Managing Your Medications Safely

If someone stopped you on the street and said, "Tell me the names of the drugs you take," would you be able to tell them? Have you ever stood in front of your pill bottles and wondered if you had taken your medication that morning?  Do you know what your pink pill is for? Or the light blue one?

The first week of April is Medication Safety Week, a useful reminder that taking medication safely is as important as "cross at the green and not in-between" or wearing a helmet when you bike. 

According to a 2024 article in the National Library of Medicine, close to 6,800 prescription medications and countless over-the-counter drugs and herbal supplements are available in the United States. The possibility of unwanted interactions and side effects is astronomical. Every year, 7,000 to 9,000 people die from medication errors, defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, pharmacist, patient or consumer," and countless others are harmed or sickened.

While many take place in hospitals, medication errors made by people at home occur at a rate between 2% and as high as 33%, according to a 2018 report by the Patient Safety Network. Other at-home errors may never be recognized or reported.

Poor vision, difficulty opening bottles due to arthritis, language barriers or cognitive deficits can all contribute to medication errors in the older adult, says Christopher Charles Paredes, a geriatrician, family practice physician and Medical Director of the Lenox Hill Hospital/Department of Medicine's Northwell House Calls Program, and an Assistant Professor of Family Medicine at Zucker School of Medicine in New York City.           

Because polypharmacy — the use of multiple medications to treat or prevent health conditions — is so common in older adults, there is an increased risk of side effects, harmful or unpleasant interactions or administration errors.

"Medication reconciliation, the process of going over the most current, accurate list of all medications a patient is taking, can be done with your health care provider or pharmacist," says Paredes. "It is an important way of making sure that patients are taking their medication as prescribed and that the current medication regimen is appropriate, especially when a patient has transitioned between levels of care, such as from hospital to home."

This intervention has been shown to improve outcomes by reducing medication discrepancies, potential adverse drug events and actual adverse drug events. Paredes explains that reconciliations have identified issues such as a patient with hypertension who was taking a lot of Ibuprofen or other NSAIDS (which tend to cause elevated blood pressure) or a patient taking an antidepressant at night (rather than in the morning) and then experiencing insomnia.

While these are not medication errors per se, having them rectified can contribute to safe and effective use of the many medications that keep us alive and well.

Always have an updated list of the medications you take and include OTC (over the counter) meds, herbal supplements, eye drops and vitamins, says Paredes, who suggests bringing the list with you to any medical appointments. It should include the name of the medication, when you take it, what the dosage is, who prescribed it and what it is for.

If, like many older adults, you see several medical specialists as well as a primary health care clinician, make sure that all are aware of what medications the others have prescribed. If a physician has ever spoken with you about some impaired kidney function, make sure any other prescribers are aware of this, since the kidneys help to filter many medications from the body.

When you are prescribed a new medicine, questions to ask include:

• Name of drug, dose and why it’s being prescribed
• When should the medication start working?
• What are potential side effects?
• If I want to stop taking the medication, is it safe to stop abruptly?
• Frequency of administration, whether it should be taken with or without food and if you should abstain from certain foods or liquids (not drinking grapefruit juice is often recommended when taking many drugs, as is avoiding alcohol.)

According to Matt Blanchette, Senior Manager, Retail Communications, CVS Pharmacy: "Pharmacists know how important it is for patients to take medication as directed by their doctor or medical professional. Failure to do so can result in complications and/or worsened symptoms. Through conversations with patients, pharmacists can better understand barriers and help patients remain adherent to their medications. Research shows that face-to-face counseling by a pharmacist is two to three times more effective at increasing medication adherence than other interventions."

Pharmacies offer a variety of helpful programs such as automatic refills (without the medications needing to be requested) and prescription management systems that coordinate eligible prescription refills so they can all be picked up or delivered at the same time. These help to prevent the consumer from running out of medication and being without it for several days.

Ask your pharmacist if there is a patient profile you can fill out, so the pharmacy is aware of all your medications and can check to make sure there are no contraindications or potential negative interactions when a new drug is prescribed.

• Read labels and product inserts. (If the print is ridiculously tiny, take a photo and then enlarge.)  Check directions, warnings, active ingredient list and information on where and how to store the product.
• For liquid medications, only use measuring devices or the tiny plastic cup that comes with the product, not regular teaspoons or measuring cups.
• Don’t cut or crush tablets unless your doctor or pharmacist says it’s safe to do so. Sometimes people save money by getting a higher dose pill and breaking it in half. If you get the okay to do so, use a pill cutter, not a knife or your fingers.
• Periodically go through your medications and safely discard those that are expired.
• If you’re using a medication patch, read the directions carefully to ascertain where to place the patch and how often it should be changed.
• If you take a number of meds through the day, set your smartphone to give you a reminder.
• Store medications in a cool, dry place, preferably not your medicine cabinet.

You may want to familiarize yourself with the American Geriatrics Society (AGS) Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, used primarily by clinicians, which identifies medications with risks that may be greater than their benefits for some older adults, and lists medication combinations that may result in harmful "drug-drug" interactions.

Medications for several conditions that are common in older adults can be harmful when taken at the same time, interacting with each other in ways that might put you at a higher risk of serious side effects.

According to recent findings by The National Poll on Healthy Aging, 7.5% of people between the ages of 50 and 80 have used at least one direct-to-consumer (DTC) health care service from an online-only provider, and the number appears to be increasing. Only one third of those polled told their regular health care provider about the medication they were prescribed and few notified their brick-and-mortar pharmacy to have it added to their patient profile.  

To be sure that you are using a safe site, see the FDA website BeSafeRx which has information on online pharmacies, and make sure your primary care provider knows about all the meds you're using.

ConsumerMedSafety.org is an excellent resource on general medication safety.

Barbra Williams Cosentino RN, LCSW, is a psychotherapist in Queens, N.Y., and a freelance writer whose essays and articles on health, parenting and mental health have appeared in the New York Times, Medscape, BabyCenter and many other national and online publications. Read More