skipping arthritis medication dosages

Skipping Your Meds?

Here's why that's a bad idea and what you can do to improve adherence


With prescription drugs, “Take as directed” sounds simple. Yet every day, millions of people – on purpose or unknowingly – skip a dose, take it at the wrong time, or use either too much or too little. Any of these can keep your medicine from helping, or even create a health risk. 

How common is the problem? Two studies of rheumatology patients at the MD Anderson Cancer Center, in Houston, show that adherence rates are low. The first study, of 110 people with RA who were prescribed disease-modifying antirheumatic drugs (DMARDs), found an adherence rate of 59 percent. In the other study, of 74 patients with lupus who were prescribed prednisone, the  adherence rate was 64 percent. In both groups only one in five patients took their drugs as prescribed at least 80 percent of the time.

This lack of adherence – or following a prescribed treatment plan – can have serious consequences, experts warn.

Why It’s Important to Take Your Medicine

If you don’t take your medication as prescribed, you will experience a worsening of pain and possibly progression of the disease, says Lars Osterberg, MD, a clinical assistant professor of medicine at the Stanford School of Medicine, in California, and an expert in patient medication compliance. If you’re taking medicine for chronic pain, for example, skipping medication can make pain harder to treat, he says. Nonsteroidal anti-inflammatory drugs and analgesics, for example, are used as much for prevention as treatment. “When pain flares, it’s hard to knock it down again,” he says. “The same goes for inflammation. If you get behind the eight ball and inflammation builds up, it can be hard to suppress that inflammation and pain.”

In other words, you may be feeling okay now, but skipping medication may set you up for bigger problems later.

Why You Have Trouble Taking Your Meds

Why don’t people take drugs correctly? Express Scripts, which administers large prescription drug programs for various health insurance plans, has been studying medication adherence issues among 850,000 of its members since February 2011. They’ve identified five major obstacles: procrastination involving either renewing or refilling, cost issues, forgetting and concerns about the drugs themselves. 

“We were very surprised that forgetfulness and procrastination make up about two-thirds of causes,” says Express Scripts’ chief science officer Bob Nease, PhD. 

You may not even realize you’re skipping a medication. “You can easily recall twisting the lid and taking out a pill,” Nease observes, “but it’s hard to remember the one you didn’t take; you were doing something else instead.”

Solutions To Improve Adherence

Fortunately there are ways to get around all of these common obstacles.  Improve your medication adherence with these solutions to common problems.

Problem: Forgetting to take medication
Solution: Use gimmicks and physical reminders. Researchers at Washington University in St. Louis, Mo., came up with one solution. In a 2009 study, they found that older adults were better able to remember if they had already done a habitual task – like taking medicines – if they also performed an unusual movement, like tapping their head, at the same time. Other reminders: pill organizers, calendars, beeping computers, smartphone app drug diaries, text messages and medication charts.

Problem: Procrastinating with refills and renewals
Solution: “About 25 percent of patients are fine about taking medication, but delay getting refills,” says Nease. Try getting a 90-day supply, he advises. Consider an auto-refill program or home delivery, if available. When you receive a new prescription, make an appointment for several weeks before it will end – even if that’s a year away.  “Doctors can be booked way ahead. Don’t wait until you’ve gotten the last refill,” Nease says. “By then, you may run out of meds before getting to see your doctor.”  Physicians sometimes phone renewal orders to pharmacies, but don’t plan on this – your doctor may need to examine you before re-prescribing.  

Problem: Coping with costs
Solution: Medication costs can be prohibitive. “Always check for lower-cost alternatives,” Nease advises. “Ask your physician or pharmacy if a generic can work, and whether you meet financial requirements for patient assistance programs, generally funded by manufacturers.” 

Problem: Keeping up with multiple meds

Solution: Medication regimens can be difficult to follow, particularly if you take multiple drugs.  Ask about combination or long-lasting drugs. They may or may not be preferable in terms of safety record, cost, side effects and effectiveness, but they can be taken less frequently, says M. Robin DiMatteo, professor of psychology at the University of California, Riverside, and co-author of Health Behavior Change and Treatment Adherence (Oxford University Press, 2010). Another option to make an appointment with your pharmacist to go over all of the medications  you take and possibly streamline them.

Problem: Dealing with side effects

Solution: It’s hard to take a medication faithfully if you know it will upset your stomach, make you drowsy or cause other unwanted effects. Always mention side effects to your doctor, says DiMatteo. Your doctor might be able to offer a similar medication that won’t have that particular effect, or let you know that the side effects will diminish as your body acclimates to the drug.

Problem: Overcoming medication anxiety
Solution:  If you are concerned that a drug is dangerous or isn’t working as it should, have an honest discussion with your pharmacist or other healthcare provider, Nease advises. Learning specifically how a medication can help, and how it works, makes it easier to follow directions and maintain the daily regimen, even when you’re feeling healthy.  

Problem: Dealing with self-image concerns
Solution: Learning that you need a daily medication can rattle your sense of being vital and healthy. “Just take it one day at a time,” Nease urges. “The key is staying on it for two weeks. It’s hard to have your antenna up for that long. Taking this medication every day gradually fades into the background, becoming as automatic as popping a vitamin.”