Once people find out that I am a physician, the topic of conversation often turns to their meds.  Many assume that I have memorized the two-thousand pages of the drug  manual known as the PDR.  I haven’t, no one has!  In short, I don’t likely know too much about the medications that you are taking.  But YOU should! People like to talk about their meds, but it is often quite disturbing to me how little they know about them.  Many can’t even get the name right!

There are four things you need to know about your meds.  What and why, how much and how often.  It could be extremely important that you know all of these.  If all you know about your meds is that you take the blue pill in the morning and the red one at night, you could be in big trouble. 

Let’s construct a worse-case scenario.  You are involved in an accident and taken to the hospital unconscious.  You are in a coma for three days.  You wake up dead! Why? Not because of the accident but because the doctors had no way to know that you were taking some medication that was keeping you alive.  They had failed to give you that “required” med and you died despite the fact that they would have pulled you through on the accident thing.

If you take any medication daily, you should carry the basic information with you at all times.  It is best to write it down and keep it in your wallet.  If you are indeed unconscious, someone will look there to see who you are.  The necessary information needs to include the “why, what, how much and how often.”   Start with your diagnosis: high blood pressure for example.  You may very well have 2 or three meds for that one problem.  Next is the name of the medication, then the “how much” = the strength of the pill.  Finally, is the how often = once a day, twice a day.  All four parts are important.             

The names of meds are the most difficult part.  All meds have two different names.  One is the Brand name.  That is the fancy, catchy name that the marketing people give to a drug.  The real name is the chemical name for the drug.  This is especially important for those of us living overseas.  Any given drug can have a number of Brand names.  If a drug is made by multiple companies, it will have multiple Brand names.  Sometimes a single company will market a drug in different countries under a different name. So, to ensure that you get the correct drug, you should always write down the chemical name.  That never changes.  Some drugs have names that sound much the same, that is another reason why you need to note the reason why you are taking a drug.  The diagnosis will help to determine the correct drug.

While getting the right drug is the most important, getting too much or too little can be a major problem.  So the how much and how often comes next.  It really is important to know if the dose is 250, 25 or .25.  Where you place the decimal point can make the difference between life and death.

I am constantly amazed at how little many people know about the meds that they are supposed to be taking. In many cases, they depend on these meds to keep them alive, yet they are very cavalier about them. Even if you don’t know or don’t care about the way the drug works in your body or the side-effects that it might cause, you SHOULD know the why, what, how much and how often.  The “blue pill” won’t hack it! 

Medications can be broken down into 2 major categories: short-term and long-term.  Long-term meds are often keeping you alive.  For the most part, it is important that you take these on the right schedule so that you maintain the correct level in your body at all times. 

Short-term meds often present a different problem: people will often just arbitrarily stop taking them.  This results in “left-over” meds.  Antibiotics are examples of short-term meds.  They are taken to control a specific infection.  Rarely are they needed for more than a week or two.  But you generally need to take all of them!  People will often stop taking them when they start to feel better. While this might be OK for some drugs, it can lead to dangerous complications and more serious infections if you do not finish all of the prescribed antibiotics.  The all too common (and dangerous) pattern is that people stop taking the pills before the desired effect is achieved (all the bacteria are dead) and then they will start taking the left-over meds at a later time and have just enough to make things worse rather than better.  I won’t go into great detail about the microbiology of the problem, suffice it to say that everyone should take all of the prescribed antibiotics every time, not stop early and not take left-over meds.

Indeed, there are cases in which you can decide to stop a medication.  If you cure your cough, you can stop the cough medicine. Then throw away the rest! It is best never to have any left-over meds; that way you won’t be tempted to take any self-prescribed meds.

Many of us are in the age group were we are likely to find ourselves in need of a number of medications.  Once a medication is begun does it always need to be taken for the rest of your life?  Well, the answer is yes and no.

Most of the ailments of older age are “incurable” in the sense that once the problem starts it is not likely to go away or cure itself.  Most medications that are prescribed for older folks are there to support or maintain, not to cure.  Take high blood pressure, for example.  It has a variety of causes, most of which never get any better and a few can worsen over time.  At best, you are likely to be taking some medication to help lower your pressure for the rest of your life. But will it always be the same drug in the same amount? Not likely.

 Medications used in modern medicine generally take one of two forms.  First, there are meds which have a direct effect and are detoxified or degraded by the body.  Second are precursor drugs which the body must act upon and alter chemically before they have their ultimate effect.  The effectiveness of either category of drug can change with age. 

In the first case, you might actually need to take less of a drug (smaller dose or fewer pills each day) to get the same effect.  This is due to the fact that over time the body’s ability to clear these drugs through the kidney or liver becomes less efficient.  In other words, the drug lasts longer so you need less drug to achieve the desired effect. Failing to reduce the dose can result in overdoses and/or increased side effects.  This is often true with quinine-based heart drugs.  In the second case, you will eventually need more of the drug, as the body becomes less efficient at processing it into a workable chemical. 

This is the reason why you should always make periodic visits to your doctor to check on the effects of the drugs that you are taking.   Many of us live in countries that place few controls on the sale of drugs.  It might be tempting to skip the doctor’s visit and just go buy more of the same drugs at the corner store.  Once or twice this might not be a problem, but over time you are running a greater risk.  By never adjusting the dose, you may very well be getting too much or too little of the drugs that you need.  Similarly, don’t resist your doctor’s suggestion to lower the dose.

For some ailments, like blood pressure or high cholesterol, diet and life style changes can have a beneficial effect as well.  You might find that you could reduce your dose (and the associated cost) over time, if you do other things to influence these problems for the better. It might also be possible to change to a less powerful (and generally less expensive) drug and maintain the same effect.  Introducing “foreign substances” into your body is never a GOOD thing, although at times it is quite necessary.  If you can reduce or stop taking a drug, so much the better.   Similarly, don’t hesitate to ask your doctor for a different medication if you feel that the current one is no longer working as well.

Free advice: Do not neglect your health or your purse foolishly by skipping those periodic check-ups.  You just might find yourself worse for it.

At the same time, NEVER just arbitrarily stop taking a drug.  Your life might just depend on it!