“I am taking all the medicines as prescribed, but why am I still not improving and having unwanted side effects?”
Have you ever thought this or asked your doctor this question? You should ask this question even if you are not having any problems.
It is easy to think that the medicines prescribed are simply not working; however, we must consider the way the medicine is being used by the individual person.
Nurse Mary recounts the story of a patient she helped who was told to take an antibiotic for an ear infection, but put the tablet in the ear as opposed to swallowing it, and another patient prescribed ear drops for swimmer's ear but took the medicine orally instead of instilling the ear drops in the ear canal. She also tells the story to our trainees about the woman who complained that her bed sheets were stained purple because she was told to use "contraceptive jelly" for contraception and used grape jelly vaginally (instead of over the counter spermicide)!
Understand how to take your medication
These are dramatic examples of what can happen every day if the doctor and the patient do not understand each other. The advances in medicine have given us thousands of new medicines which enables important options. Recently in our Center for Specialized Women's Health, Drs. Thacker and Yadav saw a woman who was prescribed an oral bone medication monthly for five years and was distressed that she continued to lose bone mineral density. To get the maximum benefit of any therapy, it is important to take the medicines in the correct way. Some of the most common medicines which necessitate very specific administration for appropriate absorption and effect are:
- Oral bisphosphonates: almost all oral bisphosphonates (which are medicines to treat and prevent osteoporosis) except Atelvia (risedronate delayed release) need to be taken on an empty stomach with a full glass of plain tap water. Oral bisphosphonates have a notoriously poor oral absorption ((from <0.7 percent for alendronate (Fosamax) and less than one percent for ibandronate (Boniva) and risedronate (Actonel)). This absorption is further decreased in the presence of other food, liquid or medicines in the gut. Therefore, it is important not to eat or drink anything else for at least 30 minutes after taking Fosamax or Actonel and at least 60 minutes after taking Boniva. (Our patient had been taking the monthly medicine with food and thus not absorbing ANY of the medicine for years!)Also, it is important to stay upright for that duration of time to prevent esophageal inflammation and erosion. People with heart burn or stomach problems may from the same class of medicine given through their veins, called intravenous yearly Reclast (zolendronic acid). The advantages are that it bypasses the stomach and hence prevents stomach absorption issues or GI side effects.
- Calcium: though it is recommended that postmenopausal women ingest about 1200-1500 mg of calcium throughout the day mostly from their diet, sometimes calcium supplements are needed. The important thing is not to swallow the entire calcium dose at the same time, as the stomach and intestines cannot absorb more than 500 mg of calcium at one time and hence, it is important to take it in divided doses.
- Vitamin D3: is a fat-soluble vitamin and can be taken either as 2000 international units (IU) daily or as one monthly oral dose of 50,000 IU can be taken with or without food.
- Thyroid medicine: this is another medicine which needs to be taken on empty stomach with plain water. No food, drink or other medicine should be taken within 30 to 60 minutes of taking daily thyroid medicine. Since the thyroid hormones are so tightly regulated in our body, it is recommended to take only the brand thyroid medicine as the generic version might have only about 80 percent of the active hormone for the same dosage which can cause wide fluctuations in your symptoms and the thyroid function blood tests (TSH).
- Cholesterol lowering medicines: should be typically taken in the evening as your body makes the most cholesterol at night.
- Medications that cause relaxation and sleepiness: like natural progesterone (Prometrium) should be taken in the evening.
So the next time you are at your doctor’s office, take charge of your health and make sure to ask your doctor and nurse (as well as, again with your pharmacist) exactly how, when and where to use your medications. Ear drops, vaginal creams, skin sprays, patches, nasal sprays, rectal suppositories, oral pills or tablets and injection therapies are all used differently.
Be Strong. Be Healthy. Be in Charge!
-Dr. Manisha Yadav and Dr. Holly L. Thacker