Why should I take all those pills?
No one should take medicines that they don't need. Most young people have the good fortune not to need any medications, and it comes as a shock when that first medication is prescribed for the unexpected diagnosis of high blood pressure, high cholesterol, or diabetes. For many of us it marks a transition between thinking of ourselves as entirely well and being labeled as having a "problem". We don't like to take medicines and we certainly don't like the idea of having to take them for the rest of our lives.
But for many of these conditions, taking medications for the rest of our lives is exactly what we need to do. Cardiovascular disease is the number one cause of death in the United States, and those conditions that put us at risk are well known - smoking, high blood pressure, high cholesterol, diabetes, poor diet and sedentary lifestyle. We have also learned that control of these risk factors dramatically reduces the risk of death and disability caused by heart attack, stroke, and other vascular disease. But often this requires taking medication. To add to the problem, often these risk factors cluster together - obesity, sedentary lifestyle, diabetes, hypertension, and abnormal cholesterol levels are often seen in the same individual. Such a person needs to take medicines, therefore, for several conditions. Complicating this further is that as time has passed we have learned that our old goals for these risk factors are not good enough, and we now aim for lower levels of blood pressure and cholesterol, and better diabetes control, than was the case even a few years ago. This means more medication. Controlling the behavioral factors - weight, physical activity, and diet - does make a big difference but even so some level of medication may be necessary. And when disease is already present - you have had that first stent put in a coronary artery or had that first heart attack - additional medications will be prescribed to reduce the risk of another event.
So it is not at all uncommon to find that you are on seven or eight medications for treating both cardiovascular disease and risk factors, and of course that doesn't even count what you might be on for anxiety or acid reflux! And even with coverage for medications the co-pays can be expensive, and some plans require that you renew your medications every month, an additional burden.
So who can blame you for thinking that a vacation from all those pills might be nice? And how hard it can be to remember to take the medications day in and day out, despite whatever else is going on in your life.
But it is truly important, and taking these medications can dramatically lower your risk. Here are some tips that can help:
- First, understand why you are taking medications. Ask your doctor what each medication is for. Understanding the importance of the medication helps you to understand why you need to take it.
- Work with your doctor or other provider to as much as possible simplify your regimen. We know that taking pills in the middle of the day is often a problem. Likewise if you only have to take medications once a day you are more likely to do it well then if you need to remember to take additional pills at night. Sometimes physicians are not aware of how complex a regimen can be. You may be on short-acting medications that can be changed to long-acting once a day medications, or you may be on two separate medications that can be combined into one.
- Use a pill box. I'm always amazed at the number of people who every morning take out one pill from each of 10 different bottles! Once a week, say on Sunday night, when you are not in a hurry and have time, fill that pillbox for the week. Then as you are rushing to get off to work it only takes seconds to take your medications.
- Use the mail away prescription plan. Almost always if your plan has a mail away option it will give you three months worth of medications instead of one, and usually you will have a smaller co-pay, often a two-month co-pay for a three months supply of medication. It is easy to do this, and once set up you can renew your medication with most plans by using the Internet.
- Most importantly, understand that there are some medications that are quite unforgiving. An unforgiving medication is one where skipping even a few pills will either lead to side effects when you resume the medication or worse, lead to a serious medical problem. Here are some examples:
- Niacin is a very useful medication for raising HDL, lowering triglycerides, and lowering LDL. It works very well in combination with statins. But it has the side effect of causing flushing, which usually disappears after you have taken the medication for a while. But just as tolerance to niacin builds up very rapidly, it can also be rapidly lost, and a number of patients have told me that if they miss even a single day they will flush the next day. So if over time you have built up to a large dose of niacin, say 2000 mg - go away for a three day weekend and forget to take your pills with you - and then come back on Tuesday and take the full 2000 mg, you may be in for quite a surprise!
- Some blood pressure medicines, when you first start taking them, can have what is called a "first-dose effect”, where your blood pressure can drop quite a bit. That is why when you start taking these medications physicians will often warn you to be careful about getting out of bed suddenly in the middle of the night. But if you skip the medicines for a few days and then start again, the same thing can happen as your body is no longer used to the medication.
- Perhaps most importantly for many of our patients who have had the newer drug-coated stents placed in their coronary arteries, Plavix (clopidogrel) is a very important medication that prevents these stents from suddenly closing. But if the Plavix is stopped for even a few days, such a stent closure can happen, causing a sudden heart attack. It is crucially important, if you are on this medication, to never omit taking it, and to make sure that you do not run out. I have seen too many patients who got into trouble because they ran out of Plavix and either failed to renew it on time or for some reason had difficulty doing so. Do not let that happen to you! If you are having trouble renewing Plavix call your physician's office and be insistent - do not allow yourself to stop taking this medication.
So the bottom line to all of this is never take medications that are not necessary, but if they are necessary, then understand why you are taking them and take them correctly. If you have any problems, or are concerned that a medication may be causing a side effect, talk this over with your physician or other health care provider.