Tips for patients - 2

1. Tips for patients - 2 Know your medicines What is medication consult?

2. objectives • Know Your Medicines: • Sources from where Indian patients get their medicines • Basics of medicines one should know • Substitution at pharmacy level • Storage of medicines • Disposal of expired and unused medicines • Medicines when you travel abroad • Meticulous record keeping • Medication Consult: • What is medication consult and why is it important? • References

3. Sources of medicines for Indian patients • Doctor's prescription • Dispensed/administered directly by the doctor (primary care physician) • Direct purchase from the chemist shop • Simultaneous use of medicines from alternate therapies, e.g., Ayurvedic medicines, homeopathy medicines This Photo by Unknown Author is licensed under CC BY-SA

4. Understand your medicines • What you do not know, can hurt you! • Therefore you should know enough about your medicine to ensure that you are using it properly • Note the following: • Medication name (both brand and generic) • Why is it prescribed – how it will help your illness • Size, colour, imprint if any • If injection, vial is clear without any particles etc • Read the patient information within the pack carefully/check with your doctor about how to take it This Photo by Unknown Author is licensed under CC BY-SA

5. Understand your medicines • What should you ask your doctor about your treatment plan and medicines? • Request for a legible written prescription (should have generic name also) – even though it may be prescribed from his clinic and summary of his medical impression about your illness • Ask about the medicine/s – broadly what does it do/do they do and how it will help your illness • How to take the medicines – the dose, how many times a day, what time during the day, before, with, after the food, anything to avoid while on the medicines • Any other special precautions? • What are the likely side effects? How to manage these and when to seek help/contact doctor? • How long to take the medicine/s

6. Understand your medicines • Do’s: • Take all your medicines as prescribed (adherence) • Follow the instructions correctly • Do not skip the doses, do not take double dose if you skip one by mistake • Complete the course as advised • Manage the side effects as advised by the doctor • Keep a medication diary especially for long term illnesses, also note down adverse effects and report to the doctor • Contact doctor if you do not feel better/feel worse or suffer from severe side effects • Don’ts: • Stop the medicines on your own because you feel well or you do not feel well • Stop the medicines due to side effects and not inform the doctor • Consult another doctor while on treatment with one and keep him in the dark about the other doctor/treatment you are taking • Stop the medicines on advise from your family members/friends • Tell the doctor that you have taken all medicines, when actually you have not! • Discard the prescription – always keep it filed with you

7. Some more dos and don’ts • Do’s: • Make sure your doctor knows about all the medicines you are/have been taking, including, • OTC medicines • Ayurvedic, Homeopathic, Unani • Vitamins, herbal supplements, home remedies etc • Try and go to the same and standard chemist shop which is nearby • Don’ts: • Change the dose or schedule without talking to your doctor • Use medicines prescribed for someone else • Crush or break the pill unless advised by doctor • Use medicines past their expiry date

8. Direct purchase or substitution at chemist shop • In India (with few exceptions), chemist shop may not have full time qualified pharmacist present in the shop • It is not uncommon for people to go directly to the chemist and ask the sales person to give medicine based on the symptoms – e.g., fever, allergy, cough cold, diarrhoea, pain in different body parts • Not all medicines he may provide would be OTC or Over The Counter medicines (the ones that can be sold without doctor’s prescription) • Thus many of these may not suit you, in fact may worsen your illness or may cause serious side effects • Secondly many times chemist offers you “substitute” medicine • It could be different brand of the same medicine your doctor has written, or • It could be different molecule/class of drug • You should not accept the “substitute” unless you get go ahead from your doctor This Photo by Unknown Author is licensed under CC BY-NC-ND

9. Storage of medicines at home • Read instructions on the label carefully about storage • Most medicines can be stored at room temperature – store in a dry, cool place, as summer months are hot in most parts of India • Store away from moisture (kitchen, bathrooms are not good places) • Make a small, dedicated medicine cabinet or drawer – keep the medicines carefully segregated with labels for what they are to be used so that they are easily available with minimum chances of errors • I have seen most unlikely places used to store the medicines – drawer of home temple, container to store grains – avoid such “conveniences” • Some medicines require refrigerated atmosphere – generally store in the general compartment of your freeze, again keep a separate corner for these • Store in such a manner that they are not accessible to children and your pets • Carefully discard empty vials, syringes (for e.g., if you are taking insulin injections) wrapped in leakproof bag

10. Disposal of expired and unused medicines • Remove them from the original containers, strips • Scratch out the information from the bottle • Do not crush the tablets or capsules • Mix them with used tea leaves, put them in a plastic bag, seal it and throw in dustbin • Break the needle if you are on home injection treatment (e.g., insulin) • Remember, everything in India can be potentially reused and recycled from the garbage – be careful This Photo by Unknown Author is licensed under CC BY-NC-ND

11. Medicines when you travel abroad • It is not uncommon for Indians to have one or more children settled abroad leading to visit and extended stay in another country • Consult your doctor before departure, carry prescription with you (in case customs question you, also helpful if there is need to consult doctor in the visiting country) • Check the laws, prohibitions in visiting country (for e.g. narcotic containing medicines) and carry doctor’s note explaining why you need these medicines • Carry a card with the names of all the drugs you are carrying with you (brand and generic) • Carry medicine supplies for entire duration of your stay + two weeks surplus • Carry in hand luggage during travel • When you are traveling long distance (India to USA), carefully manage your medications during travel, keep the same interval between the doses during transit, you will need to carefully manage first couple of doses once you reach the destination This Photo by Unknown Author is licensed under CC BY-SA

12. Meticulous record keeping • If you have chronic illness (i.e. something that lasts long, probably all your life) – for e.g., diabetes, high blood pressure, heart disease, arthritis, it is important to keep meticulous record of your symptoms, medications, side effects and tests results • Make a file and diary and keep it updated all the time – will help both you and your doctor • Make notes for yourself after you have met the doctor and write down important points he has discussed • Track your adherence – calendar update, use of compartmentalized pill boxes, mobile alerts • Almost all the chronic illnesses require change in lifestyle – eating right, keeping your weight under control, exercise and keeping active, stop smoking and tobacco use in all other forms • Common mistake is to rely only on medicines and that to for a short while without lifestyle changes – may lead to worsening of illnesses, more illnesses and complications • If you adhere to required treatment and lifestyle change (self discipline and change in the mindset needed), most people can still lead fairly normal, active, enjoyable and productive life despite the illness for several years!

13. Medication check up/consult • You need “medication check-up/consult” if response to the below question/s is yes: • Are different doctors treating you for different illnesses at the same time? • When different doctors prescribe you several medicines simultaneously, the risk of harmful interactions may rise • Do you take Over the Counter drugs, vitamins, supplements, Ayurveda, Homeopathy medicines? • Even products that do not require prescriptions can pose a risk • Do you take more than one medication for the same health issue? • While at times it may be a necessity, sometimes, it may not be necessary and can increase the risk of side effects • Do you need a drug to control the side effects of another? • Sometimes necessary, but could be a sign of more trouble • Have you been taking your medication for more than 3 months? • Are you struggling with the cost of the therapy? • You should share all the medicines you are taking and consult the specialist about the appropriateness of these

14. References: • Web MD and Medscape • Harvard Health Newsletters • On line picture library