"I line up all of my medications on a shelf
in the kitchen. In the morning, I start taking them from left to right. Then in the evening, I take them from right to left for the ones I have to take twice daily. This helps me to remember and I'm very good about staying compliant."
- Ann Treiffeissen,
liver recipient
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Almost every day, medical discoveries are made that allow the progression of a chronic health condition to be halted or even reversed. It is hard to believe that one little pill can keep a diabetic patient from having to perform daily insulin injections. A tablet can avert a deadly stroke or heart attack by keeping the blood pressure in check. Amazingly, a gelatin capsule can prevent a body from rejecting a transplanted organ. One little pill can truly be powerful, with
profound medical effects. However, no matter how potent or miraculous the medication may be, it isn't worth a darn if nobody takes it.
Compliance with medications - or,
simply, taking your medications as prescribed - is a critical component of living successfully with a chronic condition. When you are
compliant, you take an active role in your daily treatment regimen and in the decisions that affect your health. You are also taking control of your own
health and well-being.
On the flip side, noncompliance with medications can have serious
detrimental effects. For example, for the transplant
recipient, skipping doses of cyclosporine (Sandimmune®, Neoral®) or tacrolimus (Prograf®) can lead to rejection or even graft loss. When this happens, a kidney recipients may lose the effectiveness of their transplanted organ and have to use dialysis. For the person living with HIV, skipping doses of a protease inhibitor or other antiretroviral can lead to the development of resistance to current therapy and potential cross-resistance to future therapy.
Recognizing medication noncompliance may be somewhat difficult. Ask
yourself
the following questions: Do you forget to take your medicine? When you're feeling good, do you sometimes stop taking your
medicine? Are you sometimes careless about taking your
medicine? If
the medication makes you feel worse, do you stop taking it without talking to your doctor? If you answered "yes" to any of those, you are putting yourself in serious danger.
There are many reasons why people don't adhere to their medication
regimens. Fortunately, there are also many good ways to address these issues and to help individuals become more compliant to receive the full benefit of their medication
therapy. Some patients simply don't feel comfortable bringing their problems to their doctor or feel that their concerns aren't important. Others may not be aware of all of the available treatment options. Some may have a hard time with the actual administration, like
taking large pills, experiencing an unpleasant taste or administering shots. There are times when no one has explained to the patients what the medications are supposed to do and how to actually administer them. More commonly, people can be disorganized, forgetful, and have a hard time remembering their complicated dosing schedules. This can be a result of the individual's medical condition or
medication regimen. Some cannot afford the medication. To overcome these barriers, try using some of the following tips to assist you in sticking to your medication regimen.
"I have found a wrist watch that I can set with up to five daily alarms. I'm now able to set the alarm once and it reminds me when to take my medication all day long. I don't have to worry because I have my watch with the alarms. It's so much easier to remember when to take my medications now."
- Bran Low,
HIV patient
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If you have a complicated regimen, talk to your health-care providers. They
can help you find ways to simplify your therapy and make it easier to be compliant. Many medications are now available in a long-acting
formulation that can reduce the frequency
of administration. For example, the blood pressure medication, Procardia®, is typically taken three times a day. A long-acting
version, Procardia XL®, can deliver the same amount of medication per day, but only has to be taken once daily. If you are taking
different medications at various times throughout the day, you may want to check with your doctor to see if your medication regimen can be consolidated.
If you are finding that it's hard to take your medicine for any reason, talk to your physician or pharmacist. Forms of the medicine (such as liquid or tablets) which you find preferable may be available. If you have a hard time taking pills, you may be able to use a pill crusher to grind them to a powder, which you can then mix in foods or liquids. If taking large tablets is a problem, it may be helpful to cut them along the score mark. Since not all medications can be broken or crushed, check with your pharmacist first.
Learning about your medications and instructions for using them can also help you to be more compliant. Don't be afraid to ask about potential side effects and what to do if they occur. Read your drug information sheets. Being informed in advance of possible side effects can alleviate fear and anxiety that develops later if the unwanted effect occurs.
If side effects do occur, make sure to inform your health-care providers. Often times, simply adjusting the dose of the medication will take care of the problem. In other cases, switching to a different medication may be warranted. Many times, side effects will go away with continued use of the medication. At any rate, don't skip medications or adjust the dose without communicating your troubles to your health-care providers.
Communication with the members of your health-care team is one of the most important tools you can use. When you are having a problem, remember: You are not alone. Your doctor, nurse, pharmacist, social worker and others have an expertise and a dedication to help you.
"I keep all of my
medications bottles together in a big pan with a chart to mark when I take each pill. That way, I can keep track of everything in one place and know when I've taken my
medication or when I haven't because I've marked it down."
- Frank Fowler,
heart recipient
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There are even several devices on the market to enhance medication
compliance. If you have difficulty organizing your medications around your meals and other daily activities, you may find a pillbox to be helpful. Daily
and weekly pillboxes arrange medications into individual compartments based on the time of day the medications are needed. These containers are especially useful if you have a hard time remembering if you have taken a dose or not. The disadvantage of some pillboxes is that they are fairly large and cumbersome, making them difficult to transport. Also, it's important to remember that not all medications should be taken out of the original container. For instance, cyclo-sporing should always be kept in the foil packaging until the time of use. In such cases, put a small button or candy in the pillbox to serve as a place holder to remind you of a particular medication. With any medication, it's important that you keep in mind any instructions on the bottle and that
you do not throw away your original
bottles and drug information sheets.
You might find that not having your medications on hand at the time when
your dose is due can be a problem. If so, try using a small pocket or purse-sized pillbox to take your medication with you. To avoid having to routinely transport a single dose, you might find it helpful to have two supplies of
medications, one at home and one at work, for example. Ask your pharmacist to provide you with an extra labeled prescription vial or use an old one labeled for the same drug to keep your medications convenient at all times.
If remembering to take your medications is a problem, setting a watch alarm or programming your computer's clock to sound an alarm can serve as a reminder. Electronic
pillbox timers are also available. These devices not only store the medications, but can be programmed to sound an alarm when the dose is due. There are various types and sizes of electronic
pillbox timers. Some have only a single
medication compartment, while others have multiple compartments. Some devices offer the flexibility of setting multiple alarms,
while others must be reset to go off at a
different time.
"It's hard for me to take pills. When I take them with pudding or yogurt, they're easier to swallow. And since the prednisone tastes bitter, my mom crushes up the
prednisone tablets and puts all of the powder
in gel caps. The taste isn't so bad that way."
- Alyssa Johnston, leukemia patient
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If you are not taking your medications as prescribed because they are too costly, don't give up. There are many avenues of financial assistance which might be helpful. Ask your social worker, case manager or nurse coordinator for assistance. If you are a patient of Stadtlanders Pharmacy, call our social services department at 1-800-238-7828, extension 8145. In the long run, the cost of complications from noncompliance are generally much greater than the cost of the medications themselves.
Being compliant with medications can be extremely challenging. Enlist the help of friends and family for support. Organize your medication administration routine. Establish a therapeutic alliance with your health-care team, especially your doctor, nurse and
pharmacist. Educate yourself about available medical treatments. Do whatever it takes!
To maintain long-term success, take control in managing your health care.
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