4 "Your medications may interact with each other."

When your doctor whips out his pen and scribbles on his prescription pad, you may feel a little awed by his certainty of which drug and dosage you need. If you realize that the Physicians Desk Reference (PDR), a comprehensive compendium of all available drugs and dosages, weighs in at almost 4,000 pages, and the FDA posts about 20 safety-related medication labeling changes every month, your awe might shift to skepticism. 

How does your doctor know all that? The simple answer is, he doesn't. Doctors tend to know a relatively small number of medications very well -- most rheumatologists, for example, are up-to-date on every detail of arthritis meds and write so many prescriptions for them that it really is second nature. But a primary care doctor may not know the details of a highly-specialized medication you're taking for arthritis and prescribe a drug for a different condition that creates a bad mix. And if you're taking an over-the-counter (OTC) medication or supplement, your doctor may not know anything about it, much less how it will affect the medicine he's prescribing. It's unrealistic to expect any one doctor to keep up with the massive and constantly changing matrix of medication information. It would take a computer to do that - in fact, some doctors are making use of technology, like the PDR on their Palm Pilot, to keep one step ahead. 

What can you do? Rely on your pharmacist. She is plugged in to all the latest drug information, including side effects, interactions and indications, and -- especially if you get all your prescriptions from a single pharmacy -- can tell you in seconds with the help of a comprehensive computer database how your new biologic might affect your blood pressure or the medication you take for it. Pharmacies are required by federal law and regulated by state enforcers to counsel people one-on-one about medications, and many also provide detailed information about interactions from OTC meds and supplements as well as prescription medications with each prescription. But don't let your doctor off the hook: ask what to expect -- how soon can you look for an improvement with this new medication? Which side effects should you call about? Is there a less-expensive generic option for this medication?

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