Make the most of your medicines

We’re taking more prescribed medicines than ever these days. Over the last decade the number of medicines dispensed in England has risen by nearly 54 per cent, with similar rises in the rest of the UK.
Many people are taking several medicines at once too, particularly those of us over the age of 65. One study showed that one in six people in this age group receives prescriptions for ten or more drugs each year.

One reason we are popping more pills is that more of us are taking medicines to prevent health problems, such as heart disease or osteoporosis, as well as to cure them. Another reason is that we live longer now, so the number of people who need treatment for age-related conditions, such as diabetes, is growing.

One in six people over the age of 65 has prescriptions for 10 or more drugs

The fact that we now have a greater range of medicines available to us is clearly a good thing. But if you are taking two, three or more different types, managing when and how to take them can get quite tricky.

“A lot of my patients have different tablets that they have to take at different times, and sometimes you can’t take them together,” says community pharmacist Ash Soni. “Blood pressure tablets, for example, are best taken in the morning. When you’re lying asleep in bed your blood pressure will usually be OK, but once you get up and start being active it tends to go up. So taking your tablet in the morning means you get the best effect.”

On the other hand, if you are taking tablets for high cholesterol, they normally work better if taken at night. “When your body is at rest, the medicine has more time to go around doing its job cleaning up unhealthy cholesterol,” explains Ash.

Some medicines, meanwhile, need to be taken with food while others need to be taken between meals. Metformin, a medicine used to treat diabetes, for example, should be taken with meals because otherwise it can give you an upset stomach. Then there’s Alendronate, a medicine used to help prevent osteoporosis, needs to be taken first thing in the morning, 30 minutes before you have any food (or take any other medicines). “Plus, you only take it once a week, which is even more disruptive because it means not every day is the same,” says Ash.

So given how complex medicines can be these days, how can we make sure that we are taking them correctly and getting the full benefit?

A chat with your GP or pharmacist is a good place to start. “Ask them, ‘When am I supposed to take these medicines?’ then you can work out a schedule and see if it’s achievable,” suggests Ash. “If you think, ‘Actually, that’s going to be really hard to do’, then it’s a case of working out whether there are other medicines you could take that won’t have the same impact on your lifestyle.”

Your GP or pharmacist can also advise you on any side effects you may experience. Blood pressure tablets, for example, can make you feel a little light-headed and dizzy, particularly when you first start taking them. Both the doctor’s surgery and pharmacy have computerised systems that automatically make sure the drugs you are prescribed are safe for you and also that they won’t interact with each other.

Your pharmacist will help you to understand why your medicines have been prescribed and tell you how to take them

Something else you may like to consider is a Medicines Use Review, or MUR. These confidential consultations are offered by most pharmacies now, and are available annually on the NHS to anyone who has a long-term condition, such as asthma or diabetes, or who is taking more than one medicine. Your pharmacist will help you to understand why your medicines have been prescribed, how they should be taken and will also talk through any problems you may be having with them.

Something else your local pharmacist can offer is the New Medicines Service. Again, this is available free on the NHS to anyone who has one of the following long-term conditions:

Chronic obstructive pulmonary disease (COPD)
Type 2 diabetes
High blood pressure

You are also eligible if you have recently been prescribed a new blood-thinning medicine. At your first appointment your pharmacist will answer any questions you may have about your new medicine. You will also be offered a follow-up appointment two weeks later to see how you are getting on with it.

There’s no need to wait until your pharmacist offers you a formal medicines review though. “Whenever you are prescribed new medicines, it’s a good idea to say to your pharmacist, ‘This is a new medicine – can you tell me a bit more about it?’” says Ash. “We don’t always know, especially if you use different pharmacies or you have just moved into the area. And you can ask your pharmacist if you can have a quick chat about your medicines at any time.”

Do ask your GP or pharmacist about storing your medicines safely too. Most will need to be stored in a cool, dry place and some need to be stored in the fridge. Storing them in the bathroom cabinet or a kitchen cupboard isn’t a great idea as they both tend to be quite warm, steamy places. Your bedroom wardrobe or a drawer, preferably one you can lock, is a better idea.

It’s also a good idea to go through your medicines regularly and discard any you are no longer taking, even if they are not yet past their expiry date. “There’s no point in keeping them ‘just in case’,” says Ash. “Don’t chuck them in the bin where the grandchildren may find them – take them back to the pharmacy to dispose of safely.”

If you are struggling with your medicines because of side effects or you find taking them at the correct times difficult, the key thing is not to simply stop taking them. Solutions and alternatives can often be found, so do talk to your GP or pharmacist first.

“It’s about understanding you as a person, what matters to you in life and how your medicines fit in with that, so do have the conversation,” says Ash. “If you are taking medicines, they should be a part of your life but not control it.”

What to ask your GP?
When prescribed a new medicine you may like to ask your doctor:
Why am I being prescribed this medicine?
How and when should I take it?
How can I tell if my medicine is working?
Are there any foods, drinks or other medicines to avoid while I’m taking it?
Are there any side effects to look out for?
What should I do if I think I am having side effects?
What should I do if I miss a dose?
How should I store this medicine?
Are there any other treatment options?
Is there anything that can help remind me to take my medicines?
Where can I get more advice about taking this medicine?
How do I know this medicine is safe for me to take?

Within in a week I felt so much better

Karen Baza (53), from Stamford, was diagnosed with type two diabetes nearly four years ago. “At first I controlled it with diet and exercise but once my blood sugar level went above nine my GP suggested I start taking Metformin,” says Karen, a community mental health nurse. “Unfortunately it gave me really bad diarrhoea, even though I was taking it with food. I had to rush to the loo about four or five times a day.

“After a couple of months, my pharmacist at Superdrug, Yusuf, offered me a Medicines Use Review (MUR). We sat in a private consultation room and he asked how I was getting on with my medicines. I mentioned that the Metformin was giving me awful diarrhoea, and he suggested I try a slow-release version of the drug. I wasn’t due to see my GP so Yusuf wrote to her instead and suggested I switch. It was all sorted out very quickly and within a week of starting the new tablets I felt so much better. I’ve not really had any problems since.”