In previous generations, people were expected to “do as they were told” when it came to medications prescribed by their doctor. Even today, when I ask patients what they think about the plan surrounding their medications, I sometimes get a blank look from some of them (who then go on to say “you guys are the experts, why does it matter what I think”).
While I do agree that it’s important to have trust in an expert’s opinion, this doesn’t mean that the patient’s opinion is invalid either. At the end of the day, it’s the patient who goes on to take the medication. In my view, it’s absolutely essential that patients become an active partner in their own healthcare. As I’ve often said: an informed patient is an empowered patient.
Many of the most common reasons for patients not to take their medications are caused when they are not properly informed.
A couple quick points before we get to the questions to ask:
- Some of the questions are to make sure you’re getting the best care, while others are to ensure you get what you need to know about the medication.
- While the title of this post is about medications, these same questions can apply for supplements, vitamins, or any other treatments you are recommended by a provider.
In order to advocate for yourself, and to ensure that you are receiving the best possible care, consider asking your healthcare providers some (or all) of the following 12 questions about your medications:
1. Why do I need this specific medication?
This may seem like an obvious thing to some people, but in my experience not all patients will actually know why they are taking certain medications. This can even impact how you take the medication; research suggests that not knowing why a medication is prescribed is one of the reasons that people will stop taking it.
Another important reason to ask this question is to understand if you actually need the medication. Is there another similar medication that’s cheaper, more effective, easier to take, or associated with less side effects that could also do the job?
2. Do I need to change how I take any of my other medications?
Sometimes there can be situations where one medication can interfere with another. These situations, which we’d call a drug interaction, can lead to either the drugs not working properly or to more drug side effects.
- There is a family of antibiotics called fluoroquinolones (drugs like ciprofloxacin) that you shouldn’t take around the same time as calcium supplements. By taking them together, the calcium can actually prevent your body from absorbing the antibiotic (and could lead to treatment failure).
- Another antibiotic called clarithromycin (Biaxin) can actually change how your body can process other medications. One of these medications is the cholesterol medication atorvastatin (Lipitor). So if you took both together, it could result in toxic levels of the cholesterol medication.
There are many other examples of drug interactions, but this isn’t the time or place to list them all. What’s important to know is that medications can screw with each other and you should make sure that it isn’t the case when a new one is added.
3. How do I take this medication?
Should you take it on an empty stomach or with food? Should you take it in the morning or at night? Is there a way to take it to reduce side effects?
These are all variations of the same question: “What is the optimal way to take this medication?”
Another important thing to know that falls under this category is what you should do if ever you forget a dose (i.e. should you take it right away when you remember, or should you just skip the dose?).
4. How long will I need to take this medication for?
Certain medications for chronic illnesses need to be taken long term. However, there are scenarios where the treatment duration isn’t as long as what you would expect.
For example, many people would be surprised that many cases of reflux can be resolved with a relatively short duration of 6 to 8 weeks of prescription antacid medications called proton pump inhibitors. However, if you’re not aware of this, you may assume that you should keep taking it (when you often don’t).
5. What side effects should I expect?
Not much is needed to explain why this is important. In order to get a good understanding of the risk/benefit equation, you need to understand the general risks involved.
Am I saying that you should google every side effect ever associated with the medication? Not necessarily. But what you should know are the common ones, and the red flags that could signal the really bad ones.
6. If I need to stop taking this medication, do I need to slowly taper off?
Often medications can be stopped abruptly (or “cold turkey”) with no issues. However, some medications cannot be stopped abruptly. Here are a few examples of medications that generally shouldn’t be stopped abruptly after taking them for a long time:
- SSRI antidepressants
As I detailed in another post (click here for more information), SSRIs should be tapered off. Otherwise you can run into antidepressant discontinuation syndrome, which can be associated with flu-like symptoms that can last up to a few weeks before resolving.
If you have been taking benzodiazepines (e.g. lorazepam, diazepam, clonazepam, etc.) for a long time (particularly in high doses), it’s essential that they not be stopped cold turkey. Similar to what can be seen with alcohol, a severe withdrawal could occur; which can include anxiety, insomnia, and sometimes even seizures.
While opioid withdrawal is not life-threatening, it is not a pleasant experience. It can be associated with symptoms like diarrhea, nausea, vomiting, sweating, rapid heart rate, etc.
7. How do I know if the medication is working or not?
The benefits of medications can be quite obvious; for example, you have a pretty good idea if the ibuprofen you just took helped your headache or not. However, not all medications are like this.
Some chronic illnesses, such as high blood pressure, can be completely asymptomatic. So if the disease was not associated with any obvious symptoms, it’s quite likely that you wouldn’t notice any difference in how you feel. In this scenario you would be instructed to keep an eye on your blood pressure; either by buying a home blood pressure monitor, or by using one found at many pharmacies.
8. How long should it take to start working?
Unfortunately, many medications won’t have instantaneous benefits. For example, as I covered in another post (click here for more information), antidepressants can take a few weeks for initial improvements to be apparent and then months before full effect is seen.
In my experience, the patients who are not aware of this will often get very discouraged if they don’t feel much better in a week. However, those who are aware of this tend to have a better outlook.
9. Are there any over-the-counter medications or supplements that I should avoid when taking this medication?
As I explained above for drug interactions, combining medications can sometimes have consequences. This specific question is to prepare you for potential situations where you could have issues with taking an over-the-counter medication.
For example, someone who takes a specific type of blood pressure medication called an ACE inhibitor (e.g. ramipril, lisinopril, enalapril, etc.) should generally avoid taking OTC anti-inflammatories like ibuprofen or naproxen. This is because this combination can sometimes result in acute kidney failure (which would definitely put a damper on your day).
10. Do I need any extra blood tests or other follow-ups while taking this medication?
Some medications have a very narrow range of efficacy between toxicity and ineffectiveness. Or, in other words, the “Goldilocks zone” (i.e. “not too hot, nor too cold“) where the treatment works without causing toxicity is a small range.
One example is the blood thinner warfarin (Coumadin). This medication requires frequent blood tests to measure the INR (international normalized ratio) value; which will measure how the blood clots. The range that is targeted is usually between 2 and 3. Less than 2, and it doesn’t work; more than 3, and your risk of bleeding goes up.
This is why it’s essential that you are aware of blood tests or any other follow-ups required with the medication.
11. What are reasonable expectations for how well this medication will work?
If you have unreasonable expectations, you will almost certainly be disappointed. I’m not necessarily telling you that you should be pessimistic; but, having realistic goals will help you judge how well the medication is working.
A classic example is pain control after a major surgery. While pain killers will help to greatly reduce pain, it’s also probably unreasonable to not expect any pain at all. If you are trying to get to zero pain, you will likely be disappointed, and may be at risk for taking too much pain medication in order to try to achieve zero pain.
12. Can this medication be taken if I’m pregnant or plan to become pregnant?
This one obviously doesn’t apply to everyone; but it’s important to mention. There are many medications (OTC or prescription) that should be avoided in pregnancy. For example, antibiotics like tetracyclines would usually be avoided in pregnancy (unless safer options were unavailable). This is because they can be associated with bad effects on the baby’s bones and teeth.
The Bottom Line
Patients should never feel as if they can’t ask questions. Being informed allows you to become an active partner in your own healthcare. Asking some (or all) of these questions should allow you to have a head start at better understanding of your medications.
*Please note that this is not an exhaustive list*