10 Rules for Safer Drug Use

Rule 1: Have a “brown-bag session” with your doctor.

Whenever you go to a doctor you have not previously seen, or go to one with whom you have never had a brown-bag session, gather all the prescription and over-the-counter drugs and dietary supplements that you take and bring them to the doctor. With your doctor’s assistance, fill out a drug worksheet that lists all your prescription and over-the-counter drugs and dietary supplements (see www.worstpills.org/public/drugsheet.pdf).

Information to be recorded on the worksheet for each drug includes the drug name, the date it was started or the dose was changed, the prescribing doctor, the reason for using the drug, problems to watch out for, interactions with other drugs or food, new problems or complaints since starting the drug and whether the drug is working.

The purpose of the worksheet is for you and your doctor to keep an ongoing record of all drugs you are using, the purposes for which they are being used, their side effects and other essential information. It is impossible to overemphasize the importance of this first and most crucial step in preventing adverse drug reactions.

Doctors should never prescribe a drug or renew a prescription without full, up-to-date knowledge of all drugs the patient is already taking or is likely to take. Before your brown-bag session with your doctor, your pharmacist may help you to fill out parts of your drug worksheet.

Once you have brought in all the drugs and dietary supplements you are taking, ask your doctor to help you fill out the worksheet. You will probably be able to fill out much of the information concerning over-the-counter drugs and dietary supplements yourself, and your doctor will be able to help you fill out most of the information concerning prescription drugs — at least the ones that he or she has prescribed for you.

Rule 2: Make sure drug therapy really is needed.

Some drugs often are prescribed to treat situational problems such as loneliness, isolation and confusion. Whenever possible, nondrug approaches to solving these problems should be tried first, including taking up new hobbies, socializing with others and getting out of the house. When a person is suffering from depression after losing a loved one, for example, support from friends, relatives or a psychotherapist often is more effective than an antidepressant.

Nondrug therapies such as weight loss and exercise are preferable to drug therapy for mild high blood pressure and mild type 2 diabetes. Increasing fiber and liquid intake is preferable to using laxatives for constipation. Wearing support hose is less expensive, safer and probably more effective than taking heart or water pills for swollen legs due to “bad” veins in the legs (not due to heart disease).

Only rarely should drugs be prescribed for anxiety or difficulty sleeping, particularly in older adults. Many of these drugs are dangerous and addictive.

One last condition for which drug therapy is rarely, if ever, appropriate is any disease or adverse reaction caused by a drug. For example, the proper treatment for drug-induced parkinsonism is stopping the use of the causative drug — not taking a second drug to treat the problem.

Always talk to your doctor about whether a drug may cause side effects that are worse than the condition you want to treat. The guiding principle: Use as few drugs as possible to reduce adverse reactions and increase your odds of taking the drugs that really are necessary.

Rule 3: When starting a drug, begin with as low a dose as possible.

If drug therapy is indicated, in most cases, especially in older adults, it is safer to start with a dose that is lower than the usual adult dose. In other words, “Start low; go slow.” A lower dose will cause fewer adverse effects, which almost always are related to the size of the dose. Some experts suggest that elderly patients start with one-third to one-half of the usual adult dose for most drugs. Next, they should watch for side effects, increasing the dose slowly and only if necessary.

Rule 4: When starting a new drug, see if it is possible to discontinue another drug.

If your doctor is considering adding a new drug to your treatment, this is an opportunity to re-evaluate the drugs you already are taking and eliminate those that are not absolutely essential. The possibility of an adverse drug interaction between the new drug and one of the old ones may lead to discontinuing or changing a drug anyway.

Rule 5: Regularly talk to your doctor about stopping your drugs.

At least every three to six months, review with your doctor your need to continue each drug you are taking. For many mind-affecting drugs, such as sleeping pills, tranquilizers and antidepressants, this re-evaluation should be more frequent. The prevailing principle for doctors and patients should be to discontinue any drug unless it is essential.

Many adverse drug reactions are caused by continuing to use drugs for too long after they are needed. Many drugs — such as antidepressants, sleeping pills, tranquilizers and others that are prescribed for an acute problem — are not needed beyond a short period of time and eventually start causing risks without providing benefits. Slow and careful weaning off of these drugs may significantly improve a patient’s health.

In addition to considering whether to stop a drug, you and your doctor should discuss the possibility of lowering your dose.

Rule 6: Find out if you are having any adverse drug reactions.

If you develop any adverse reactions after beginning to use a drug, contact your doctor. Ask whether you really need a drug in the first place, and if you do, ask whether a safer drug could be substituted or a lower dose used to reduce or eliminate the adverse effect.

If you, a relative or a friend develops any new reactions (mental or physical) after starting a drug, notify your doctor or tell your friend or relative to notify his or her doctor.

Rule 7: Assume that any new symptom you develop after starting a new drug was caused by the drug.

If you have a new symptom after starting a drug, report it to your doctor.

Rule 8: Before leaving your doctor’s office or pharmacy, make sure the instructions for taking your medicine are clear to you and a family member or friend.

Regardless of age, a person’s chance of developing an adverse reaction from a drug is high enough that at least one other person — a spouse, child or friend — should know about the possibilities. This is especially critical for drugs that cause adverse reactions such as confusion and memory loss. For older adults, the complexities of drug use may be greater, especially for those taking more than one drug and those with physical or mental disabilities. In these cases, it is even more important to inform another person about possible adverse drug reactions.

Rule 9: Discard all old drugs carefully.

Many people are tempted to keep and restart drugs that they had stopped taking, which in itself is a dangerous idea. In addition, new drug treatments may make the older drugs much more dangerous when used in combination. You also may be tempted to give drugs, such as antibiotics, to a friend or relative who you believe may benefit from them. Resist these temptations and avoid further problems caused by using outdated drugs by throwing them away when you have completed your course of therapy.

Rule 10: Ask your primary doctor to coordinate your care and drug use.

If you see a specialist and he or she wants to start you on new medicines in addition to the ones you are already taking, check with your primary doctor first — usually an internist or general or family practitioner. In addition to having a primary care doctor, it is equally important to use one pharmacist, if possible.