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Scott Webb: I'm sure we've all wondered if we need to keep taking prescribed medications after we begin to feel better. And the answer is of course, yes, we do. And joining me today to emphasize this point and educate us about all things prescription meds is Dr. Kevin Frank. He's a family medicine doctor with Genesis.

This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. Dr. Frank, it's so great to have your time. We were just kind of speaking off the air here a little bit, that we've all been through this. We've all been prescribed things. We've been told to take all of them. Sometimes we listen, sometimes we don't. It's really great to have an expert on to kind of take us through this, emphasize the importance of taking our medications, you know, only our medications, taking all of them and so on.

So let's get rolling here and start with maybe the most obvious one, the one I kind of referenced there, is if I'm feeling better, is it okay to stop taking my medications?

Dr. Kevin Frank: The quick answer is no. So whether it be an acute issue, like a sinus infection or a respiratory infection, sore throat, or be it a more of a chronic issue like hypertension and diabetes, the medications prescribed by your provider are there for a purpose. If you've been prescribed a five or ten-day course of antibiotics, you need to finish those. If you've been prescribed cholesterol medication, you finish those, because that's a very important part of the treatment plan that your provider set forth. So the intention is that you're going to take all your medications as prescribed.

Scott Webb: Yeah, for sure. And I've had that experience where I was taking an antibiotic or something like that. And right up until that last pill, I wasn't sure that they were really working and it literally felt like it was the last pill. You know, they kind of put me over the top, so to speak. So I think you're so right to do as we're told, take all of them, only our medication and so on. And I think we've all been through this because we get busy, whether it's on the weekends or whatever it might be, and we miss a dose of our medications. What do we do in those instances?

Dr. Kevin Frank: So typically, if you miss a dose, especially if it's a once-a-day medication, it's best to take the medication again as soon as you remember. So if you're in routine of taking your medicines in the morning, it's the middle of the day and you realize you forgot to take the medication, it's best to take that medication at that time. If it's taken multiple times a day, you might want to consult with your provider to see whether or not they want you to take the missed dose. But again, typically with once-a-day medications, taking a missed dose as soon as you realize it and then getting back on schedule is the best way to proceed.

There are a few medications that are based on morning dosing, you know, mealtime dosing, evenings, and again, in most special circumstances, they're typically on the bottle, you may want to consult with your provider. But again, usually the best idea is to take the medication as soon as you realize you forgot and then get back on the schedule the next day.

Scott Webb: Yeah, that sounds right. And let's say in the case of an antibiotic and we really want to knock something out, whatever we've got going on, is it okay to maybe not follow the directions? Is it was okay to maybe take an extra one to try to get, you know, a jumpstart, a headstart on things? I'm guessing not, but I figured I'd ask you.

Dr. Kevin Frank: Your answers correct. You should not. Typically, the reason medications are prescribed multiple times a day, like antibiotics is because if you take a large enough dose at one time, there's significant side effects. So typically, when the medicines prescribed two or three times a day, it's to minimize side effect or discomfort to the patient, but to provide, you know, the full care that's needed.

There are exceptions to that rule sometimes, but for the most part, taking extra medication tends to lead to side effects, maybe some discomfort and you may have some unwanted side effects, like rash, upset stomach, vomiting or diarrhea. So typically, follow directions on the bottle because they're set up that way for a purpose and it's typically going to mitigate side effects.

Scott Webb: Yeah, and those side effects sound unpleasant, so every good reason to follow the directions. And I've always wanted to ask, when we're told that we should take something with food or not with food or those types of directions, why is it important that we follow those directions?

Dr. Kevin Frank: Some medications are affected by absorption if it's taken with food. One of the most common medications I get would be thyroid pills. Thyroid medication should be taken on an empty stomach without other medications and certainly without food, because it affects absorption. Other medications, and antibiotics are notorious for this, tend to cause upset stomach, so it would ease the symptoms there and reduce the likelihood of side effects if taken with meal time. Other times, you know, most medications are not affected by a meal or not a meal, but if the directions on your box say take with food or do not take with food, you want to follow that.

Another thing that we look out for sometimes is grapefruit juice. There are some medications that specifically grapefruit juice will affect absorption. So we generally discourage patients from taking their medication with grapefruit juice. The best thing to take your medicine with is typically water. And whether it does say at or not at mealtime, you can mitigate that. But I would definitely say using water to take your medications and then following the directions if it says not to take with meals or with meals is your best advice.

Scott Webb: Yeah. I just had a medication recently and the pharmacist told me, "If you chew on antacid, don't take your medication right after that." She said to give it some time between antacids and medications. And I didn't really understand why, but I figure she's an expert, she would know. Why not listen, right?

Dr. Kevin Frank: Exactly. And then the antacid is a type of medication and there are definitely drug interactions that can occur. Another thing that would be commonly discussed by your providers if it's safe to take these medicines with other medications you take, which is a very important reason why you should not take medicine that's not prescribed for you, because a lot of folks think, "Oh, it's just an antibiotic. It's harmless. I've taken this before," but the medicine that was prescribed for somebody else was taking into account the medicines they currently take. And if you're taking other medicines that may interact with that, you may end up having a significant side effect.

Scott Webb: Yeah, definitely. And along those lines, you must have read my mind here because I was going to ask, I have some leftover antibiotics, right? And someone, you know, gets strep or gets it from me or however that might work or let's just say somebody else in my household has something that a doctor might prescribe the exact antibiotic for, and I just happened to have a few left over, is it okay to just say, "Hey, go ahead and finish these"?

Dr. Kevin Frank: As we discussed earlier, you shouldn't have any antibiotics left over if you did follow the doctor's directions. But, again, if there are leftover medication, it's typically not a good idea to start treating yourself without being evaluated by a provider. It's especially dangerous to take other people's medication. But even if it's prescribed to you for a similar element, if you have some leftovers, again, you're not going to have a full course of treatment, which may actually exacerbate the problem. Antibiotic resistance is something we deal with these days. So if you took a partial course of an antibiotic for a previous infection, now you have a similar type infection and you take again another partial course of an antibiotic, you may be actually breeding drug resistance. So we may have to use much stronger antibiotics for much longer period of time. So, in general, take the medicine you've been prescribed for the full amount. If there is some extra leftovers for a future occasion, I would not recommend taking those. I'd recommend consulting with your provider and getting an updated prescription to treat your acute infection.

Scott Webb: Yeah, that's such a good point, right? If we were actually listening to our doctors and pharmacists and following directions, we should never have any leftover medications for ourselves or anybody else really, right?

Dr. Kevin Frank: Exactly. Yeah.

Scott Webb: And when it comes to expiration dates, so like if the milk in the fridge is expired, you know, that seems obvious, don't drink the milk or don't eat the yogurt, whatever it might be. But how important are expiration dates when it comes to medications? And if it's less than a year, are they still good generally?

Dr. Kevin Frank: So when it comes to expiration of prescription medications, patients are not generally aware of when the actual medication expires. The date that's listed on your prescription bottle is when the last time that prescription be refilled. So taking your medicine beyond when it is refillable or beyond the actual expiration date does carry some risks. Typically, the medicine's less potent, less affective, you know, passing an expiration date. There are certain medications, specifically inhalers, that use a propellants to deliver the medication into the lungs, that actually can become more problematic if it'd taken beyond that expiration date.

So in general, if you have older, outdated medication, it's best to dispose of those properly and not continue to take those. And if you need a refill of your medication, you should contact your provider and get an updated prescription.

Scott Webb: Yeah. And generally, it's not recommended that if we have expired medications or leftover medications, whatever the case might be, we really shouldn't just throw those right in the garbage, right? We should take them someplace, whether it's a local police station or whatever we have in our local communities that is set up to gather people's expired or unused medications, right?

Dr. Kevin Frank: Certainly. You can talk to your provider. You could talk to your pharmacy and like you said, local law enforcement. But in an easy way for patients to dispose of unwanted or expired medications is to dump them out into either a coffee filter or onto a paper towel, moisten the medication, so it starts degradation and throw them away. One thing you want to avoid doing is flushing used or expired medication in the toilet. It's not the adviced way to dispose of it. So at home again, coffee filter or paper towel, moisten it, throw it away, recycle your bottle. Well, if you don't feel comfortable doing that at your own home, talk to your provider, your pharmacist or law enforcement about proper disposal of medication.

Scott Webb: Yeah, that sounds right. And speaking of tips, and you've been a wealth of information today, really educational stuff, this is maybe the million dollar question. What can you do? What can you recommend to help us to remember to take our medications? Is it to put it in our phones, to, you know, have alerts, to post notes and things all over the kitchen or the bathroom? What tips do you have, doctor?

Dr. Kevin Frank: Those are some excellent points. That is a big issue for a lot of patients, especially on chronic medications, is remembering to take them. And I tend to work with my patients and find out what works best for them. Morning dosing versus evening dosing. Again, if there's no preference because of medication, the way it should be prescribed, I find out what's easier for my patient, taking it in the morning or evening, I recommend doing it that way. Getting a pill minder, one of those Sunday through Saturday little pill minder where you dispense your medications each day of the week. It's a nice visual reminder. You can look down and see, "Oh, how have I taken my medicine today?" Oh it's Wednesday. I've not taking medication."

And for those who are tech savvy or have smart phones, which most of us do, you know, setting a daily reminder to take your medication is very helpful. But working with your pharmacist, working with your provider, there are different ways that medicines could be dispensed. There are now availability of blister packs where your medicine's to be dispensed in morning or afternoon and evening doses. So it's easier to remember to take them. Again, they can be put into pill minders, and of course, setting alerts, Post-It notes on your vanity mirror in the morning, in your car, you know, whatever it takes to get you to remember to take your medication. There is no wrong answer. Just what works best for you and your lifestyle is what I recommend.

Scott Webb: Yeah, that's perfect. What works. You know, I have a reminder. And I have one of those pill things like you say, because then sometimes I'm like, "Wait, did I take my medication? Or did I only think about taking my medication?" And that's what's so great about those things is I can pop open the little door and go, "Yep, I took it" or "Nope, still need to take it." Really great advice today. Great knowledge today. Thank you so much for your time and you stay well.

Dr. Kevin Frank: I appreciate your time today. Thanks very much.

Scott Webb: And for more information, go to genesishcs.org.

And thanks for listening to Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.