• Medications

     
     
     
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    3/18/2013

    Medication safety is best achieved through open and honest conversations between a doctor and patient. If, as a patient, you find challenges to taking your medication as prescribed or have concerns, discuss these with your physician. Your physician, based upon interactions with other patients and his or her professional expertise, may have tools or suggestions to help you stay on track with taking prescribed medication sand prevent potentially harmful drug interactions.

     



    Taking Your Medication

    The biggest step in medication safety is also a surprisingly simple one: actually filling the prescription and taking the medication; and yet, research indicates that more than 60 percent of cardiovascular patients do not take their medication as prescribed. Failure to take medication properly is called nonadherence (also noncompliance). Nonadherence includes never filling prescriptions, not picking up prescriptions, not starting the medications, or not following dosing instructions.

    Patients may use any number of common excuses for failing to take medication. Ultimately, there are no good excuses when your life is on the line. Among heart attack patients who were discharged from the hospital, those who filled none of their prescriptions within 120 days had 80 percent greater odds of death than those who filled all of their prescriptions. That's just one example.

    Here is a list of common reasons patients give for never filling prescriptions, not picking up prescriptions, not starting the medications, or not following dosing instructions:

    I feel better, so I do not need medication.

    Always check with your doctor before you stop taking medication. If you are a cardiovascular patient, your medication serves both maintenance and prevention functions. Going off antiplatelet medication, for example, could allow blood to clot, causing a new heart attack or stroke.

    I do not feel better.

    Just because you cannot feel a medication working does not mean it is not doing its job. Some important medications are not going to change the way you feel, but they will affect your chances of having a heart attack or stroke.

    You should not ignore any news you hear, but you also should never stop taking a prescribed medication without talking to the doctor who prescribed it. Part of being an informed patient is paying attention to new information about any medications you are on. If you see a news headline that worries you, or your dentist or another provider asks you to stop a medication in advance of a procedure, call your cardiologist who prescribed the medication. This is especially important if you have a stent and are on dual antiplatelet therapy (DAPT). Your interventional cardiologist knows if it is safe for you to stop the DAPT even briefly. If your cardiologist disagrees with having you stop a medication for a procedure, he or she can call the other provider and discuss the best options for you.

    And, if new research indicates that the medication is not the best option for you, it is likely far more dangerous to suddenly stop taking the medication than to take a few more doses while you seek additional information from your physician.

    I cannot Afford

    Never try to economize by skipping some doses or taking a portion of a dose. Doing so can be dangerous. The cost of medication is a legitimate concern, but it cannot stand in the way of you taking care of yourself. If you are worried that you will not be able to pay for your medications, talk with your doctor. Your health is more important than any unnecessary sense of shame you may feel. Your doctor may be able to switch you to a cheaper medication, or refer you to a service or social worker who can help you find ways to afford your medication. See How to Afford Your Medications for more information.

    I simply forget

    Remembering to take medications can be difficult, but the outcomes of not taking it are too serious. If you have trouble remembering to take your medication, write down a list of medications and dosing information or mark the information on your calendar, enlist the help of family or friends, or use a service such as automated phone reminders or an electronic pill box that notifies you when it is time to take your medication. See Know Your Medications and How to Take Them for more information.

    I Don not want to take a lot of medications

    Taking your medication can be the difference between life and death. No one wants to take a lot of medications. But taking them could save your life. If you have any questions about the number of medications that you are on, talk with your doctor to make sure they are all necessary.

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    Side Effects

    Trust your intuition: if a side effect seems serious, get help right away. However, do not stop taking a medication without consulting your doctor. You should make your doctor aware of any side effects you are experiencing. Many side effects are better than a cardiovascular event such as a heart attack or stroke. Contact a doctor right away if you are experiencing serious side effects. Many of these will be listed on your medication information pamphlet or prescription bottle label.

    If you find yourself struggling with adhering to your medication plan for the reasons above, or for any reason, talk to your doctor. Do not be embarrassed or worry about being scolded. Your safety is most important, and that means that you and your doctor must work together to find a solution.

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    Interactions

    Bills and PillsSometimes researchers discover that certain drugs, foods, vitamin or herbal supplements, alcohol and other medical conditions can affect one another and can make a medication less, or more, powerful than was intended or lead to other side effects. For example, researchers have discovered an interaction between clopidogrel (sold under the brand name Plavix) and proton-pump inhibitors (a group of medications used to treat gastrointestinal disorders including Prilosec and Nexium, for example). Proton-pump inhibitors can reduce the effectiveness of clopidogrel.

    Other times patients do not realize they need to tell their physician about everything they are taking, including over-the-counter medications, vitamins, herbal supplements, and hormone-based birth control. Forgetting to tell your physician about supplements and medications, or feeling too embarrassed to do so, can have serious consequences. For example, St. John's wort, an herbal treatment many try for depression, is known to interact with several heart medications, including warfarin (Coumadin) and clopidogrel (Plavix) and could result in increased risks of bleeding. Many of the most popular herbal supplements can lower or increase the effectiveness of cardiovascular medications, or cause other effects such as higher blood pressure or a change in heart rate.

    Both examples describe interactions--when substances behave differently in combination from how they would on their own. Be sure to talk with your cardiologist and primary care physician about everything you are taking, including over-the-counter medications, vitamins, herbal supplements, and hormone-based birth control and ask about possible interactions.

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    Other Potentially Dangerous Interactions

    Hormone-Based Contraceptives

    Birth control pills may place women at higher risk of high blood pressure and blood clots that can cause stroke or heart attack. Women over age 35, smokers, and women with high blood pressure, diabetes, or unhealthy cholesterol levels are most at risk. The birth control patch may pose an even greater risk because of its higher levels of estrogen.

    The connection between birth control pills and risk of heart disease remains unclear. If you have other risk factors, such as a history of heart disease in your family or if you are a smoker, talk to your physician about your concerns and options.

    Erectile Dysfunction (ED) Medication

    ED is fairly common among men with heart disease but if you have ED and are taking medication for it, it is very important that you tell your doctor because if you have any of the following conditions, ED medications may not be advised:

    • Certain high-risk heart problems, including chest pain (angina), heart failure, abnormal heart rhythms (arrhythmias), or a recent heart attack
    • Uncontrolled high or low blood pressure
    • A history of stroke within the last six months
    • Eye problems such as retinitis pigmentosa
    • Sickle cell anemia, leukemia, multiple myeloma, or another health problem that can cause an erection that won't subside (priapism)

    Side effects from any of these medications may include headache, flushing, indigestion or nausea, stuffy or runny nose, back pain and muscle aches (with Cialis), and temporary vision changes (with Viagra). It is unlikely that you’ll have a serious side effect, but if you have a sudden loss of hearing or vision, or an erection that lasts longer than four hours, seek medical help immediately. See Erectile Dysfunction for more information.

    Several web databases provide information on drug interactions, for example, AARP’s drug interaction checker, but the best way to avoid dangerous interactions is to speak with your physician and disclose all medications and supplements that you are taking.

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  • More About Medications

    Continuum of Care

    You might come under a cardiologist's care for having risk factors for cardiovascular disease or for existing disease. Regardless of the severity of your cardiovascular disease when you come under a cardiologist's care, you will become a part of the continuum, or spectrum, of care. The spectrum of care describes treatment options that range from least invasive to most invasive: lifestyle changes, medical therapy, angioplasty and stenting, and surgery. Your cardiologist will assess your level of disease and talk with you about your treatment options.

    How to Read a Medication Label

    To take your medication safely, you must be sure you understand the dosing instructions and any interactions. This sounds simple, but medication labels can be confusing. Let’s look at some common types of labels and the kinds of information that appear on them.

    Medication Safety

    Medication safety is best achieved through open and honest conversations between a doctor and patient. If, as a patient, you find challenges to taking your medication as prescribed or have concerns, discuss these with your physician. You are likely not alone in your concerns, and your physician, based upon interactions with other patients and his or her professional expertise, may have tools or suggestions to help you stay on track with taking prescribed medications. Open dialogue with your doctor about what medications you take is also the only way to prevent potentially harmful drug interactions.