Is That the Right Medicine for You?

Not Created Equal

What kind of mistakes are you at risk for? According to eye-opening research by the Institute of Medicine, from the moment your doctor writes a prescription, any of a number of things can go wrong -- often in the hospital, but not always. A pharmacist misreads the physician's scrawl. A doctor, unaware of research about when a drug shouldn't be used, prescribes it for you anyway. A patient forgets to tell a doctor about an herbal remedy she's taking, resulting in a dangerous drug interaction. "Mistakes can be made with something as common as birth control pills or allergy medication," says Jim Jirjis, MD, director of primary care at Vanderbilt University Medical Center in Nashville. These mess-ups may not be life-threatening, but they can have very serious side effects.

Experts say women are at special risk. Until recently, most medicines were tested primarily on men, under the assumption that the two sexes would process them the same way. "We now know that women respond differently to many medications," says Rosaly Correa-de-Araujo, MD, PhD, director of Women's Health and Gender-Based Research at the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services. "Women have a lower body weight, a higher proportion of fat, smaller organs, and a slower rate of metabolism, as well as different hormone levels. All of these factors affect the way a medication is metabolized, absorbed, and eliminated by the body." In addition, during the menstrual cycle, water retention frequently occurs, which can lead to dilution of a medication. As a result, even if you, your doctor and your pharmacist get everything right, you still might need to readjust the dosage of your medication.

Which isn't to say you should flush all your prescriptions down the toilet. What you need to do is educate yourself. "There are many things women can do to protect themselves," says Dr. Correa-de-Araujo. For starters, pay close attention to your body's response to a new medication and tell your doctor if you notice anything she didn't tell you to expect. For instance, is the drug less effective during your period? If so, you may need a different dosage.

When You Get Your Next Prescription...

• Tell your MD about all the drugs you're taking. We mean everything, not just other prescriptions, but also over-the-counter remedies that you take regularly, including herbal remedies, vitamins, painkillers, and even antacids. "Most people don't think of all these substances as drugs, but they are, and they can have bad interactions with other drugs," says Albert Wertheimer, PhD, a professor at the Temple University School of Pharmacy in Philadelphia. "So even if something seems inconsequential, don't leave it out."
• Remind her of any drug allergies, as well as of medical conditions you're being treated for by someone else. Yes, it's all there on your chart in front of her on the zillion forms you filled out, but you never know if she missed a page or if the info didn't register, says Scott Strayer, MD, an assistant professor of family medicine and public health sciences at the University of Virginia in Charlottesville, who researches ways to improve patient care.
• Tell her if you're trying to get pregnant or planning to try in the near future. Even if your doctor doesn't ask, volunteer this information. "There are some medications [such as Accutane for acne] that can cause birth defects and miscarriage," explains Dr. Correa-de-Araujo.
• Make sure you can read and understand your prescription before you leave your MD's office. Doctors aren't known for their perfect penmanship; one misunderstood letter or misplaced decimal point and you can end up with the wrong drug or dosage. If your doctor is going to call the prescription in to your pharmacy, write down the drug, what it's for, the dosage, and how often you're to take it, advises Dr. Strayer. This way, if there is a communication error, you'll be more likely catch it.

• Go to only one drugstore. All of the Rx drugs you're taking will be in their system, and a pharmacist is more likely to notice if you're taking meds that don't mix well, says Dr. Wertheimer.
• Ask to fill out a patient profile at your pharmacy. On it, you can list every OTC drug you take -- information that the pharmacist will then have in the computer and can check for possible harmful drug interactions. (See "Careful! These Drugs Don't Mix," on Page 3.)
• Run your Rx by the pharmacist. Tell him what your condition is, and check that your prescription treats it. Also make sure that you understand usage directions -- when to take the medication, how often, with or without food -- and ask any questions you didn't raise with your physician, like what to do if you forget to take a dose.
• Make friends with your pharmacist. The next time you need, say, cold medicine or an over-the-counter painkiller, ask for his recommendation, given what else you take. If he has a face to put with your name, he may be more likely to call your physician if he questions your prescription.

• Speak up. If you're calling your doctor with a health problem and she says that she'll call the Rx in to your pharmacy, be sure to remind her again of all the other medications you're currently taking (OTC ones included), drug allergies, and medical conditions. Do this especially if it's the weekend and you're talking not to your regular physician but to her on-call replacement. "That doctor is probably going to be at home or maybe in her car," says Dr. Jirjis. "Most likely she's not going to have your chart in front of her."
• Look up your prescription online. There are so many new medications and new research coming out all the time, it's nearly impossible for doctors to stay on top of everything they need to know. "We're bombarded with new information and we can't possibly memorize all of it," says Dr. Strayer. Because of this, doctors rely increasingly on drug-reference databases, several of which are available free on the Internet. For information on prescription drugs, Dr. Strayer recommends checking out Epocrates.com or Medscape.com. To read up on any vitamin and herbal supplements you may be taking, he suggests the Natural Pharmacist. (Google "The Natural Pharmacist" or go to ConsumerLab.com for the link.)

Careful! These Drugs Don't Mix

Most of us think of over-the-counter (OTC) drugs as harmless -- who hasn't at one time or another popped more than the recommended number of Tylenol or Advil? "But none of them are perfectly safe," says Dr. Wertheimer, who reviewed OTC drug usage for the Institute of Medicine report. "OTC preparations, as well as vitamin and herbal supplements, can be dangerous when taken in combination with certain other drugs," says Wertheimer. Consult your doctor if you're worried about the common mismatches outlined below.

Originally published in FITNESS magazine, November 2006.