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Arthritis Today

How Pharmacists Can Help You Safely Juggle Multiple Meds

Do you take more than one medicine for arthritis? Find out how your pharmacy could help you avoid dangerous drug interactions.

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What’s in your medicine cabinet? Is it filled with several medicines prescribed by different doctors and an array of over-the-counter drugs? The older you are, the more likely you are to take several medicines a week, according to several reports from the Slone Epidemiology Center at Boston University. 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.

Taking more than one medicine to treat a single condition or to manage multiple health issues is called “polypharmacy.” Polypharmacy, among older adults in particular, is a growing concern as it raises the risk of dangerous side effects and drug interactions.

 “Sometimes, a person sees multiple specialists and each doctor prescribes medications, so you get some overlap or duplication,” says Donald Miller, PharmD, professor and chair of pharmacy practice at North Dakota State University in Fargo.

Even if you faithfully stick to your doctors’ instructions and closely follow the directions for taking each drug, you could still unknowingly be taking medicines you don’t need or worse – you could be combining drugs that can have unintended interactions, says Miller.

Risks of Taking Multiple Medicines

Many of the drugs you take for arthritis and other conditions can potentially interact with one another. “The effect of one drug can be boosted or partially cancelled out by another,” explains Miller.

Here are two examples:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) and naproxen (Aleve) can hurt your kidneys. Take an NSAID with painkillers, diuretics or other drug that affects the kidneys, and you increase your risk of kidney damage.
  • NSAIDs reduce the effectiveness of medicines used to treat high blood pressure and certain heart conditions.

Your age also plays a role in how drugs interact. 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.

You might not even realize that you’re mixing drugs, especially when you take over-the-counter medicines. For example, many multi-symptom cold relievers and headache remedies contain NSAIDs or acetaminophen, ingredients that may not be obvious on the front of the package. Adding these products to an NSAID or acetaminophen your doctor has already prescribed could lead to a potential overdose.

Certain “all-natural” herbal remedies also can have dangerous interactions with drugs often prescribed for OA. Taking supplements containing ginkgo, ginger, or dong quai along with NSAIDs can increase the risk of gastrointestinal bleeding. Some Chinese herbs can contain high doses of anti-inflammatory medicines.

The Pharmacy’s Role in Medication Management

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. “That’s where the pharmacist can come into play.”

“Pharmacists are really another layer of defense,” says Dr. Harvey. Going to a pharmacist who is familiar with your medication history can bolster that defense.

“If you can stick with one pharmacy you trust, the staff can constantly be looking out for your welfare on medications,” explains Wendy Brown, PharmD, associate professor in pharmacy practice at North Dakota State University.

Your pharmacist can go through your medicines—including OA meds, over-the-counter drugs and herbal remedies—to make sure they’re appropriate for you, and to identify potential side effects and interactions. It is a service known as medication therapy management, or MTM.

How Medication Therapy Management Works

Step 1. 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” Brown says. The process usually takes about 30 minutes.

Step 2. Your pharmacist will give you a written action plan. This plan 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.

Step 3. Plan to have a comprehensive medications review with your pharmacist at least once a year, Brown suggests. If you’re having issues with your medicines or problems sticking to your dosing schedule, you may need to see the pharmacist more often.

Medicare and some private insurers will cover the cost of medication therapy management. Your insurance company should contact you if you’re a good candidate for this service, or you can call them to ask about it.

People who have tried medication therapy management have found that it helps streamline their medication use. A 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. By eliminating unnecessary medicines, they also cut down on drug costs.

Your Role in Medication Management

Managing your medications involves your doctor and pharmacist, but it really starts with you. You need to be an empowered, active participant in the process, starting whenever you get a new prescription.

Miller says you should ask these questions every time your doctor prescribes a new medicine:

  • Why are you prescribing this?
  • What is it for?
  • How will it react with other medications I take?

Other things to ask your doctor:

  • Are you starting me on the lowest possible dose that will help my symptoms but reduce side effects?
  • How do I take this medicine? For example, NSAIDs should be taken with food to prevent stomach upset.
  • Can I drive when taking this medicine? Some narcotic drugs can cause dizziness, so your doctor may tell you not to drive right after you take them.
  • What result do you expect me to have from this medicine? “A lot of people expect to leave the office with a medication that will result in them having no pain whatsoever,” says Dr. Harvey. Understanding the doctor’s goals will give you more realistic expectations.

Maintain an updated list of every medicine you take—including over-the-counter medicines and herbal remedies—and keep it with you at all times, Dr. Harvey says. Every time you see a new doctor or revisit one of your existing doctors, share the list with them.

Finally, if you determine that a drug isn’t working for you, find out how long you should keep taking it. “We don’t have any medicines that halt or reverse the process of osteoarthritis,” adds Dr. Harvey. “Ask, ‘How long am I going to give this a go before I say it’s not working and stop taking it?’”

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