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Arthritis Today

Juggling Multiple Meds with Medication Therapy Management

Do you take two or more medicines? Find out how your pharmacy could help you avoid dangerous drug interactions.

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If you’re taking more than one medication, you’re not alone. In fact, if you’re over 65, there’s good chance you take five or more prescription medicines a week to treat osteoarthritis (OA) and other health conditions, according a report by the Slone Epidemiology Center at Boston University. There’s also a good chance that some of these drugs to have the potential to interact with one another. Flagging and avoiding these interactions is where a service called Medication Therapy Management (MTM) may help out.

When medications interact, “the effect of one drug can be boosted or partially cancelled out by another,” explains Donald Miller, PharmD, professor in the department of pharmacy practice at North Dakota State University in Fargo. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) can hurt your kidneys. If you take an NSAID with painkillers, diuretics or other drugs that affects the kidneys, you increase your risk of kidney damage. NSAIDs also reduce the effectiveness of medicines used to treat high blood pressure and certain heart conditions.

Aging can compound the problem. As you get older, your metabolism slows, which means it takes longer for your liver to break down and remove each drug from your body. “Medicines that normally don’t interact with each other will now do so because they are in your body longer,” says William F. Harvey, MD, assistant professor of medicine and clinical director in the Division of Rheumatology at Tufts Medical Center.

Doctors typically go over their patients’ medicines whenever they prescribe a new drug, as well as at follow-up visits. “But sometimes if you have multiple doctors, no one knows what the other one is doing,” says Miller.

How does MTM work?

Miller says when you participate in an MTM service or program you work with one pharmacy that  keeps all your records in one place. The pharmacist goes through your medicines to make sure they’re appropriate for you, and to identify potential side effects and interactions.

People who have tried medication therapy management have found that it helps streamline their medication use. An analysis published in 2015 in JAMA Internal Medicine found that MTM may reduce the frequency of some medication-related problems, including non-adherence, and lower some health care costs. And 2008 study in the Journal of the American Pharmacists Association found that patients who used this service had fewer problems with their drug therapy and were more likely to achieve their treatment goals.

If you’d like to try MTM the first step is to make an appointment to sit down with the pharmacist and go over your medicines. The pharmacist can see if your medication dosages are too low or too high and note if you have any side effects or drug interactions. This process usually takes about 30 minutes.

Next, your pharmacist will give you a written action plan, which will include recommendations to help you maximize the benefits of your medicines while reducing side effects and interactions. You’ll also get a comprehensive list of all the medications you take and the reasons why you take them. The pharmacist will share this list and any recommendations with your doctors.

You should plan to have a comprehensive medications review with your pharmacist at least once a year. If you’re having issues with your medicines or problems sticking to your dosing schedule, you may need to see the pharmacist more often.

In addition to reducing the risk of side effects and improving treatment, many people find that medication management saves them money.  If you are interested in giving it a try, contact your insurer who may cover the cost. Medicare and some private insurers do for certain patients, because by eliminating unnecessary medicines, they cut down on drug costs, too.

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