Follow Directions: Take ALL Your Medication

The doctor hands you a prescription for antibiotics. The pharmacist hands you the bottle of pills that you're supposed to take for the next 10 days. But after a few days of taking the medicine, you forget a dose. And then another. And another. Soon, the bottle of pills is pushed to the back of the medicine cabinet, unfinished.

You have just become a medical statistic, part of a growing problem discussed by drug companies, doctors, pharmacists, and other health care experts.

About half of all prescriptions are not used correctly, experts say. And nearly a quarter of patients never bother to get their prescriptions filled. Among older adults, more than a third of all hospital visits can be blamed on medication noncompliance, or not taking the medication according to instructions. Not taking your medications correctly can cause serious complications and even death.  

Noncompliance takes several forms. In the above example, stopping antibiotics early is one form of noncompliance. Another form is, "Gee, if 1 pill worked well, then 2 would be even better."

More expensive drugs

One fallout from noncompliance is the use of more expensive drugs, which increases the cost of health care. If a patient is given an inexpensive "first-line" medication to treat an infection, but doesn't take enough of the drug, the infection isn't cured. And the bacteria causing the infection may now be resistant to the first drug.

The result is that doctors now have to turn to a second-line drug more often and more quickly than they used to. The first drug might have cost only $6; the second drug can cost up to $40. That's a significant increase that might not have been necessary if directions had been followed the first time around.

Another problem associated with taking too much or too little of a drug, is that the wrong dose can cause new problems.

Some cardiac patients, for instance, take an anticoagulant (blood thinner) called warfarin, to prevent blood clots from forming. Because of their condition, these patients must take the drug for the rest of their lives. If taken correctly, the drug works very well. But if the patient takes too much of the drug or takes it too frequently, then the blood does not clot at all. This can cause extensive bleeding if the patient falls, bruises, or cuts himself.

A patient who doesn't take a medicine the way it was prescribed can also foil a doctor's attempt to learn whether a drug is doing its job. An arthritis patient who doesn't follow the prescribed drug regimen, for example, will not make any improvement in his condition. The doctor, not knowing that the reason there is no improvement is the patient failed to take the medicine, will think the drug didn't work and switch the patient to a different drug. If that occurs several times, the doctor can run out of options for treating the condition.

Taking your medicine

For many long-term therapies, when the drug is working, the patient feels fine. Patients will sometimes want to taper down the dose or stop medication as soon as their condition has stabilized or their symptoms are improved. The truth is, many times the medicine is treating a condition or symptom, not curing the disease. And whether they like it or not, the medicine is necessary.

Another reason for noncompliance is the complexity of modern prescriptions. When your prescription bottle says to take one pill every 6 hours, does that mean 6 hours around the clock, or 6 hours only when you're awake? (That's 4 times a day versus 3 times a day, a significant difference in dose.) If the prescription says to take 1 pill in the morning, what happens if you work the night shift? Do the directions mean to take it when you wake up — in the afternoon, in this case — or before noon no matter when you normally sleep?

Another factor is how you receive those dosage directions. When you are sick enough to head to the doctor's office, you aren't in the best frame of mind to listen to what the pharmacist is telling you. All you want to do is go home to bed.

Cost of medication is yet another factor in noncompliance. Some patients will try stretching their prescription by taking a pill every other day rather than every day.

Don't become a statistic

What can you do to make sure you don't become a medical statistic on noncompliance?

Ask a lot of questions, experts say. Ask about side effects — what should you expect? If the drug is too expensive for you, ask if a less expensive alternative is available.

Doctors, too, can take steps to help compliance They can make sure patients understand what their illness or condition is, and how the medicine is supposed to help them. Is the drug supposed to cure the illness, or just relieve symptoms? Doctors should present the most critical instructions first, when a patient is more apt to make note of them.

Doctors should also explain to patients what may happen if they don't take the medicine appropriately. Will the disease get worse? Will symptoms get worse?

Pharmacists can help by explaining how and when to take your medications, providing you with a pillbox, and suggesting using calendar reminders for refills rather than waiting until the bottle is empty.  

Patients need to understand the seriousness of taking medications as prescribed. Support from doctors and pharmacists must be required. Ask your doctor and/or pharmacist about ways they or their office can assist you in taking your medications properly.  

Tips for taking your medicine

You can take several steps to ensure that any medicines you take are as effective as possible:

  • Bring all the medications you take to each appointment with your health care provider and make sure your pharmacist knows all the medications you are taking. If you take any over-the-counter medications, vitamins, or herbal supplements, be certain to inform both your health care provider and pharmacist. 

  • If you are having trouble figuring out when to take a particular drug, discuss it with health care provider or your pharmacist.

  • Don't forget to tell your health care provider and your pharmacist about any allergies you have, so they can assess whether those allergies will interact with drugs you are taking.

  • If you can, have all your prescriptions filled by the same pharmacy so that the pharmacist can prevent any problems with drug interactions. Problems can occur if the pharmacist isn't aware of other medications you are taking when he or she fills a new prescription.

  • If you take a number of medications, carry a list with you of all the drugs and how much you take of each 1.

  • When you take multiple medications, always ask your doctor or pharmacist about potential drug interactions.   

  • When you get a new prescription filled, make sure you understand how the drug should be taken and what is supposed to happen.

  • If you develop any new symptoms or your conditions worsen after starting a new drug, call your doctor or pharmacist to discuss it.

  • Use a pillbox if you take multiple medications.

  • Write refill dates on your daily calendar rather than waiting until the bottle is empty. 

  • Don't take other people's medicines.

  • Finish all of your medication as prescribed 

Who's compliant?

Over the years, medical researchers have looked at who is more compliant about taking medicine as prescribed:

  • Age. Although you might think that elderly adults might have more trouble with taking medications correctly, age doesn't really make a difference. Old and young alike are noncompliant.

  • Therapy. The more complicated the therapy, the less likely the patient is to be compliant. A dose taken once a day is more likely to be remembered than a dose taken 2 or 3 times a day.

  • Disease. Patients taking medication for diseases and conditions, such as high blood pressure, diabetes, and asthma, are more likely to be compliant than patients taking antibiotics. Those with high blood pressure and diabetes also are more likely to follow their medical regimen than those taking pain relievers.

  • Education. You might think that the more education you have, the more compliant you are. Not true. Patients with more education tend to be as compliant as or less compliant than those with less education.