You can probably remember your last checkup, but when was the last time your medications had a checkup? Not quite sure about that? Let me explain.
When was the last time you gathered all of your pill bottles in a bag and took them to review with your doctor or pharmacist? This means your prescription medications from every doctor you see (past and present), your over-the-counter medications, your supplements, your herbal remedies – everything.
The Institute for Safe Medication Practices calls this a “brown bag checkup,” and it is absolutely essential to your health and well-being, particularly if you are elderly and/or take four or more medications.
In our increasingly compartmentalized and fragmented health care system, it is not uncommon for patients to be receiving prescriptions from multiple sources. Also, with the pervasiveness of direct-to-consumer marketing of dietary supplements, herbal remedies and over-the-counter medications, use of these products has increased exponentially.
Have you ever considered how your medications may be interacting with one another and with your body?
The fact of the matter is that taking four or more medications, often referred to in medical parlance as “poly-pharmacy,” substantially increases your risk of adverse effects. Few people realize that supplements and over-the-counter medications influence their prescription medications, often by altering their metabolism (distribution, effect, breakdown and removal from the body).
Similarly, it is not unusual for patients seeing multiple health care providers to be receiving prescriptions from each. In some instances, medications may interact, but it is also not unusual for medication classes to be duplicated or for therapy to be duplicated. This means taking two medicines for the same purpose that act the same way. That can be a dangerous combination.
When I conduct brown bag checkups with my patients, I often find medications that have expired but are still being used. I find medications that have been discontinued that are still being used. I find “urgent care” medications (antibiotics, painkillers) being used sporadically or intermittently. I find duplicates of the same medication filled on different dates but being used together.
The problem is especially significant for older people. As we age, our body changes with regard to the way it deals with chemicals such as medications and supplements. Not only does this increase the risk of side effects, but it also increases the risk of medication interactions.
Adverse effects from medications are one of the leading causes of hospitalizations for older people!
Patient safety has moved to the forefront in the practice of medicine. Today, hospitals and doctors routinely undertake a practice known as medication reconciliation. This means reconciling the list of medications used by the patient in each instance of care (clinic, hospital, ER) with the list of medications that they are actually prescribed.
Yet, if there are 25 bottles of medication at home, this process can be difficult.
So maybe it’s time to gather up all those bottles, put them in a bag and schedule an appointment with your doctor or pharmacist to review them. Maybe it’s time for your “brown bag checkup.”
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.