Posts Tagged ‘medication’


“Billions wasted on pricey drugs” was the headline in the newspaper this week. Medicare claims that the program is wasting hundreds of millions of dollars because doctors continue to prescribe and patients continue to ask for pricey name brand drugs when cheaper generic drugs are available.

I agree that this is a major problem which needs to be addressed. My own medical group is working hard and with good success to change the prescribing habits of doctors to use the more reasonably priced generic drugs whenever possible.

What exactly are generic drugs? They are copies of brand name drugs which have the same dosage, side effects, intended use, risks, strength and safety of the brand name drug. In other words, the brand name drug and the generic version of it should be identical.

The generic version of a drug can be manufactured and sold once the patent on the brand name drug has expired. The generic costs much less than the brand name drug mainly because the generic manufacturers don’t have to duplicate the hundreds of millions of dollars spent on research, development and marketing conducted by the original manufacturer.

There is concern by many that generic drugs are cheaper because of a compromise in quality or effectiveness. However, the Food and Drug Administration requires that generics be as safe and effective as the brand name drug. The generic must be bioequivalent to the name brand product, which means that the amount of active ingredient is delivered to the body at the same time, and used in the body in the same way as the brand name. The generic will often be a different color, shape or flavor than the brand name and it also may have different inactive ingredients, but the active ingredients must always be the same.

There are a few classes of drugs, such as anti-seizure medications, thyroid hormone replacement, and blood thinning drugs, where it is best not to switch back and forth between generic and brand name versions. Your doctor can explain this in more detail.

Since nothing in life seems perfect, I recognize that there may be instances where a generic version of a drug just doesn’t seem to work as effectively as its brand name equivalent. This needs to be discussed with your doctor and dealt with appropriately since the number one issue in the doctor patient relationship should be: What’s best for the patient?

Patients do, for the most part, have a choice of generic versus name brand drugs, but must realize that both private and public insurance plans may not pay for the non-generic or will require a higher co-pay, thus increasing the out of pocket cost of the drug. Feel free to discuss this with your doctor and pharmacist.

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On occasion I have patients present to me with the sensation that a pill was stuck in their throat. This is not an uncommon occurrence. A number of people do have problems swallowing medication in tablet or capsule form. When a pill actually does get stuck it is usually not really in the throat but in the upper esophagus just below the throat.

Certain conditions involving the esophagus will predispose one to having difficulty swallowing pills such as strictures (narrowing), scleroderma (hardening) and a condition called presbyesophagus where the muscles of the esophagus do not function properly.

Warning signs of a stuck pill are:

– Feeling of a tablet or capsule stuck in the throat.

– Pain with swallowing.

– Achy dull pain in chest after swallowing a pill.

There are techniques that help one to swallow pills more easily:

– Relaxing and taking several deep breaths before swallowing.

– Taking several sips of water prior to swallowing a pill to help lubricate the throat.

– Cutting large pills (not capsules) in half after consulting with your pharmacist to be sure it’s OK to do this. Use a pill cutter purchased at your pharmacy rather than a kitchen knife.

– Do not lie down shortly after taking your pill or it will be more likely to get stuck in your esophagus. This is especially true when taking medicine just before lying down to sleep at night.

Pills and capsules can also be more easily swallowed when mixed with food. If you have trouble swallowing them whole, pills can be crushed and mixed in most any type of food. Capsules can be opened and sprinkled on food. They can be mixed with small servings of applesauce, pudding, or flavored Jello. Some pills are time released and should not be crushed. Again check with your pharmacist to ensure that your particular pill or capsule can be mixed with food.

Any pill that gets stuck in the esophagus will usually dissolve within one to two days causing no harm and the sensation will disappear. There a few pills worth mentioning that may cause damage, usually temporarily, to the esophagus. These are aspirin, doxycycline (a commonly prescribed antibiotic), potassium chloride, vitamin C, and iron.  On rare occasions one of these stuck pills can cause an ulcer or a more dangerous perforation (hole) in the esophagus.

The same advice, with approval from the pharmacist, can be used for children’s medication which is usually prescribed as a liquid. It can be made more pleasant tasting when mixed with chocolate syrup, ice cream, jelly or jam.

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In a recent column, I said that antibiotics are usually not necessary to treat most upper-respiratory infections. I have been asked to discuss antibiotics in more detail.

An antibiotic is a type of medication that kills bacteria, or at least inhibits growth, thus curing an infectious disease.

The first antibiotic to be discovered was penicillin, which was produced from a common mold and was discovered accidentally by Alexander Fleming in 1928. It wasn’t used to treat disease until 1941, but it became extremely helpful when it was found to cure the myriad infections of the soldiers in World War II.

Today, there are more than 100 different antibiotics on the market, treating bacterial infections ranging from the minor, such as strep throat, to the life-threatening, such as meningitis.

As of yet, we have very few antibiotics that can treat viral infections. There are none to treat the common cold and only a few that can help treat influenza. However, bacterial infections — the cause of such common diseases as strep throat, bladder infections, skin infections and many ear infections, for example — can be cured by the use of antibiotics.

If an antibiotic is used, your physician will choose the one most likely to be effective against the type of germ causing your infection. Other factors in the choice of an antibiotic include medication cost, dosing schedule and potential side effects.

Antibiotics have been over-prescribed for a number of reasons, including patients’ expectations or insistence on use of antibiotics; physicians prescribing them because they don’t have the time or willingness to explain why they are not necessary; and medical legal reasons.

The consequences of over-prescribing antibiotics are twofold.

First is the possibility of a bad reaction to the antibiotic. This might span from minor conditions — a bothersome rash, diarrhea or a yeast infection — to a life-threatening allergic reaction called anaphylactic shock.

The bigger problem, as I see it, is the emergence of resistant germs. This happens when the overuse of antibiotics allows the development of germs that are no longer killed by most of the common antibiotics.

As opposed to the post-World War II decades, when drug companies were pumping out new antibiotics faster than germs could become resistant, we are now in a situation in which, for various reasons, drug companies are not putting in the resources to develop new antibiotics. This will become a serious crisis when we reach a time when many infections will not be treatable with existing antibiotics.

As I have emphasized previously, when seeing your physician for an illness, it is best not to have expectations of being treated with antibiotics. Rather, let your physician decide whether antibiotics are needed, and expect an explanation from him or her as to the reasoning behind that decision. You should also be given suggestions as to what you can do to make yourself feel better during the course of your illness.

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When receiving a new prescription medication from your doctor, I recommend the following steps:

  • Inform your physician of any allergies you may have.
  • Bring a list of all the medications you already take, or bring the actual medications in their original containers.
  • Make sure your doctor is aware of any other medical condition for which another practitioner may be treating you.
  • Ask about the benefits and risks of the new medication.
  • Notify your doctor if you have difficulty swallowing pills or liquid medication and also if you prefer to take the lowest number of doses possible.

After agreeing on the new medication, make sure you have the following information from either the doctor or the pharmacist. (A pharmacist always gives a computerized handout with most of the important information about the drug.)

  • The name of the medication.
  • When, how much and how long to take the medication.
  • What it’s supposed to do.
  • What are the possible side effects.
  • What food, drinks or activities might affect the medication.
  • How the medication should be stored.

Discard any medication that has:

  • Expired.
  • Been discontinued by your doctor.
  • No label on the container.
  • Changed color or smell or seems different from how you remember it.

Since September 2008, it has officially been illegal to discard medicines and sharps (needles, etc.) by flushing them down the toilet or throwing them into the trash.

Most local pharmacies will accept unwanted medications and sharps. Sharps should be transported in an approved safe container that can be inexpensively obtained from any participating pharmacy.

Medications that should be safely discarded include prescription drugs, over-the-counter medications, pet medicines, vitamins, medicated creams and ointments and liquid medication in containers.

Contact your local pharmacy to ensure that they accept your throw-away drugs and sharps. For more information on this topic:               831-454-2160        or http://www.sharpmedsolutions.org.

Editor’s note: This is the third and last in a series of columns about prescription medication.

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Many people take more than one medication, see more than one doctor or have more than one health problem — that makes it essential that you and your doctor are aware of all the medications you take and understand any possible drug interactions that may occur.

When seeing your doctor, bring all your medications or a list of medications you take.

It is very important to read the information given by the pharmacist when picking up your medication. This information can describe possible drug interactions, which can have several harmful consequences.

  • Drug and drug interactions: when two or more drugs interact with each other, such as a sleeping pill (a sedative) taken with an allergy medication (an antihistamine).
  • Drug and food/beverage interactions: food can interfere with drug absorption.
  • Drug and condition interactions: taking the decongestant Sudafed when one has high blood pressure can significantly raise blood pressure.
  • Drug and over-the-counter-medication interactions: taking an antacid can block other medication from being absorbed in the stomach.

One common drug-drug interaction is taking an antibiotic and the effect it has on birth control pills. Medical literature says that antibiotics pose a very small risk of a woman getting pregnant, though they can make birth control more ineffective. A woman being advised of this small risk may decide to temporarily use a back-up birth control method.

Some medications are altered by what you eat and when you eat it. Food may delay or decrease the absorption of a drug, causing it to be less effective. Most medications work best on an empty stomach, which means taking it either one hour before eating or two hours after eating. On the other hand, some drugs work better when taken with food just after a meal. Your medication label will tell you how to take it. If there is no mention of taking it with or with out food, then it can be taken either way.

Patients often ask if alcohol can be consumed while taking medication. The general rule of thumb is that medication and alcohol taken close together may change the potency of a drug. The most serious reaction is the combination of alcohol and narcotic pain medications, sleeping pills or sedatives. Many accidental or suicidal deaths we hear about in the media are the result of these drugs being combined with alcohol.

I do not advise consuming alcohol while taking medication, but I realize that it is a fact of life. If drinking is done in moderation, then it is best that the consumption of alcoholic beverages and the taking of medications be separated by at least two hours.

Regardless, it is important to stress that when taking prescription medication, carefully read the instruction sheet given by the pharmacist as well as the label on the container. This will help to ensure safe and effective use of your medication.

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Before you leave the pharmacy with your prescription medication, take a close look at the label on each container. Make sure it has the following:

  • Your name as well as the prescribing doctor’s name.
  • The name and phone number of the pharmacy.
  • The date it was prescribed.
  • The name and the amount of the medication.
  • Simple understandable directions.
  • The expiration date.
  • The number of refills, if any.

When you arrive home with your medication, be sure to keep it in its original container to prevent future confusion. An exception to this rule would be to put the medication in a weekly pill container, which is the best method for taking medication on schedule. These containers can be purchased at your local pharmacy.

You may dispose of the cotton plug often found in the medication’s container. Always keep containers tightly closed. When bringing a new medication into your home, take time to throw out any medication that has expired or has been discontinued by your physician. (Proper disposal will be covered later.)

Take time to read the drug information given to you by the pharmacist. This is usually a fairly detailed computer printout of things you need to know before taking your first dose. Reading this information will help you understand how often and when to take the medication, what side effects may occur, whether to take the drug on a full or empty stomach, and whether it needs to be refrigerated.

It’s probably safe to say that most people who have prescription medication are not aware of proper storage techniques. Heat and humidity are the greatest factors in the deterioration of stored medications, especially tablets and capsules. The medicine cabinet in the bathroom is actually the worst place to store medication because of the high heat and humidity. A cool, dark, and dry location such as a top dresser drawer or a high shelf in a closet is preferred.

Keeping them out of the reach of children is of utmost importance. Of equal importance is to keep controlled drugs, especially narcotics, in a locked and secure location. Do not store medication in the glove box of your car, as the intense summer heat will cause rapid deterioration.

What actually happens to medication beyond its expiration date? In almost all cases, the drug loses its potency but does not become dangerous or toxic. One notable exception to this rule is common aspirin, which breaks down to form acetic acid (vinegar) and salicylic acid, which are stomach irritants.

Regardless of the expiration date, if at any time you open a medication container and it either looks or smells different from how you remember it, either dispose of it properly or have your pharmacist check it for you.

Editor’s note: This is the first of a three-part series on managing medication. Future columns in this series will cover drug interaction with other drugs and alcohol, tips on traveling with your medication and proper disposal of unused drugs.

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