This Patient Guide offers a list of general recommendations for people who have been prescribed drugs or take over-the-counter medications. All specific questions about medications should be directed to a physician or pharmacist.
Drug availability, storage and disposal
- Many medications are available over the counter. However, others require a physician’s prescription. Before a long weekend or vacation, patients should make sure that they have enough medication with them. Some patients who take prescription drugs carry an extra written prescription for emergencies so they can have the medication refilled if they run out while away from home.
- When traveling abroad, it is a good idea to bring a letter written and signed by a physician on letterhead stationery identifying the drug, whom it is for and the condition it is treating. Some countries take a hard look at prescription pills and drugs coming across their borders. When traveling, also be sure to keep medication bottles protected (such as wrapping them in clothing) and accessible (such as keeping them in carry–on baggage during air travel). As a general rule, medications clearly marked with the manufacturer’s labels may be carried onto a plane once they have been inspected, according to the U.S. Transportation Security Administration.
- It is also a good idea to carry a list of all medications, including their names, dosages and the condition for which they were prescribed, in a wallet or pocketbook at all times.
- Many medications are available for purchase on the Internet, although these medications may not necessarily be safe, effective or legal. In 2004, the U.S. General Accountability Office reported on various safety risks to consumers who buy drugs from Internet pharmacies. These risks include receiving medications that are not authentic, are improperly handled (e.g., climate control not maintained during shipping), and not approved for sale in the United States by the U.S. Food and Drug Administration (FDA). Some medications may contain dangerous ingredients, excessive or inadequate amounts of certain ingredients (making the drug too strong or too weak), or may have expired. In addition, instructions for use and warning information may be missing, or consumers may not receive medications for which they have already paid.
The FDA, Drug Enforcement Agency and Department of Justice each play a role in the regulation of Internet pharmacies. Legitimate Internet pharmacies must be state-licensed pharmacies operating in the United States. Consumers can confirm this by contacting their state board of pharmacy. Sites that include the VIPPS (verified Internet pharmacy practice sites) seal, issued by the National Association of Boards of Pharmacy, indicate the pharmacy is properly licensed to sell medication online. Consumers who wish to report online pharmacies they believe to be operating illegally should report the problem Web site to the FDA.
- Patients are advised not to take herbs or other supplements without their physician’s approval. These substances are not regulated by the Food and Drug Administration and may contain unsafe ingredients or interact with medications.
Drug storage and disposal
- Some people use needles and syringes to self-administer their medications. Unsafe disposal practices can make syringes dangerous. Caution is necessary to ensure that people are not accidentally cut or stabbed by used needles. Syringes should not be placed where they might be re-used because of the risk of transmission of infection or the presence of residual medication. Many states have laws that dictate how to dispose of syringes and other medical waste (generally defined as any material that touches human blood). Patients should consult with their state’s department of health to learn about regulations.
- Medications should be stored away from heat, direct sunlight and damp areas.
- Some drugs, such as insulin and tumor necrosis factor (TNF) inhibitors, must be stored in a refrigerator to prevent spoiling, but not frozen.
- Medications should be stored out of the reach of children, preferably in a locked box or cabinet. Child-resistant caps should be tightened once a medication has been used. If adults have difficulty opening child-resistant caps, they can request non-child-resistant caps from their physician or pharmacist. However, this increases the need to keep medications safely out of the reach of children.
- Outdated medications should be discarded safely. Patients were once advised to flush unwanted medications down the toilet, but in 2007 government agencies and the pharmaceutical industry launched a campaign to stop this practice in order to protect the water supply. People are now urged to remove the label, crush medications or dissolve them in water, mix them with a substance such as sawdust, cat-box filler or coffee grounds, then seal them in a plastic bag and throw them in the trash.
Special care should be taken when discarding potentially hazardous drugs. For example, all supplies used for giving or preparing chemotherapy drugs for cancer patients should be disposed of using specially marked chemotherapy waste bags. These bags should be sealed securely using rubber bands or “zipper-lock” features and returned to the hospital or other approved site for proper disposal. Hazardous drugs that are thrown away in the regular trash could end up harming children, pets or others.
Drug dosage, missed dose and overdose
- Dosage of medications will vary, depending on the type prescribed and the condition being treated, as well as the patient’s weight and age.
- If the dosage or appearance of a medication is different after a refill than it was previously, patients should check with their physician or pharmacist before taking the medication.
- Patients should not split pills without their physician’s approval. To save money on prescriptions, some people are requesting higher-dose pills and cutting them in half. It might be safe to split certain pills, but there may be questions about proper dosage, and some medications, including capsules and certain pills, cannot be divided.
- Many patients have trouble remembering whether or not they took their medication. An inexpensive pill holder may help patients keep track of medications and avoid an overdose. These organizers consist of compartments labeled for each day of the week. Some pill holders also have different compartments for the times of the day at which medicines are to be taken (morning, noon, night and/or bedtime). These can help when managing multiple medications or a medication that is taken several times a day. Several manufacturers also sell watches, alarms and organizers that remind patients of the need to take scheduled doses of medications.
- Oral medications are generally best taken with water or milk. Some medications cannot be taken with milk, such as certain antibiotics. Calcium-fortified products, such as certain brands of orange juice, may also slow the absorption of such medications.
Unless otherwise directed, medications should not be taken with grapefruit juice or grapefruit, which can affect the body’s ability to absorb, use or expel some substances, including some blood pressure drugs, cholesterol-lowering drugs, heart medications, antidepressants, anticonvulsants, HIV drugs, erectile dysfunction drugs like Viagra or Cialis, opioids and immunosuppressives. This interaction could lead to an inadequate dose or a potentially toxic buildup in the body. Tangelos, Seville oranges and possibly pomegranate juice may have similar effects on medications. The list of medications affected by grapefruit juice and whole grapefruit is growing, according to the American Dietetic Association. However, a physician may recommend grapefruit as part of a healthful diet for many individuals.
Some medications must be taken with food, whereas others should be taken on an empty stomach. When in doubt about how to take a drug, patients should always consult their physician or pharmacist.
- Patients must stand up or sit up for a certain period after taking some medications, such as a drug for osteoporosis.
- Medications should be taken according to the schedule recommended by a physician. For example, some drugs, such as certain corticosteroids, may be recommended for the morning because they can interfere with sleep. Others, such as tricyclic antidepressants, may be recommended for nighttime as they can help patients sleep. Taking medications as recommended also reduces the risk of suffering side effects.
- Patients should consult with their physician or pharmacist to determine the best course of action to take if they miss a dose of a medication.
- Patients should never take a double dose of a medication unless directed to do so by a physician.
- Patients experiencing overdose symptoms should call emergency numbers (911 in the United States and some other countries) or their local poison control center immediately. Callers should have the following information ready:
- Patient’s age, weight and current condition (e.g., conscious, unconscious, dizzy, vomiting)
- Specific name of medication, its strength (e.g., 50 milligrams) and how many pills the prescription originally contained
- Time(s) that medication was taken
- Amount of medication taken
- Patient’s age, weight and current condition (e.g., conscious, unconscious, dizzy, vomiting)
- Patients generally should not attempt to drive to the emergency room or ask anyone else to drive them. Symptoms may worsen on route and ambulance personnel will usually arrive at the patient’s location more quickly than the patient can get to a hospital. In addition, emergency medical teams are trained and equipped to provide the aid immediately necessary.
- Patients should not induce vomiting unless instructed to do so by a poison control center or their physician. Most overdose patients will require hospitalization.
Previous medical practice recommended using syrup of ipecac to induce vomiting in cases of poisonings or suspected overdose. However, in recent years the American Academy of Clinical Toxicology and the American Academy of Pediatrics have advised that syrup of ipecac should not be administered routinely in these situations. The first response to a suspected overdose or poisoning should be a call to emergency services or a poison control center.
Injections and oral solutions
- Wash hands with warm, soapy water prior to giving injection.
- Use latex gloves if so instructed when injecting medications.
- Cleanse the site to be injected with fresh alcohol pad or cotton ball soaked in alcohol. Wait for site to dry.
- Hold syringe like a pencil or dart with one hand while pinching a 2- or 3-inch fold (5 to 8 centimeters) of skin between the thumb and index finger of the other hand.
- Insert needle at 90-degree angle to pinched-up skin.
- Check for blood before injecting medication. With the hand not holding the syringe, pull back plunger slightly. If blood appears in syringe solution, do not inject medication. Withdraw needle and start again at a new site. If no blood appears, slowly press down on plunger until it stops.
- Hold an alcohol pad on injection site after removing the needle. Do not rub.
- Apply a bandage if there is bleeding at site of injection.
- Immediately put syringe and needle into proper disposal container. Ideally, this should be a “sharps box” (available from a pharmacy). However, any sealed, puncture-proof disposal container will work. Find out what services are locally available for proper disposal of biological waste.
Injections into the muscles in the buttocks are a common way of delivering medications for pain, nausea and other conditions. However, recent research shows that injections in the buttocks fail to reach muscle in many people, particularly women and overweight people. Patients are advised to ask their physician about alternative sites.
- Patients should use only the dropper provided in the prescription package to measure the amount of medication used.
- The solution may be mixed into a glass of water, non-citrus juice or soda. Once the glass has been drained, patients should put a little more liquid in, swish it around and drink it to ensure that no medication remains in the glass.
- The medication should be added to the liquid immediately before taking it. Any mixed medicine that is not immediately swallowed should be discarded.
- The oral solution may also be mixed into applesauce or pudding if allowed by the instructions.
Time-release medications and eye drops
- Patients taking time-release tablets should swallow them whole. Crushing or breaking the pill will result in too much of the medication being absorbed by the body at one time and can produce symptoms of medication overdose.
- Time-release tablets are indicated by any of the following words after the drug name: time release (TR), sustained release (SR), extended release (ER), long-acting (LA) or controlled release (CR).
- If possible, ask someone to watch to make sure the drops are getting into the eye.
- Wash hands with soap and water before using eyedrops.
- Lie down or use a mirror.
- Look up at the ceiling with both eyes.
- Pull lower eyelid down with one hand.
- Place one drop on the inside of lower lid without letting the bottle touch the eye.
- Blink and dab away any excess fluid.
- If more than one drop is required, wait five minutes before putting in the second drop (unless directed otherwise on packaging).
Patients may sometimes have difficulty swallowing pills because of issues such as a sensitive gag reflex or anxiety about taking pills. Patients should consult their physician for ideas to help them best swallow their pills. In some cases, a liquid solution may be prescribed instead of pills. Tablets or capsules can sometimes be crushed and mixed with food or beverages. However, patients should always check with their physician before breaking, crushing or chewing oral medications.
Tips that may make pill-swallowing easy include:
- Take the pill with soft foods. Placing a pill in a teaspoon of soft food (e.g., yogurt, pudding, applesauce, flavored gelatin) may help it go down more easily. Patients should be careful not to consume too much of the soft food at once, which may cause choking. Patients should consult their physician about any possible interactions between their medication and the type of soft foods they are using.
- Use cool, never hot, liquids. Washing down a pill with hot or warm liquids may cause it to dissolve before it gets to the stomach where it can be absorbed.
- Try carbonated beverages. Sometimes swallowing pills with a cold carbonated beverage (e.g., ginger ale, sparkling water) can aid swallowing.
- Drink before attempting to swallow the pill. Taking a few sips of water before attempting to swallow a pill can hydrate the throat and make it easier to swallow the pill.
- Let the pill float. Adding a pill to water or other liquid being held in the mouth may make pill-swallowing easier.
- Place the pill at the back of the tongue. When placing a pill directly on the tongue, placing it as far back on the tongue as possible may help swallowing.
- Use a straw. Drinking liquid through a straw, after a pill is already in the mouth, may make it easier to swallow pills.
- Take pills while standing or sitting up. This can help the medication quickly pass through the throat and esophagus and into the stomach. If possible, patients may wish to avoid lying down for 30 minutes after swallowing pills.
- Relax. Do not rush while swallowing pills. Being relaxed can make pill-swallowing easier. Taking a deep breath prior to attempting to swallow pills may help.
- Avoid taking too many pills at once. Taking pills one at a time may help prevent problems with swallowing.
Drug side effects and monitoring
Drug side effects
- The severity of a side effect varies from patient to patient. Thus the occurrence of a side effect will not necessarily result in termination of the medication.
- Patients experiencing side effects should contact their physician immediately, but should not abruptly discontinue using their medication unless instructed to do so.
- Patients should keep all scheduled appointments and continue taking the medication even if their symptoms have ceased.
- Patients should inform all their healthcare providers (including dentists) of the medications they are taking. Some medications can affect the results of diagnostic tests or the outcome of procedures and surgeries. Some pain drugs and other medications can also interact with other medications, reducing the effectiveness of either (or both), or reacting together to produce potentially serious side effects.
- Patients may wish to wear a medical alert bracelet or necklace indicating that they are taking a specific medication and for what condition.
- Patients are advised not to abruptly discontinue using their medication without the direction of a physician. Some medications can cause severe reactions such as seizures when abruptly discontinued and need to be tapered off gradually.
Special concerns for women
In addition to general guidelines for drug use, there are certain considerations regarding medications that apply specifically to women.
Women who use birth control pills or other methods of hormonal birth control (such as shots or implants) should always inform their physician and pharmacist of this fact. Birth control medications can be affected by other medications, or even some foods and drinks. For example, some antibiotics and herbal remedies can reduce the effectiveness of birth control pills.
Women should also inform their physician and pharmacist if they are pregnant or considering becoming pregnant, or if they are breastfeeding. This will help prevent usage of over-the-counter or prescription medications that could potentially cause health problems for a fetus or newborn. The Centers for Disease Control and Prevention (CDC) advises that most medications taken when a woman is breastfeeding probably do not harm the baby, but that their effects have not been fully studied. In addition, some medications can negatively affect a woman’s fertility. Some women may find that natural hormonal fluctuations also impact how a medication affects their body. They may wish to speak to their pharmacist or physician for recommendations or substitutions for a drug.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about drug recommendations:
- What is the dosage and frequency of my medications? What kind of records should I keep?
- Where and how should I store my medications?
- Should I take my medications in a certain way, such as with meals or on an empty stomach? Do I need to avoid taking medications with grapefruit juice, grapefruit, tangelos, Seville oranges, pomegranate juice, calcium-rich products, coffee or anything else
- Are there tools to help me keep track of my medication schedule?
- What should I do if I miss a dose or take too much?
- What precautions should I take when using or disposing of needles and syringes?
- Can any of my medications react with each other?
- How should I notify you of my medications prescribed by another doctor?
- Do you need to know about over-the-counter drugs, herbs, supplements, minerals and vitamins I take?
- What are the possible side effects from my medication?
- What should I do if I experience side effects after using my medication?
- How do we know if I need less or more medications because of changes in my disease, symptoms, pain tolerance or other factors?
- Am I taking too many medications? If so, can you safely take me off any medications? What is the procedure if I want to discontinue a drug or change the dosage?
- I’m going on vacation; what preparations should I make regarding my medications?
- What is the safe way for me to dispose of expired or unwanted medications?