You’re Taking Too Many Pills
Some medications you need, some you don’t.
The Story
Last week, SJ came in begging us to organize her medications. She was taking a couple benzodiazepines, a stomach acid reducer, three thyroid pills, and an antidepressant every day.
First thing I wondered was why SJ was on 3 strengths of the same thyroid medication. Turns out she was taking 2 old strengths with the new. The same was true with her anxiety medication. She wasn’t even sure why she needed the stomach acid pills anymore. It was prescribed 30 years ago for some mild heartburn.
In one quick consult, SJ went from 7 to 3 pills a day. She might even get off her anxiety medication one day with her pill stress gone. Seven pills a day was hardly a lot. However, the pill burden was enough to cause dangerous confusion and non-compliance.
She was not a unique case.
The Problem
Some symptoms are transient. Yet, you could end up on life-long PPIs just because of a little heartburn decades ago. You could be on benzos forever because of anxiety issues back in your high school years. We need to start reevaluating the necessity of your medications. Let’s break your medications down to 3 general categories — acute, maintenance, and specialty.
Acute medications treat acute illnesses. These conditions are often severe and short-lived. Some conditions that may be transient are acute pain, acute anxiety, seasonal affected depression, and exercise-induced asthma. The medications used to treat these conditions are often wrongly used long-term and are our best targets for reevaluation. The aforementioned PPIs are a good example of this. If your GERD is short-term, so should your treatment.
Maintenance medications treat long-term conditions. Drugs for high blood pressure, high cholesterol, and diabetes are common examples. Even in this category we can find things to change. A simple example is using combination pills. Januvia and Metformin are often used together to treat diabetes. Many providers forget that the combo, Janumet XR, exists. When appropriate, this simple change could reduce your pill-burden from 5 pills to 1 pill a day.
The opposite applies for specialty medications. These drugs are used to treat complex conditions like cancer, chronic kidney disease, multiple sclerosis, and rheumatoid arthritis. Too often do patients try to discontinue these medications against professional recommendation. Yes, they are expensive. Yes, they have severe side-effects. But they are saving your life.
The Drug Cascade
This deserves it’s own section and probably, it’s own article. The drug cascade describes the medical phenomenon of being given drugs to treat the side-effects of other drugs. Only the very first drug in the cascade is meant to treat your initial symptoms. Imagine if you’re on that drug unnecessarily. Stopping it means you can stop all the subsequent drugs in the cascade.
The Facts
In 2014, a retroactive cross-sectional study looked at the correlation between the number of pills per day and the number of hospital readmissions. They studied 400+ patients with a mean number of doses per day of 18. Unsurprisingly, a positive relationship was found. They noted that the main cause for readmission was medication non-compliance.
Reducing pill burden means helping the patients focus on taking the drugs that matter.
That extra allergy pill might distract them from taking their blood-thinner. The kicker is we’re all a couple diagnoses away from living that 18-pill life.
Plenty of other studies show similar results. Some even point out the affects on personal cost and national cost. If you don’t care about the pill burden, then you might care about the financial one.
The Solution
Show intent to a relevant healthcare professional. The most direct approach is to your doctor. Though if you deal with multiple prescribers, it’s probably easier to tell a pharmacist who has access to all your doctors and the knowledge to suggest changes. Consultant pharmacists may be more appropriate if you are a complex patient in need of more thorough care.
The reason why showing intent is good enough is because you don’t want to “Steve Jobs” your condition. He infamously rejected proven treatments for his pancreatic cancer in favor of alternative methods that eventually lead to his death. Don’t try to do too much. Show your intention and let the professionals do the rest.
The Bottom-line
Take initiative. If you are tired of taking all those pills, then let someone know. You have access to experts and information that can help you streamline your drug regimen. You just have to ask.
