Medicine Chest: Ten Ways
to
Mess Up Your Meds
by Glen Pietrandoni R.Ph.
When you have worked in a
pharmacy for as long as I have, you hear some very odd things
over and over again. I thought I would share some of these
comments (embellished a little for dramatic effect) with the
readers. Even though they may seem humorous, they are important
educational opportunities for pharmacists to help clients
with the overall success of their treatment.
10) “I missed my drugs
this weekend, so I guess I was on a Drug Holiday since Thursday.”
A true “Drug Holiday” is
prescribed by your doctor, on a specific schedule, with a
therapeutic goal in mind. Drug Holidays are not when a patient
decides to take a few days off of drugs and enjoy the weekend.
This is how drug resistance occurs and will reduce the effectiveness
of your therapy.
9) “I don’t know the
name of my medicine, but I think it was round and white and
looks like an aspirin tablet.”
It is very important you
know the names of the medications you are taking and what
they look like. I can’t stress this enough! So many medications
look alike and sound alike. You may not always be in the care
of an HIV expert. Believe me, there are a lot of medical professionals
who do not see HIV patients on a regular basis and are more
confused than many of you about these drugs. You have to protect
yourself and double-check everything.
8) “The prescription
label says ‘take three times a day,’ so I took all three at
once.”
Unfortunately, the
drugs used in HIV must be taken exactly as prescribed, with
very little wiggle room. If the prescription says to take
“twice daily,” it usually means very close to every 12 hours
(8 am and 8 pm, for example). The hardest one is “three times
a day.” Those drugs should be taken every 8 hours (8 am, 4
pm and midnight). Because this is sometimes hard to do, some
people try to squeeze those doses together to 8 am, lunch
and dinner. In this example, the patient has three doses between
8 am and 6 pm (10 hours) and no drug again until 8 am the
next day (14 hours later). Over time, this may allow for resistance
to develop to the drug.
Many drugs are now, or soon
will be available as once-a-day dosing. This is great news,
but please be careful to note that they may or may not be
able to be dosed at the same time. Some drugs are still “empty
stomach” and other “with food.” Even though they are both
once a day doses, the two drugs may have to be taken at different
times during the day. This is the case once a day Videx EC
(take on an empty stomach) and Viread (take once a day with
food). Please check with your provider or pharmacist if you
need help with the scheduling of your medication.
7) When refilling prescriptions,
the pharmacist gives the customer another bag full of drugs
and he/she says, “I have enough of these protease inhibitors,
you gave me a whole bottle last month.”
Usually, a pharmacist gives
you a 30 day supply of medication. When 30 days pass, and
if you took all of your doses correctly, your bottle should
be empty. If you find you have pills left at the end of the
month, the pharmacist is concerned that you have missed doses
or taken the medication incorrectly. If you can, give the
pharmacist a few minutes of your time to help you. Pharmacists
can be a great resource of information and tips about adherence
and side effect management. We are not the drug police, we
are trying to help you.
6) “The bartender I always
go to is Thor. Nobody touches my hair except for Fredrique.
I just go to any pharmacist because it doesn’t matter who
fills my prescriptions.”
A lot of people get their
medications in the mail and others go to large pharmacy chains
where you are never sure who the pharmacist is that day. That’s
no problem if you can try to speak with the same person each
time you need them. Find a pharmacy and pharmacist that you
are comfortable with and then get their name. When you have
questions for them, introduce yourself and ask to speak with
the same pharmacist each time. Before you know it, you will
be fast friends!
5) “My viral load was
undetectable last month, even though I missed a few doses,
so I guess it is okay if I miss a couple doses once in a while.”
Even though you may get great
results from your doctor, the goal of drug therapy is to have
the viral load as low as possible for as long as possible.
A few missed doses should not be a problem, but repeated adherence
problems may shorten the duration of the regimen’s effectiveness.
A change in the drug regimen may have to occur sooner than
you would like when there is poor adherence.
4) “I went to the health
food store and bought all kinds of herbal products that the
clerk told me would help my immune system.”
Be careful with over-the-counter
medications, including herbal products, because we don’t know
enough about how these agents affect HIV or the drugs used
to treat HIV. We already know that there are some drug interactions,
like St. John’s Wort and protease inhibitors. Tell your doctors
and pharmacists about these items you are taking. Be honest
with your providers about anything you take prescribed from
other doctors or that you buy on your own, including the use
of alcohol and recreational drugs.
3) “I have a few days
of medication left, so I will wait until this weekend to go
to the pharmacy and get refills.”
Sometimes the pharmacist
has to reach the doctor for refill authorization or fix an
insurance problem. If you wait until the last tablet is being
swallowed on a Friday afternoon, it may take a few days to
resolve these problems. Plan ahead so you and your pharmacist
will be a lot happier! Usually a phone call to the pharmacy
is all that it takes to get the ball rolling.
2) When trying to get
prescription refills, the pharmacist tells you that your insurance
coverage has changed, and you say “I got a letter from the
insurance company, but I didn’t pay attention to it.”
It seems like insurance plans
change all the time, and it is very important to keep up-to-date
on this. It may be as simple as a change in the ID number,
or it could be a complete change in coverage. Pharmacists
spend about half of their time with insurance companies and
billing for medications. If there is a change in your plan
or benefits, please let us know so you don’t get stranded
out there without pharmacy coverage. We don’t want the insurance
companies to be the cause of any missed doses. Be a step ahead
of them and read your insurance papers and notices.
1) “I’m going out of town for a year
and an half, so could you give me all 18 months of my refill
medication today?”
Usually insurance companies
pay for one month’s supply of medication every 30 days or
so. Sometimes they will allow up to three months, but that
depends on the insurance company’s agreement with your employer
or the agency giving the insurance benefit. Be careful if
you have a plan for medication paid for only in the state
you live in, or through specific pharmacies. This is especially
true with Medicaid and ADAP programs. Theses benefits are
usually not transportable to other states.
Don’t forget to take advantage
of a pharmacist’s knowledge of drugs. It is usually free and
most pharmacists are available at any time to help you with
any problems that you may have.
Glen Pietrandoni is director
of Clinical Pharmacy Services for the Walgreen Specialty Pharmacy,
focusing on HIV, located in the Howard Brown Health Center
of Chicago. Contact: Glen.Pietrandoni@walgreens.com.
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