Taking unnecessary medications is dangerous, inconvenient, and costly.
I recently met an elderly patient who was discharged from my large hospital to a sub-acute (rehabilitation) facility.
Unfortunately, during a routine catheter insertion at the sub-acute facility, the patient experienced an unintended complication, causing mental confusion and excessive bleeding. He was shipped back to my big hospital’s Intensive Care Unit (ICU) for resuscitation and potent intravenous medications to improve his low blood pressure.
When the patient arrived in ICU, he had detailed transfer orders listing his current medications.
Since the patient had only left the acute hospital for half a day, I normally wouldn’t review all the medications on the transfer orders at the bedside with family. However, the patient and his wife were a captive audience so I briefly chatted with them about the medication list. As clinical pharmacists we are trained in assessing individual medications. The first step is to determine “indication”, which is the reason why a medication is being used.
I started at the top of the list, with the first medication, allopurinol (Zyloprim). The patient had been taking it for years, and had no idea why! I was somewhat shocked, so I asked if he had ever had gout; the reason this medication is often prescribed.
To my horror his wife replied, “What are the signs and symptoms of gout?”. I quickly responded that it was usually a painful, swollen joint sometimes occurring in the toe or finger. They then said that he never had gout!
Next I asked who had prescribed the allopurinol and why it was prescribed. The family didn’t know. It was clear to me that the patient should not be taking this medication since he did not have gout.
I talked to the hospital physician and suggested that we stop the allopurinol since there was no reason to continue the medication. The physician agreed.
What was even more surprising is when I looked back in the patient’s medical notes, he had been asked by another physician to stop the medication two years before.
Every time you are prescribed a medication, you should be told at a minimum the drug name, the dose, how often to take the medication, and the reason for taking the drug. This can help you avoid taking a medication with no benefit for an extended period of time. As for clinical pharmacists, we are responsible for periodically reviewing every medication with patients, so that we can pick up these types of drug therapy problems.
How can you avoid taking unnecessary medication?
- When starting a new medication, ask your doctor about:
- The name of the medication.
- Why they prescribed the medication. Does the medication prevent a future condition or does it improve or cure a condition?
- How long will you need to take the medication for (days, months, years). When can the medication be stopped or re-evaluated?
- Read your prescription bottles.
- Maintain a complete and up-to-date medication list. Know exactly the name, the dose, and how often you take your medications.
- Share your medication list with all your health care providers.