Safe medication use for people age 65 and older

Older adults commonly take prescription and over-the-counter (OTC) medications. The following information is a practical guide to taking medications safely and effectively, as well as some tips on saving money.


Be in charge
Know your numbers
It's important to know the goal for taking your medication. When taking high blood pressure medication, for example, ask your doctor what your blood pressure should be -- such as below 140/90. If you're taking cholesterol medication, know the goal for your cholesterol level.

Resist tampering
Your doctor prescribed your medication based on years of research that helps him or her determine the most accurate dose. Never make changes in dosing, no matter how small, without asking your doctor.

Tell all
The more your doctor knows about your lifestyle, the better he or she can help you take care of yourself. Inform your doctor of any nonprescription medications, nutritional supplements, herbal products or vitamins you're taking. Nothing is insignificant.

Timing is everything
Know the best time of day to take your medication. For example, diuretics (medications that help the body get rid of fluid through increased urination) are best taken in the morning to avoid middle of the night trips to the bathroom.

Don't forget your dentist
If your dentist prescribes a medication, make sure he or she is aware of your other prescription medications to avoid any potential interactions. Let your dentist know about any serious health problems, such as conditions affecting your heart valves. You may need to take antibiotics before any extensive dental work.

Friendly pharmacist
Pharmacists are a wonderful resource for medication information. Get to know your pharmacist, and don't hesitate to ask any medication questions.

Also be aware that the U.S. Food and Drug Administration (FDA) now provides medication labels that can be more easily read by older adults. Some even have directions printed in Braille.

Review, review, review
Most doctors require patients to have a yearly exam before renewing a prescription. Each year, bring in all the medications, supplements and nonprescription medications you take. This is a great time to catch outdated medications, verify proper use, and look for medication interactions.

New prescriptions
Ask your doctor the following questions, as suggested by the FDA:

What are the brand and generic names of the medication?
How is the medication supposed to work?
When and how should I take this medicine?
How long will I need to take this medication?
What should I do if I miss a dose?
What are the possible side effects of this medication?
How should I store the medication?
Can this medication be taken on an empty stomach, or should I eat first?
Is it safe to drink alcohol while I take this medication?

Medication dos and don'ts
Crushing pills
Never crush extended-release products (typically labeled with an "XL" after the name), enteric-coated pills (such as aspirin) or sublingual medications (pills meant to be placed under the tongue and absorbed, such as nitroglycerin). Crushing these medications changes the way they're absorbed by your body and can be dangerous in some cases. If there are other medications you want to crush and mix with a liquid, check with your doctor or pharmacist first.

Switching containers
It's important for the original label to stay with the medication so you're sure to take it correctly. The original container may also be tinted -- many medications can degrade when exposed to light. If the original medication bottle has a childproof cap that's difficult for you to open, you may want to ask your pharmacist for a nonchildproof version rather than switching containers. (Make sure to keep the medication out of the reach of children and pets.)

Driving
Heed warnings about drowsiness and driving on your medication labels. Remember that your medications may interact with other products, such as over-the-counter medications, alcohol and dietary supplements.

Forgetting to take medication
There are some fancy methods to help you remember to take your pills, such as beeping chains and pagers, electronic pill containers, and telephone or computer services. Whether you choose to go high-tech or simply tape a note on the bathroom mirror, it's important to find a method that works for you. If you have trouble remembering to take your medication, ask your pharmacist or doctor for ideas.

Finish your prescription
Unless otherwise directed by your doctor, finish the complete course of medication as originally prescribed. Don't skimp on the full dose of any medication. This is especially important when you're taking antibiotics. Not completing a course of antibiotics may allow the remaining bacteria to multiply again, which may cause your symptoms to return.

Throw out old medications
Once a medication expires, throw it out. It may not be effective any longer. In fact, some medications can lead to serious illness if taken past the expiration date.

Store medication carefully
Medications need to be stored in cool, dry places. Although bathroom and kitchen cabinets are common places to keep medications, these areas of high moisture are not the best choice. Instead, you may opt for a dresser drawer or hall closet. Just make sure the medication is out of the reach of children and pets.


Side effects
Learning to cope with side effects can make some medications easier to tolerate.
Know when to take medications
Dizziness is a common side effect of high blood pressure medication. Spacing your doses correctly can help reduce the dizziness. Sometimes taking medications with food can combat nausea. Certain medications, however, must be taken on an empty stomach, so be sure to check the label. Ask your doctor or pharmacist for tips on when to take your medications to minimize side effects.

Know when to switch medications
Medications tolerated well by one person may be poorly tolerated by another. If the symptoms are too bothersome, talk to your doctor about an alternative.

Identify side effects
Never attribute new symptoms to aging or other factors without talking to your doctor. For example, common symptoms such as memory loss, poor balance or erectile dysfunction can all be due to medication. Also, keep in mind that aging slows metabolism, which may decrease the ability of your liver and kidneys to rid your body of certain medications efficiently. If the level of a certain medication in your bloodstream becomes too high, you may experience dangerous side effects. Talk to your doctor before altering your medication dose.

Consider proven home rememdies
Certain home remedies or over-the-counter products can help alleviate some medication side effects. For example, prune juice, a stool softener or a laxative can help fight constipation. Yogurt with active cultures can help ease diarrhea or the vaginal yeast infections commonly caused by antibiotics. Over-the-counter artificial salivas can ease the dry mouth caused by many medications. It may also help to avoid salty, spicy and acidic foods.

Take vitamins if recommended
Antibiotics, seizure medications and diuretics can diminish nutrients in your body. Your doctor may suggest a vitamin or supplement to help meet your nutritional needs.


Medication interactions
It's important to be aware of all types of medication interactions. For example:
Drug-herb interactions
Herbs are not as harmless as they appear. Talk with your doctor if you take any herbs with prescription medications, and keep the following specifics in mind:

Ginko increases the effect of blood thinners.
Ginseng decreases the blood-thinner effect of warfarin.
Saw palmetto increases the effect of the hormone estrogen.
Valerian increases drowsiness with opiates or barbiturates.
Anesthesia can interact with certain herbs as well. Remind your doctor of any herbs you take before any type of surgery.

Drug-condition interactions
Sleeping pills can make breathing problems worse in people who have emphysema or sleep apnea.

Nasal spray decongestants and bronchodilators (asthma medications) can be dangerous for people who have heart disease, high blood pressure, thyroid disease or diabetes.

Antihistamines, decongestants and antitussives (found in many over-the-counter cold products) can worsen urinating difficulties for men who have an enlarged prostate.

People who have asthma or diabetes may not be able to take beta blockers (medications commonly used to treat high blood pressure or irregular heart beats) or may need to take specific types of beta blockers.

Drug-food interactions
Asparagus, spinach, broccoli and other foods high in vitamin K promote blood clotting. Eat these foods only in moderation if you're taking a blood thinner such as coumadin.

Grapefruit and grapefruit juice can cause the body to absorb greater amounts of certain medications (including statins and calcium blockers). This process may increase the risk of side effects from these medications. Try orange juice instead.

Taking osteoporosis medications such as alendronate (brand name Fosamax) with food can decrease the amount of medication your body absorbs.


Fighting high medication costs
Ask for generic medications or a cheaper medication
Generic equivalents alternatives are available for most common medications.

Compare pharmacies, shop online or use mail order
Pharmacies often have different prices. Call around for the best deal. Some drugstore chains offer better deals online. For a complete list of online pharmacies, check out the National Association of Boards of Pharmacy Web site at www.nabp.net.

Understand your formulary
Health plans typically develop a formulary or a list of drugs they will cover. If your medication is not listed on the formulary, a similar drug is often covered. If there is not an alternative in your formulary, ask your doctor to help you seek an exception from the insurance company.

Request samples from your doctor
You may be able to receive a small supply of medications directly from your doctor. It's important to understand how to properly and safely use these sample medications, however. The medication containers may not be labeled in the same manner as medications you receive from a pharmacy.

Take advantage of special discounts
A variety of special discounts are available for Medicare enrollees who have no prescription drug coverage, such as:

Together Rx program: Opened in June 2002 with participation from multiple drug companies. The program is available for people who have incomes less than $28,000 (or $38,000 for couples). There is no cost to enroll and no membership fee. For details, call (800) 865-7211 or go to www.togetherrx.com.

Pfizer Share Card: Available for people who have incomes less than $18,000 (or $24,000 for couples). With this program, a 30-day supply of a Pfizer drug is $15. For details, call (800) 717-6005 or go to www.pfizerforliving.com.

Lilly Answers Card: Available for people who have incomes less than $18,000 (or $24,000 for couples). With this program, a 30-day supply of a Lilly drug is $12. For details, call (877) 795-4559 or go to www.lillyanswers.com.

Purchasing medications outside of the United States
You may be familiar with people traveling to Canada or Mexico to buy medications at a lower cost or buy prescription medications without a doctor's prescription. You may also know of those who purchase medication from other countries through the Internet. As the debate about this practice continues on state and national levels, keep in mind that these medications may be unsafe, ineffective or even illegal.
For instance, labeling and instructions may be in a language you don't understand or may not include all the information you need to safely take the medication. Also, these medications may not go through the same quality assurance procedures required in the United States. If you're considering purchasing or using medications from outside the United States or obtained through the Internet, especially medications that require a prescription in the United States, discuss it with your doctor.