Illustrations by Greg Clarke
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How to Be Drug Smart
By Russell Wild
Prescription drugs are life-savers—but only if they're used correctly. To get the most from your medicines—and save money—check out this expert advice from some of the nation's top doctors.
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Taking Charge of Your Rx Needs
Doctors do the prescribing, but it's up to you to take charge of the details
Be curious
"Before you leave your doctor's office, know what your condition is and how the drug will help you," says Janice Douglas, M.D., chief of the division of hypertension at Case Western Reserve University School of Medicine in Cleveland. "Don't let the doctor say, 'Okay, you have high blood pressure, so let's get you on this medication.'" Know what your numbers are and what you're aiming to achieve. Only by knowing that you're aiming for, say, a blood pressure level below 140/90 or an LDL cholesterol level of under 100, will you know if a drug is working for you.
Don't play doctor
The pharmaceutical industry has done much to develop drug therapies that can help us live longer and better lives. Painstaking research has gone into determining the dosage and effectiveness of every prescription medicine. Make sure when you leave the doctor's office or the pharmacist's counter that you understand the instructions exactly—whether you're to take one pill or two, whether once, twice, or three times a day. If the medicine doesn't seem to be working or if you're experiencing side effects, always consult your doctor. You should never tinker with the dosage on your own. The instructions are there for a reason: to be followed.
Share your life story
When you meet with your doctor, discuss any and all health conditions you may have, chronic as well as acute, and reveal every medication you're taking—including nonprescription medicines, nutritional supplements, herbal products, and vitamins. You'll get better treatment if the doctor has a complete picture of your health and habits.
Watch the clock
"The hour of day you take a drug can greatly alter its effectiveness," says Douglas. "Research shows a 40 percent higher risk of heart attack and a 49 percent higher risk of stroke in the morning. So if there was ever a time for your high blood pressure medication to be working at its peak, morning is it." To get that result, you might be better off taking your pills the night before: Most antihypertensives you take in the morning won't fully kick in until afternoon. Whatever drug you're prescribed, ask your doctor when the best time is to take it.
Open up to your dentist
Many of the medications used by dentists—including anesthesia, antibiotics, and painkillers—don't mix well with certain prescription medications. A great number of drugs can cause dry mouth. "Saliva is your best defense against tooth decay," says Richard H. Price, DMD, of the American Dental Association. "If your mouth is perpetually dry due to medication use, we might want to take extra steps, such as prescribing a fluoride gel, to make your teeth more resistant to decay." Also tell your dentist if you have conditions that compromise your general health, particularly heart valve problems. That way you'll likely receive antibiotics before having any serious mouth work done.
Make friends with your pharmacist
Your druggist knows a lot about prescription drugs. Get to know your pharmacist, and make sure that he or she knows your conditions and the pills you're taking. If you're not sure whom you should pester with questions—your doctor or pharmacist—ask both. "You can never get too much information," says Dalia Abdelmacksoud, assistant director of clinical pharmacy services at NYU Medical Center.
Plan a review session
If you're popping multiple medications, meet with your doctor every six months to review what you're taking (including supplements and nonprescription drugs). Think of it as your body's state of the union address: a chance to address any problems and even uncover problems. According to one study, one in five Americans over 65 takes at least one inappropriate prescription drug.
Identifying the Right Dose for You
Careful! The amount of medicine you need may vary with age, weight, gender, and more
The ethnicity factor
The majority of Americans are Caucasian, and most drug-trial participants are Caucasian. But a small difference in a few genes can affect the body's reaction to drugs. Studies show that four times as much of the popular ulcer drug Prilosec accumulates in the blood of Asian Americans as it does in Caucasians. (And the drug rises 40 to 50 percent higher and lasts 50 percent longer in the bloodstreams of all elderly people.) The manufacturer of Prilosec suggests "dose adjustments" for Asian Americans, but the advice is buried in the package insert's "Clinical Pharmacology" section—which your physician may not have read. Ask your doctor if ethnicity might affect your dosage.
The bigger the muscle, the smaller the pill
The amount of medicine you need often can be reduced—and sometimes eliminated—through lifestyle changes. Weight loss, exercise, and salt reduction can lower high blood pressure. Eating less saturated fat and more fruits and vegetables can lower cholesterol. Arthritis pain can be alleviated by warm-water soaks, stretching, and the application of ice. Make sure you discuss lifestyle changes and home remedies with your doctor.
Ladies' choice
Few drugs are one-size-fits-all—a problem that's magnified when women take man-size doses. "Women have different metabolisms and tend to be smaller," says University of California, San Diego professor Jay Cohen. "A 105-pound woman taking the same dosage as a 200-pound man might be taking too much." Women also tend to be more sensitive to drugs than men, adds Cohen, noting that the 1997 withdrawal of Seldane, an antihistamine, occurred because of heart problems that primarily struck women. Women should ask their doctors about medical literature that addresses gender issues (as opposed to the often oversimplified advice on the package).
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