Minimize Risks of Multiple Medications

When people fail to follow instructions for taking prescription drugs, they are putting themselves at risk for an adverse drug event (ADE), which is any injury that results from the use of a drug. ADEs, which include a diverse range of symptoms including dizziness, fainting, nausea, diarrhea, rash, weakness, heart palpitations, internal bleeding, liver damage, and impaired vision or hearing, account for more than 1 million emergency room visits and more than 250,000 hospitalizations a year.

The risk of an ADE rises when a person takes more than one medication, which is more common among older adults.

“The more drugs a person takes, the greater the likelihood of an adverse drug effect,” says Marcus Reidenberg, MD, Emeritus Professor of Pharmacology at Weill Cornell Medicine.

Reasons for Risks

“Some patients don’t take each medicine as prescribed; they may miss doses or take medications more often than prescribed. In addition, patient adherence to chronic [long-term] medications is often poor, with discontinuations being common and adherence rates averaging around 50 percent. In other words, about half of what we prescribe is just not taken, and, usually, we don’t even know it,” explains Dr. Reidenberg. “At times, there is simply confusion about medicines, especially as the number of prescribed medicines increases.”

Some patients who have insufficient funds for their medications may take doses every other day or just a few times each week, or they may just not get their prescription filled. If you cannot afford your medications, there are many assistance programs that may be able to help you get your medications at a reduced cost or for free; ask your doctor or pharmacist for information.


To help prevent adverse drug events:

  • Keep an updated list of drugs, OTC products, and supplements you take, and give it to your doctor(s), including any specialists you see.
  • Ask your pharmacist to help you develop a plan or system that will be easy to follow.
  • Sign releases at your doctors’ offices so that every doctor has your permission to share your records, including medication changes, with your other doctors.

Patients often neglect to tell their healthcare professionals all the medicines, including prescription and over-the-counter drugs and vitamin, mineral, and/or herbal supplements they are taking. This increases the risk of a potentially harmful drug interaction. For example, the action of warfarin, a medication that inhibits blood clotting, can be decreased or increased by various OTC drugs, as well as some supplements.

Although ADEs can be serious, most can be successfully resolved with no permanent damage or injury. Fortunately, the majority of ADEs are preventable, but only if patients, doctors, pharmacists, and other caregivers communicate and share information with one another.

Do a Medication Review

Set up an appointment for a medication review with your doctor. Provide your doctor with a list that includes the name of each drug you take, including the dosage and frequency. Don’t forget to include inhalers, eye and ear drops, laxatives, pain patches, and supplements (vitamins, minerals, and herbal products such as echinacea, melatonin, and St. John’s wort). Update your list whenever a medication is added, changed, or discontinued. Keep a copy of the list with you at all times.

Once your doctor reviews everything you are taking, he or she may stop some medications, recommend alternatives, alter the dosage, or change the time at which some drugs are taken.

Make a Schedule

Dr. Reidenberg suggests scheduling medications only twice a day when possible and using drug-dispensing devices. Computerized dispensers ring a designated telephone or cell number if meds have not been taken. If you don’t use a pill dispenser, at least use a pill organizer.

If you have a smartphone or a tablet, you may be able to get a mobile app that will remind you when to take each medication. Most apps are free, and many are provided by pharmacy chains or drug manufacturers.

Many drugs and pill bottles look dangerously similar. It is easy to make a mistake by not recognizing the difference between drugs. Ask for drug labels that have large print, and make sure look-alike medications are clearly separated in the place where they are stored. You can also affix adhesive labels to the tops of pill bottles and write the names of the medications on the labels; use colored pens or markers to make it easier to tell them apart.

Work With Your Pharmacist

It’s best to use one pharmacy for all prescription medications. The better your pharmacist knows you and your medications, the less likely you are to make a mistake.

Pharmacists should ask if you have any questions about a prescription. Take advantage of this opportunity and ask about:

▶ Common side effects

▶ Possible drug/food/alcohol interactions

▶ Whether drugs should be taken on a full or empty stomach

▶ Different types of pill dispensers, and what your pharmacist recommends

“Be sure everyone involved with your care knows everything you are taking,” says Dr. Reidenberg. “Take your medicines as prescribed, and don’t hesitate to get a device to help you remember to take your medicines on the proper schedule.”

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