mean the medication isn’t working. On the other hand, if a medication is used to relieve symptoms of pain, nausea, or allergies, we know the medication is working when we no longer experience those symptoms.
- How long will I need to take it? Some medications may only be prescribed for a few days/weeks, such as pain medicine right after an injury. Other medications may require lifelong treatment, such as those used to manage chronic conditions such as hypertension, diabetes, or high cholesterol.
- Can I get a refill? How often/how many times can I get a refill? Some controlled medications, also referred to as “C-II” medications, are never allowed refills as limited by DEA regulations. Examples include medications that have a high risk of addiction such as strong pain medications (i.e. morphine) and amphetamines used for treatment of ADD/ADHD (i.e. Adderall). For lesser controlled medications like benzodiazepines (i.e. Valium) and sleeping medications (i.e. Ambien), up to five refills are allowed on each new prescription. However, early refills (usually less than 28 days from the previous fill date) are prohibited.
Your insurance company may not pay for early refills on any medication, regardless of whether or not they are controlled substances. So if you need an early refill because you’re going out of town for an extended period, or the dog really did eat them, be prepared to either ask for an authorization or pay the “cash price”. The cash price is the price an uninsured person would pay for that medication.
- How should I store my medication? As we discussed in our last post, be sure to learn how your medication should be stored. The majority of medications can be stored at room temperature, but some require refrigeration, or storage in a dark area. Other medications must be stored in the original manufacturer bottle. Again, kitchens and bathrooms are generally not ideal due to heat and humidity.
- What side effects may I experience? As we know, all medications have potential side effects. Discuss the most common ones with your provider, and what you should do if you experience them.
- What can be done if I get side effects? Discuss management of side effects with your provider. There are some easy fixes for many side effects. Stomach upset can usually be alleviated by eating a small meal prior to taking the medication. If a medication is making you sleepy, it is likely best to take it at night.
When possible, try to avoid adding yet another medication to manage a side effect of a previous one. For example, if a pain medication irritates your stomach, try not to add yet another medication to treat your GI upset. Each new medication carries new potential side effects and drug interactions, creating a snowball effect. Alternatively, see if eating a small snack just before or with the medication is helpful.
- Will I need labs or other tests to make sure I am receiving the correct dose? Some medications like Dilantin, Depakote, and lithium require periodic blood tests to make sure you are receiving the appropriate dose. The lab will determine the concentration of the medication in your blood to make sure it is within “therapeutic range.” This means you have enough in your system to work effectively, but not so much that we worry about toxicity. If the doctor learns that your medication level is too high or too low, s/he should adjust your level accordingly.
- What happens if the medication doesn’t work for me? Ask how long it may take for your medication to start working, and how long before you feel the full effect. Some medications, like mental health medications, can take up to 12 weeks to reach their full effect. But if that window of time has passed, and you still aren’t feeling better, you should request a follow-up appointment with your provider to discuss alternative medications or therapies.
- Are there foods, drinks (including alcohol), other medications, or activities to avoid while I’m taking this medicine? Grapefruit interacts with most statins, a common class of cholesterol medication. Dairy may interact with certain antibiotics. Some other meds may require that you avoid direct sunlight to minimize skin irritation (chemotherapy medications for example). You will want to be aware of these limitations to be sure they are practical for you. Someone who works outside in construction or landscape, for example, should not agree to take a medication that forces them to limit their time in the sun.
- Should I take this medication with food, or on an empty stomach? Food, or lack thereof, can alter the absorption of certain medications in our body. Again, discuss this with your doctor or pharmacist to make sure you are administering your medication properly.
- Does this new prescription mean I should stop taking any other medications? Be sure to clarify if this new medication is an addition to the medications you are already taking, or a substitution for one of your other meds. If it is a substitution, you should stop using the 1st medication before starting the 2nd (unless otherwise instructed).
- What happens if I miss a dose? Should I take the dose when I remember it, or should I wait until the next dose is due? For many medications, you will want to take your medication as soon as you remember it. The exemption would be unless you’re within a few hours of taking your next dose. Oral contraceptives (birth control pills) are one major exception here. Follow the instructions that come with the medication carefully, but in most cases, if you miss a pill one day, you should take two pills the next day.
In summary, the more you know regarding any new medications, the better prepared you are to tackle any situation that may arise from taking that medication. What are you thoughts? Are there any questions you like to ask your doctor or pharmacist that I didn’t think of?
