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The science and art of taking medications

A great deal of research has been done regarding people’s behaviour about taking their medication.

A great deal of research has been done regarding people’s behaviour about taking medications. It has been found that many individuals stop taking their prescription medications shortly after starting them; others take them incorrectly, and therefore do not receive the full benefits of the drug. Of particular concern are medications prescribed for chronic health conditions, such as high blood pressure, high cholesterol, hypothyroidism and diabetes.

Although many factors contribute to these behaviours, one of the most common reasons why people don’t take their medications properly is the complexity of the schedule. If medications regimens are spread throughout the day, with some medications taken before meals and others after meals, doses can easily be missed. Conversely, if medications are taken together, without consideration of potential interactions, this may lead to treatment failure.

How to get started?

The best thing you can do to ensure that you take all of your medications is simplify your medication schedule to match dose time(s) to your everyday activities; this can help you stay on track. Identify the times during the day that you are most likely to remember taking your medications, and match taking the medications to your preferred times. If a medication has often been missed because of an inconvenient time, think about changing it to a more convenient one.

Who can help?

Start a conversation with your pharmacist. You can request a medication review appointment to discuss any concerns you may have regarding missing doses or “pill burden” (often defined as the use of four or more medications). Be sure to bring all your prescription and over-the-counter medications – as well as vitamins, herbal remedies, eye drops, and topical creams or ointments – to your appointment.

What are some possible solutions?

If breakfast is the best and only time you are able to take your medications:

    • Discuss with your pharmacist whether all the prescription medications that you take daily can be taken together safely at breakfast.
  • In some cases, it may be necessary for your pharmacist to request from your doctor a longer-acting formulation of the same medication so you can take it once daily in the morning or suggest a similar medication that can be taken without preference of time so you can take it in the morning.

If you are able to take medications more than once daily:

  • Consider taking most prescription medications that are taken once daily at breakfast; take the remainder later in the day, to spread out the pill burden.

If you find it cumbersome to take some medications before meals and others after the meal:

  • Discuss with your pharmacist whether it is possible to take all your medications before or after a meal, rather than separately. Generally, taking them right after a meal causes less stomach discomfort. In fact, very few medications are affected by food. If this does happen, though, your doctor can make a small dose adjustment.  

Let’s look at some cases to see how to simplify medication taking.

Case 1 – Mary

Mary is a very busy working parent with 3 school-aged children. She is taking gliclazide 40 mg twice daily and metformin 500 mg three times daily for her diabetes.

Problem: Mary admits she often forgets to take her metformin in the afternoon, when work gets busy, and she sometimes forgets to take her metformin and gliclazide in the evening. She usually realizes the mistake at bedtime, but her fear of low blood glucose levels during the night keeps her from taking them at that time.

What can be done? Mary’s doctor could change the gliclazide to a long-acting formulation (gliclazide MR), so she only needs to take it once daily, with breakfast.

Her doctor could also change the metformin to a long-acting formulation, so it can be taken once daily at breakfast; or, her doctor reduce the frequency to twice daily with the second dose taken at bedtime.

Case 2 – John

John leaves home daily at 5:00 am and works a 12-hour shift. He usually eats a hearty breakfast and takes all his prescription medications at breakfast. He has been taking simvastatin for high cholesterol. At his last check-up, however, his cholesterol levels remained elevated.

Problem: Simvastatin is best taken in the evening. As John has been taking it in the morning, he did not get the full benefit of the medication.

What can be done? His doctor could change his simvastatin prescription to another cholesterol-lowering medication (such as atorvastatin or rosuvastatin), which can be taken any time during the day. In John’s case, he would take it at breakfast. 

Case 3 – Mabel

Mabel is taking several prescription medications for her blood pressure, diabetes, high cholesterol and high blood pressure. She believes in spreading the pills throughout the day to avoid drug interactions. As a result, she takes medications at breakfast, mid-morning, lunchtime, mid-afternoon supper and bedtime.

Problem: On days she goes out with her daughter, she misses her mid-morning blood pressure medication.

What can be done? Mabel can ask her pharmacist to help simplify her medication schedule so the blood pressure medication can be taken at another time that is more convenient. 

Mabel could also use a multi-compartment daily dose planner to organize her medications; that way, she could bring the relevant compartment with her on any social outings and take the medication at the correct time.

Before you make any changes to your medication schedule, be sure to discuss your medication needs with your doctor, pharmacist or diabetes care team. Remember: the key is to success is to take your medications consistently at the times best suited to your lifestyle and daily activities.

What concerns do you have about taking your medications?

I look forward to receiving your comments in the Medication section of our Community Forums.

About Freda Leung

Freda Leung is a consultant pharmacist who specializes in diabetes and geriatric medication management. She is a Certified Diabetes Educator (CDE), a Certified Geriatric Pharmacist (CGP), a Certified Respiratory Educator (CRE) as well as a graduate from “Teacher of Adults Certificate Program” from Centennial College. Freda is also a faculty member of the Institute for Healthcare Communication; a facilitator to “Choices and Changes - Clinician Influence and Patient Action” and “Brief Action Planning”, programs developed for health care professionals to support self-management in people living with chronic health conditions. Currently she is a clinical pharmacist at The Scarborough Hospital GAIN geriatric clinic. Her other professional activities include: consultation to long term care homes on diabetes management; teaching continuing education programs at The Ontario Pharmacists’ Association and speaking on topics related to diabetes, geriatric medications and health behaviour changes.

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