Papercut and colored pencil art by Sheryl Aronson X 5

Tuesday, August 17, 2010

Should You Play With Your Meds?

Before I get into the topic of playing with meds (stopping, starting or changing the dosage of medication without the guidance of a doctor), I have to post a disclaimer.  I am not a doctor or pharmacist, and can not and will not presume to tell you how to take your medication.  I am not advocating the practice of playing with your meds, I am writing this post because I acknowledge that people do play with their meds, and often they do it without understanding what they are doing, which can be dangerous.

The two most common reasons for admission to the psychiatric crisis unit where I work are stopping medications and taking too much.  People stop taking their meds for several reasons.  They don't like the side effects, the med costs too much or they think they don't need it anymore.  Some medications cure the problem, and these medications are prescribed for a short term.  Other medications don't cure the problem, but they control the symptoms.  These medications are prescribed long term, and if you feel like the problem is gone, it is because the medication is working.  If you stop taking this kind of medication, the symptoms will likely return.

So what should you do if you think you no longer need a medication you are taking, if you don't like how it affects you, or you think you need to adjust the dosage up or down?  Call your doctor, tell them what you are thinking.  (S)he will guide you with any changes in your medication, or explain to you why changing would not be a good idea.  Your doctor doesn't know that there is a problem unless you tell them, you should work together as a team to optimize your medications.  We sometimes have patients admitted to our hospital units so their doctor can closely monitor a medication change.  Most meds don't need this level of monitoring, but do need some guidance from your doctor.

Sometimes, despite knowing that it is not the best route, people change their meds on their own.  As I said before, I can not tell you how to take your meds, but I can give some suggestions that can help you manage your meds safely.  The most important thing is to know about each of your meds: the name, what you take it for, the strength, dosage, when it should be taken, with/without food, etc.  Among the things to find out are any interactions to avoid.  Some medications affect other medications, and should be taken at different times.  Sometimes there are foods that interact, such as grapefruit juice, which interacts with several types of meds.

There are some meds which can give you rebound or withdrawal symptoms if you stop them cold turkey.  These medications need to be tapered off of slowly, some over a shorter, others over a longer period of time.  If you think a medication is helpful, but does not do as much as you want, you might be tempted to increase the dosage.  Either taking it more often than prescribed, or taking more each time you take it may increase the effect you want, but it might not, and it might be dangerous.  Your liver and kidneys are responsible for filtering out foreign substances from your body.  Increasing a medication might be toxic to your liver or kidneys.  This is one of the many reasons why having a doctor's guidance for med changes is important.    

Medications are usually delivered with a sheet of information.  Sometimes these are very helpful, but often they are too generic, and don't give all the info you should have about your meds. Pharmacists are very knowledgeable (its their job), and can answer any questions you might have.  There are websites and books that have information about meds.  I f you just take one or two meds, you can go to the website for that med, or for the manufacturer to get full info- more than you ever cared to have.  If you take several meds, it might be worth investing in a book about
medications.  Here are some popular ones.
Some good med info can be found at these websites (among others): Web MD, Rx List, Drugs.com.  Useful info includes dosage, side effects, maximum to take at a time and maximum in a 24 hr period, interactions to avoid, contraindications, whether the med needs tapering, the mechanism by which the med works and how it is metabolized and removed from your system.  Some meds are fast acting, and are effective each time you take them.  Others need to build up in your system, and adjusting the dosage up one day and down the next can throw off the balance.

When a patient comes in to our hospital after taking too much medication, we ask them why.  Sometimes it was deliberate, either a suicide attempt or a call for help.  Often, though, they say something like "I just wanted the pain to go away for awhile", or  "I just wanted to sleep". I can understand this urge.  There have been times that I felt this way.  Taking an overdose of medication can be too costly for the brief 'relief' it might bring.   Keep open communication with your doctor.  If you show understanding and responsibility, your doctor may give you some flexibility in how you take your meds. Whether (s)he does or not, you are the one taking care of your body.  Take your medications responsibly.

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