Ten Tips For Ensuring Medication Safety
by Seymour Ehrenpreis and Eli D. Ehrenpreis

People over the age of 65 represent 14% of the US population but consume more than one-third of prescription medications. The average senior citizen uses more than five different medications each day. This does not count nonprescription, over-the-counter drugs. As many as 90% of seniors also use herbal remedies and vitamins. While there is risk associated with each type of medication - including side effects, allergic reactions or interactions with food, alcohol or other drugs - the risk is magnified in seniors as they are typically more sensitive to these effects.

Well known practitioners and educators in clinical pharmacology and internal medicines, maintain that it is imperative that caregivers educate themselves about the proper use of medications:

• From avoiding the risk of interactions, to understanding and following instructions for storage and dosing. The following suggestions may help to ensure safe and effective use of medications: Be familiar with the dosage instructions - including whether a drug should be taken with food, with milk or other fluids or on an empty stomach. Not following the dosage instructions can result in a medication being less effective or causing complications. It is also important to note that in most medicines recommended dosages are determined using trials with a younger population. In many instances, seniors may require a different dosage.
   

• Familiarize yourself with circumstances under which the medicine should not be taken - including a history of allergic reactions, existing conditions, etc. This is particularly true for the elderly who generally have a number of medical conditions which younger adults do not have.
   

• Understand the storage instructions and follow them. Because of moisture and heat, it is sometimes best not to store medicines in the bathroom.
   

• Be aware that there may be warnings to avoid heat, cold or sun when taking a medication. Some medications may cause great sensitivity to sunlight resulting in severe sunburn or skin eruptions which can be dangerous. In addition, it may be necessary to avoid excessive heat or cold when taking certain prescription medications. In such cases, saunas, whirlpools and even exercise in the heat of the day should be greatly limited or avoided completely. It should be noted that seniors are particularly vulnerable to extremes of heat and cold.
   

• Be aware of instructions about avoiding particular foods and/or alcohol. Particular foods and beverages may be off-limits when taking certain medications. Grapefruit juice, a favorite among seniors, for instance, can interact with a number of medications and render them ineffective. It is equally important to find out if dietary supplements may be required when taking a particular drug. Some medications may deplete the body of nutrients. Consequently, a patient�s diet may need to be adjusted accordingly.
   

• Understand what possible side effects may occur and watch for them. Be particularly mindful of reactions or symptoms that should be reported to a doctor immediately. It is important to note that medicines often affect senior citizens differently than younger adults. What may be an innocuous reaction in a younger person may in fact be much more serious for a senior. Be vigilant about educating yourself on possible drug-related reactions and be especially vigilant about knowing which may require immediate medical attention.
   

• Be certain to learn whether there are specific over-the-counter medications that should be used with caution or avoided altogether when taken along with prescription drugs. Too often, many may assume that over-the-counter medications are �safe� simply because they are widely available and accessible. It is not always recognized that some over-the-counter drugs may actually weaken and impede a particular prescription drug�s effectiveness. Common antacids, for example, have the potential to minimize the effectiveness of a number of important drugs - in particular certain antibiotics - and the combination should be either avoided or taken only after consultation with the treating physician or a pharmacist.
   

• Understand the risk associated with taking any herbal supplements in conjunction with medications. Similar to over-the-counter medications, many assume that herbals are completely �safe�. Using herbs to treat specific medical conditions has become increasingly widespread in the not-so-distant past. Unfortunately, many physicians and pharmacists are unaware of interactions or complications that herbals can cause. Interactions with herbals can reduce effectiveness of medications in a number of cases, but in some instances herbals can actually increase the toxicity of a medication. Consequently, it is imperative to proceed with extreme caution and be educated about the potential for problems.
   

• Familiarize yourself with what to do in the event of a missed dose. There are instances where simply taking the medication at the next opportunity is not recommended. Doubling of the dose to make up for a missed dose could be very dangerous. Such problems are compounded for seniors who are taking several different drugs during the day at different dosing schedules. The best way to avoid these problems: keep a diary.
   

• Learn how to discontinue the use of a drug. In some instances, stopping the dosage abruptly can have severe consequences, particularly when they are used daily over a long period of time.

Seymour Ehrenpreis and Eli Ehrenpreis are authors of The Prescription & Over-the-Counter Drug Guide for Seniors. Seymour Ehrenpreis, Ph.D., is former Chairman and currently Professor Emeritus in the Department of Pharmacology and Molecular Biology at the Chicago Medical School. Eli D. Ehrenpreis, M.D. is assistant Professor of Medicine at Rush Presbyterian- St. Luke�s Medical Center in Chicago, Illinois and a practicing gastroenterologist in Arlington Heights, Illinois.

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