When you’re prescribed a new medication, how much do you learn about it before taking your first dose? It’s smart to be inquisitive: While medications come with label warnings, the precise meaning of instructions like “take with food” or “avoid sunlight” isn’t always clear. Plus it’s helpful to understand how to deal with common medication slip-ups, such as missed doses, before they happen.
The doctor who prescribes you a medication, as well as the pharmacist who fills it, can both educate you on the specifics of taking that drug. All you need to do is ask. Here’s a breakdown of common medication challenges and what patients need to know to get ahead of them.
What can be challenging or confusing about taking medication?
Instructions about taking a medication with or without food: When the label says “take with a meal,” a small snack will suffice for most medications, says Charmaine Rochester-Eyeguokan, a professor at the University of Maryland School of Pharmacy. But some medications do require a larger amount of food. Others have specific requirements about the types of food or drink they need to be consumed with, or shouldn’t be paired with, which may or may not be written on the label.
Some patients face food insecurity and are unable to predict when they’ll be able to get food next, says pharmacist Christina M. Madison. In that case, you might resort to taking medication without food or skipping doses altogether, despite recognizing the potential health risks.
Patients also interpret “take on an empty stomach” in different ways. Patients have told Rochester-Eyeguokan they skipped doses because they accidentally ate something, when they could have waited two hours after their meal and then taken their meds.
Instructions about what to do before or after taking a medication: If you’re instructed to “avoid sunlight” for as long as you’re on a medication, does that mean you need to avoid going outside entirely for weeks or months? Not quite, says Rochester-Eyeguokan. Instead, it means you need to limit exposing your body to sunlight by taking stricter skin protection measures, such as wearing long sleeves, hats and sunscreen.
Unlike the sunlight directive, if a label says to “avoid alcohol,” experts recommend avoiding alcohol the entire time you’re on the medication. For someone on the antibiotic metronidazole, a drop of alcohol can bring on nausea, vomiting or an elevated heart rate. They’d also need to avoid other meds and food products that contain alcohol or propylene glycol (a type of alcohol).
While not every drug that mixes poorly with alcohol causes such a severe adverse reaction. But even an over-the-counter-medication like Claritin requires you to be alcohol-free while you’re on it. That’s because it makes you feel drowsy and uncoordinated, and alcohol exacerbates the effects. But you probably wouldn’t need to avoid all meds and food products with propylene glycol listed as an ingredient.
And what if you’ve take your last dose — can you finally have a glass of wine? Again, it depends on the medication. For metronidazole, you need to wait three days after the last dose before drinking. For Claritin, your doctor or pharmacist might advise waiting a day.
Instructions about timing: It’s not uncommon for patients to misinterpret timing instructions. For instance, Rochester-Eyeguokan says a patient might think “take every four hours” requires waking up at night to fit in a dose. Or, if the label says, “take four times a day,” a patient might cluster doses together, instead of spacing them out evenly. In many cases, doses need to be spread out to ensure stable levels of medication in the body all day long.
Sometimes medications work better, or are tolerated better, when taken at a certain time of day, even if their labels don’t tell you that. Antidepressants in the SSRI family are one example. Patients are often told to take SSRIs in the morning so they don’t interfere with sleep.
Then there are quick-release and extended-release medications, introducing another factor into the timing equation. Quick-release meds are often taken for rapid management of a specific symptom. For example, migraine medication acts immediately to relieve pain, so it needs to be taken as soon as the headache sets in for maximum effectiveness. The longer you wait, the less effective it becomes.
An extended-release drug is usually taken once per day, ideally around the same time each day so that medication levels don’t dip too low. This is important for an epilepsy medication, like Levetiracetam XR, to prevent seizures.
What to do when you miss a dose: If you miss a dose, closely adhering to the set dosing schedule is more important for some medications than others, says Rochester-Eyeguokan. For drugs like oral contraceptives, most antibiotics and the cholesterol-lowering statin atorvastatin, if you forget to take a dose at your scheduled time, you should be fine taking it two or three hours later, as long as it’s not too close to your next scheduled dose. You might need to skip the missed dose entirely if it trails too closely behind the next dose, to avoid double dosing.
But if you miss a dose at a certain time for sulfonylureas, a medication that lowers blood sugar levels, you may need to be more cautious about whether and how to take the missed dose. If you’re doing a physical activity or unable to consume any carbs, it’s probably better to skip the dose entirely, to prevent blood sugar from plummeting too low.
How to know if a side effect warrants concern: Sometimes a patient who experiences common side effects from a new medication is advised to keep taking it. Other times, a doctor will recommend somehow changing the medication regimen. This might include modifying the dosage or taking it at a different time of day to prevent interactions with other drugs, says Rochester-Eyegoukan.
How can you sort out these issues before you start taking a new medication?
Ask questions during your visit and/or when you pick up your medication: Ideally, when a doctor prescribes you a new medication, they’ll lay out the need-to-know info right away, says Dr. Katrina Firlik, cofounder and chief medical officer of HealthPrize Technologies. If they don’t, initiate a Q&A session yourself. Here’s a list of suggested questions, courtesy of Rochester-Eyeguokan, Madison and Firlik, to get you started:
- What is this medication supposed to do? Why am I taking it?
- How long should I use it?
- What happens if I don’t take it as prescribed?
- When do I take it with regard to my other medications or supplements?
- What do I do if I forget a dose?
- How precise does the timing of doses need to be? What happens if it’s not precise?
- Does the medication work better if I take it in the morning or at night?
- What does “take with food/water/on an empty stomach” mean exactly?
- What does “take X times a day” or “every X hours” mean exactly?
- Are there any foods, drinks or activities I should avoid while taking this medication? What should I do if I accidentally consume or do these things?
- Which side effects should I be aware of? What should I do if I experience them?What are signs that my body is experiencing a serious reaction? What should I do?
- Can I cut the pill in half or crush it? What other options do I have if I have trouble swallowing it?
This list of questions from the Food and Drug Administration is worth checking out too.
Your doctor is usually better equipped to answer questions about why you’re taking a medication, how long you’ll need to take it, how not taking it as directed can affect your health and what the likeliest side effects are.
A pharmacist can also explain medication-related side effects and answer questions about how to take a drug safely and effectively, why it needs to be taken a certain way and what to do if you accidentally take it incorrectly or forget doses.
If you don’t have a list of questions on you when you pick up your Rx, you can always ask the pharmacist to go over the most common mistakes patients make when taking that medication or issues that patients most frequently need guidance on. “To maximize the expertise of the pharmacist,” Firlik says, “it is important to have all of your prescriptions filled at the same pharmacy, if possible.”
Ask for the most convenient regimen possible before your doctor writes your prescription: When your doctor mentions a new medication they want to prescribe you, Madison encourages advocating for a medication regimen that suits your lifestyle and circumstances. Do this before the doctor writes out the prescription.
Let your doctor know if you’re more willing to tolerate common side effects of one medication than another — maybe you could deal with sensitivity to sunlight but not insomnia or dry skin. Also be upfront if you’re worried that cost, unstable housing or limited transportation access might interfere with your ability to obtain, store or take medication. Here are questions to help you tell your doctor:
- If I have a choice between multiple medications, how do the side effects compare?
- Is the medication covered by my insurance? If not, is there a different one that is covered?
- If you’re uninsured or underinsured: Are there generic versions of any medications used to treat this issue? If not, are there cheaper brand-name alternatives?
- I’d prefer to take as few doses per day as possible. Can you pick a medication with fewer daily doses? Or is there a way to reduce the number of doses required with this medication?
- Is there a medication that doesn’t have special requirements, e.g., doesn’t need to be taken with food or refrigerated?
- Can I receive a 90-day supply of my medication instead of a 30-day supply so I don’t have to go to the pharmacy as often?
- Can the medications be mail-ordered?
- Would it be possible to arrange for all my prescriptions to be filled and picked up on the same day?
If a medication must be taken with food and you’re facing food insecurity, ask for help: Patients facing housing insecurity may not have the ability to store their medications properly, says Madison. If this is true for you, you may resort to only buying the few medications that you know you can store appropriately.
At the clinics where Madison and Rochester-Eyeguokan work, clinicians connect patients with a food pantry if they need it. Let a pharmacist or doctor know about your circumstances, experts urge. If you have internet access, Madison says you can find a nearby food pantry by typing your zip code into the American Academy of Family Physicians’ Neighborhood Navigator.
If you have a problem or a concern, call the doctor or pharmacist: Stay calm and call the doctor, says Dr. Michael Hochman, a primary care doctor at the Keck School of Medicine of the University of Southern California and host of the Healthy Skeptic, MD podcast. You should be able to get an answer within 24 to 48 hours. Alternatively, you can reach out to your doctor via an an online patient portal or call a 24-hour pharmacy, if either options are available.
Bring your medication list to every doctor’s appointment: “In the majority of cases, when someone is on more than five medications, a couple of them are probably not necessary and can be discontinued,” says Hochman. Bring your medication list to each doctor’s appointment, so the doctor can do a medication reconciliation to make your regimen as convenient and helpful for you as possible. You’ll also open up the conversation to ask any lingering questions you have.