The Hungry Pharmacist

When taking medications, whether they are prescription drugs or those available over the counter (OTC), it is important to clarify any potential uncertainties before starting their use. When a medication is prescribed, the doctor usually explains its most significant characteristics, and similarly, the pharmacist should provide all the necessary information at the pharmacy. However, we often witness that this is not always the case, or we assume there is no need for any explanations. As a result, errors in usage occur, which can significantly determine whether a medication works at all and to what extent.

In this text, we will address the most common mistakes when taking medications:

1. Skipping doses or improper dosing
   This is one of the most common mistakes during medication use. Some medications need to be taken at specific times. For example, antibiotics usually must be taken at precise intervals; if prescribed three times a day, they should be taken every eight hours to achieve their full effect. Birth control pills are also best taken at the same time each day, as are certain hormones. Levothyroxine, used to treat Hashimoto’s thyroiditis, must always be taken in the morning. Improper dosing also impacts a medication’s effectiveness. Often, this issue arises from forgetting to take the medication, which may result from a lack of routine. Sometimes, when a dose is missed, people compensate by taking a double dose, which can be counterproductive.

For medications taken daily for chronic conditions, creating a weekly plan is crucial. Pill organizers with compartments for days and times (morning, afternoon, evening) can help plan the therapy. For short-term use, a similar approach can be taken, or reminders such as notes, alarms, or notifications on a mobile phone can be used. Many apps today are specifically designed for this purpose. Ask your pharmacist to write the correct dosing instructions on the medication packaging to avoid forgetting.

2. Combining medications without consultation
   Before starting any medication, especially if you’re already using other drugs, consult your doctor or pharmacist about possible interactions. For chronic therapies, your doctor has an overview of your condition and can recognize potential interactions, excluding a medication or modifying the therapy if needed.

For example, cholesterol-lowering drugs like atorvastatin combined with amlodipine, used for high blood pressure, can cause muscle pain, which, in some cases, may lead to severe consequences (rhabdomyolysis). The doctor can assess the risk and decide whether to combine these two medications. If another doctor then prescribes clarithromycin, an antibiotic, with this combination, it can pose a serious problem since this combination is generally contraindicated.

When we catch a cold, we often avoid visiting the doctor and instead buy something from the local pharmacy to save time and avoid contact with other patients. Many popular cold remedies (like Tylenol Cold in the USA or Aspirin Complex in Europe) contain pseudoephedrine, a substance that constricts blood vessels in the nasal mucosa, enabling decongestion and easier breathing. Few people know that nasal sprays containing xylometazoline act in the same way, and using both simultaneously is contraindicated.

Therefore, it is important to inform your pharmacist about the medications you are taking, both acute and chronic, to identify potential interactions. For instance, if you are buying ibuprofen and the pharmacist asks about other medications, you might think, “Why are they asking so many questions? I’m never coming back here.” However, ibuprofen should not be taken with aspirin, as it can cause bleeding or stomach pain.

Additionally, combining medications with certain foods can increase or decrease the level of the drug in the blood. For example, vitamin D is best taken with a fatty meal because it is fat-soluble. On the other hand, blood thinners like phenprocoumon, acenocoumarol, or warfarin are vitamin K antagonists. Taking them with foods rich in vitamin K, such as cabbage, spinach, or broccoli, can reduce their effectiveness.

This is why it is crucial to keep your doctors and pharmacists informed about your medications.

3. Stopping therapy too early
   As mentioned earlier, some medications, like antibiotics, must be taken at the same time each day. For the treatment to be effective, it is also necessary to follow another rule: finish the entire course of antibiotics. Otherwise, two potential risks arise:
   • The treatment may be incomplete, and the infection could return.
   • It contributes to the development of bacterial resistance to antibiotics.

I have already written about the discovery of penicillin and how resistance develops, as well as the potential danger this poses to humanity. This fact alone should motivate us to be more responsible.

Even if you don’t care much about the rest of humanity but value your own well-being, you should protect yourself from recurring infections or superinfections that can occur if the antibiotic course is not completed.

4. Taking medications at the wrong time
   As mentioned earlier, some medications must be taken at specific times. Here are a few examples:
   • Taking ambroxol (used for coughing and dissolving mucus in the respiratory tract) in the evening before bed can cause a sleepless night due to coughing and mucus buildup.
   • Taking furosemide (used in antihypertensive therapy) at night may lead to frequent trips to the bathroom, which is undesirable.
   • Corticosteroids, produced in the adrenal glands, are usually secreted in the morning as they are “wake-up” hormones. Prednisolone, commonly used for allergies or inflammation, is recommended to be taken in the morning when the body naturally produces it.
   • The liver produces cholesterol primarily in the evening, so cholesterol-lowering drugs (statins) are usually taken before bed.

From these examples, it is clear that not only how medications are taken but also when they are taken is crucial.

5. Storing medications improperly
   I was quite surprised when I saw a friend storing all his medications in the refrigerator. I didn’t realize how many people do the same. There are guidelines for storing medications, usually listed as one of the last pieces of information in the package insert.

Regular tablets, capsules, creams, and ointments are generally stored at temperatures up to 25°C (77°F). Some require special storage conditions, such as various injectables like insulin or Ozempic. These are stored in the fridge at the pharmacy, but once used at home, the pen no longer needs refrigeration and can be kept at room temperature. Always ask your pharmacist about the proper storage of your medications to avoid confusion.

If necessary, read the medication information as well.

Before purchasing or receiving a prescribed medication, take the time to familiarize yourself with potential errors that may occur. Perhaps you’ve recognized some mistakes you’ve been making, or maybe you weren’t even aware of how certain factors can influence the effectiveness of your medications.