Prescription Medications: Q & A with Dr. Grant Fowler
Part one of a two-part series on prescription drugs
Did you know that there are discount programs for some prescription medications available through various stores, organizations and companies? Or did you ever think that getting mail order prescriptions during the hot summer months could potentially destroy them?
Here's a chance to brush up on everything you should know about prescription drugs. Grant Fowler, MD, professor and vice chairman of the Department of Family and Community Medicine at The University of Texas Health Science Center at Houston (UTHealth) Medical School, offers his expertise:
Q: What information should your doctor tell you when prescribing a medication?
Dr. Fowler: Your physician should explain why you need a new medication or how it will be helpful. He or she should also state when and how long you should take it and warn you of any serious side effects. If a drug is for an illness or disease, your physician should have taken the necessary steps to properly diagnose you.
Q: What should your pharmacist ask you when dispensing a medication?
Dr. Fowler: A pharmacist should ask you about your allergy history and what other medications you are taking. Then, he or she should double check if your new medication is still a good choice based upon your responses. Some medications may make other medications less effective, so it's important to cross-check everything.
Q: What are some things to keep in mind regarding possible side effects? What are some more common side effects?
Dr. Fowler: Almost any medication can cause a rash in some individuals. If you develop a rash while taking a medication, you should tell your physician. In general, each type of medication can cause its own minor side effects such as diarrhea, constipation, nausea, drowsiness, headache or feeling thirsty. Some people, however, may experience very serious side effects such as hives or trouble breathing. More serious long-term side effects might include worsening of liver or kidney disease. Some patients may experience side effects while taking a medication while others won't. Side effects should be listed in the package insert or dispensing materials, which your pharmacist should give you when filling your script.
Sometimes side effects subside after taking a medication for a while. For instance, when beginning to take certain birth control pills, you may have some menstrual spotting, feel nauseated or experience weight gain. However, after a few months, the side effects dissipate. Certain antidepressants can cause nausea for the first week, which quickly subsides.
Q: Why might a patient have to start on a low dose and work up to a full dose?
Dr. Fowler: Certain medications have unpleasant side effects. Starting at the lower dose allows the patient to develop tolerance to the medication over time. This is especially true in elderly patients whose metabolism of medications may be slower.
Q: What is the ideal storage temperature for prescriptions? What happens to medicine when it's exposed to extreme heat or cold?
Dr. Fowler: Some drugs are more vulnerable to heat than others, such as liquid medications like insulin. They can break down and become less effective. As a result, they are packaged in ice when shipped. Biologic medications (i.e., those that replace natural hormones) may also break down when exposed to high temperatures. Examples include thyroid medications and birth control pills. Most other medications should be stored at room temperature (68 to 77 degrees Fahrenheit) unless suggested otherwise. Cold temperatures are usually not problematic.
Use caution when traveling. Don't put medications in your car's trunk, which can get quite hot. Put them in your carry-on bag when flying.
Q: What are the differences between generics and brand name drugs?
Dr. Fowler: Nearly eight in 10 prescriptions in the United States are generics. The main differences are the name and the price. On average, the cost of a generic is 80 to 85 percent lower than the brand name. Generics are regulated by the U.S. Food and Drug Administration (FDA) and require the same approval as brand names and bioequivalents. When studying generics, the FDA determined that the average difference in absorption with a generic was up to a 3.5 percent variance. However, because of these absorption differences, some generic drugs may not work as well for some patients. You should discuss this with a physician.
Q: Can you stop taking antibiotics when you feel better?
Dr. Fowler: You should take antibiotics for as long as they are prescribed. Stopping them early may result in some slightly resistant bacteria staying alive, accumulating and causing an infection that is then resistant to the medication.
Q: Can you take drugs past the expiration date? Are they less effective or possibly dangerous?
Dr. Fowler: Although I recommend taking all medications prior to the expiration date, certain medications can remain effective for years after the expiration date printed on the packaging. The federal government actually tested more than 100 expired drugs and found that 90 percent of them were still effective even 15 years after the expiration date. However, I would suggest taking medications only for one or two years after the expiration date, and only in emergencies. Exceptions are biologics, such as liquid medications, birth control pills, thyroid medication, insulin and tetracycline — an antibiotic. You should never take these medications after their expiration dates.
Q: What is the best way to dispose of old, unused prescriptions?
Dr. Fowler: Follow the instructions on the medication's packaging. Do not flush them down the toilet or wash them down the sink unless specifically instructed to do so. If you do, they can end up in your septic system and water supply and can cause harm. Find out if your community offers prescription drug take-back programs. Otherwise, take the medications out of the bottle and mix them with coffee grounds or cat litter to make them unattractive for children or pets. Place the mixture in a sealable bag to prevent leakage and dispose with your regular garbage.
Q: How do mail-in prescriptions usually work? What are the benefits?
Dr. Fowler: Mail-in prescriptions usually decrease your copayment. Typically they are offered in a 90-day supply and are ideal for maintenance drugs (i.e., drugs you take on an ongoing basis). This can save you multiple trips to the pharmacy. During hot summer months, try to avoid letting medication sit in a hot mailbox, which can reach temperatures greater than 150 degrees. This can decrease a medication's effectiveness or even destroy it. During that time, consider having medication mailed to your workplace or see if your local pharmacy can offer 90-day prescriptions.
Q: Other than health insurance, are there any discount programs patients might want to be aware of?
Dr. Fowler: National organizations, such as AARP, have discount programs available. Many pharmaceutical companies have cards, often downloadable from the Internet, which allow a discount for medications. In addition, many supermarket chains (e.g., Kroger, Walmart, and Target) have programs available with a list of covered medications, usually generic, that are $4 for a one-month supply or $9 for a 90-day supply.
Q: Is it OK to mix prescriptions with alcohol or other prescriptions? What are some specific ones to be careful with?
Dr. Fowler: To be on the safe side, you should not drink alcohol when taking any medication to improve mental health. Additionally, you should not mix any medication that can cause drowsiness with alcohol. Most diabetic medications should not be mixed with alcohol. Beyond this, look for warnings on the package.
Q: What should you do if you miss a dose?
Dr. Fowler: This depends upon the medication. Each medication is different, so it should be researched as to how to handle a missed dose. If you forget to take a birth control pill, for example, you should take it immediately even if that means taking two pills in one day. Keep in mind that the pills may be ineffective for a time, so be sure to take any necessary backup precautions.
Blood pressure medications are heart medications, and are only good the day they are taken. They should never be double-dosed, your blood pressure may go too low; you can't make up missing a dose on them. So, each one should be researched. A medication's package insert should contain information regarding how to handle a missed dose.
Q: What are the benefits of getting all of your prescriptions at the same pharmacy?
Dr. Fowler: The pharmacist might catch possible interactions. If you take generic medications, you will more likely get the same medication from the same manufacturer each time you refill it, which is ideal.
Q: Why might a patient receive a prescription for a condition that it's not FDA-approved for, such as metformin for pre-diabetic patients?
Dr. Fowler: Metformin, the most commonly prescribed medication for diabetes, has been proven to prevent diabetes in pre-diabetic patients. However, the FDA doesn't approve medications for a pre-disease state.
Another reason may be because certain principles of medications are sometimes not discovered until the medication goes off patent (i.e., becomes available as a generic drug). Pharmaceutical companies rarely study a medication after it goes off patent. For example, gabapentin — a seizure medication — helps with pain, especially neuropathic pain. But a drug company will not fund a study to support this because it won't be able to get exclusive rights to selling it.
Another example is topiramate. Originally marketed as a seizure medication, it has been found to prevent migraine headaches.
Q: Why might a doctor order a refill in some instances but not in others?
Dr. Fowler: State laws forbid the refill of certain medications beyond six months. If you have a disorder that is difficult to control, your doctor may refuse to refill your medication for very long if he or she feels it necessary to see you regularly to monitor your condition.
Q: If someone has questions regarding a prescription, who should they contact?
Dr. Fowler: If you have any questions regarding a medication, don't hesitate to contact your physician’s office or pharmacist. A pharmacist may be the easiest person to reach. If it is a brand name medication, the manufacturer might have an 800 number to call.