Advice from Neighborhood Pharmacists

The best prescription? Educate before you medicate

written by AMBER LANIER NAGLE | photos courtesy of ADOBE STOCK

Are there certain foods you shouldn’t eat if you take blood thinners? Can you sip a glass of wine with your medication? What is a black-box warning and how do you know if your medication has one?

If YOU THINK A PHARMACIST’S ONLY DUTY is filling prescriptions, you are wrong. The man or woman behind the counter at the corner drugstore is one of the most valuable members of your personal healthcare team — a trusted, yet often overlooked, resource.

Consider this: your pharmacist may be easier to talk to than your physician, and he or she probably has more time to address your questions than your doctor does. Indeed, pharmacists offer a wide range of patient care services including Medication Therapy Management (MTM), which covers medication therapy reviews, pharmacotherapy consults, anticoagulation (commonly referred to as blood-thinning substances) management, immunizations, health and wellness programs, as well as many other clinical services.

“The relationship — the communication — between a pharmacist and a patient is critical. We are the last line of protection for our patients,” said Jennifer Shannon, owner of and clinical pharmacist at Lily’s Pharmacy in Johns Creek. “We see patients every month when they come in to get refills, whereas a doctor may only see a patient every few months.”

Shannon recently gave a presentation to her community focusing on the role of the pharmacist on a patient’s healthcare team.

“I asked, ‘How many of you have sat down and talked to your pharmacist?’” she said. “Out of 60 people, one person raised his hand. One. We can be big assets if we are used, and patients could have better long-term outcomes. That’s what we want — better outcomes.”

The next time you stop by the pharmacy to have a prescription filled, slow down, read the information sheet that accompanies your medication and tap into the wealth of information standing just beyond the counter.

Here are some questions to consider asking your friendly neighborhood pharmacist.

Can this medication cause sun sensitivity?

ACCORDING TO APRIL HENNINGTON, a pharmacist at CVS Pharmacy inside the Target on Cumming Highway in Canton, you may develop a skin rash or blistering sunburn if you venture into the sun while taking certain medications. Sun sensitivity (also known as photosensitivity) is an inflammation of the skin induced by the combination of sunlight and particular medications or substances. 

“Knowing which medications may cause sun sensitivity is particularly important in June and the other warm, sunny months when we spend more time outdoors,” Hennington said. “If you are taking a sun-sensitizing medication, you need to stay in the shade, cover up with long sleeves and a wide-brimmed hat, or wear a thick layer of sunscreen with a high SPF.” Examples of medications that may make your skin more sensitive to sunlight

Examples of medications that may make your skin more sensitive to sunlight include: antibiotics like tetracycline and sulfa-drugs like Bactrim; diuretics like Lasix; heart-condition drugs like Captopril used for treating high blood pressure; and arrhythmia drugs like Cordarone that regulate heart beats. Even common over- the-counter pills like Benadryl, Advil and Aleve can cause sun sensitivity in some people.

If I don’t use all of this prescription, what should I do with the remainder?

WHEN YOU NO LONGER NEED your medication or it has expired, it is important to dispose of it properly to help reduce harm from accidental exposure or intentional misuse. Many medications typically flushed down a toilet can be harmful to water. For this reason, some meds require lawful disposal.

Check with pharmacies and local police departments about their disposal services and take-back programs, which allow customers to safely dispose of unused, unwanted or expired drugs on certain collection days.

Given my other medications, do you see any reason why I should not take this drug?

EVERYONE SHOULD CAREFULLY READ the information sheets that accompany each prescription. These sheets list possible drug interactions. But it’s not that simple.

“My advice would be to go to the same pharmacy — or chain of pharmacies — to fill all of your prescriptions,” said Dan Lorenzen, a pharmacist who recently retired from The Longstreet Clinic in Gainesville. “That way the pharmacists have a record of all your medications at their fingertips, and they can review it to determine if there’s a potential problem. Plus, the computer systems at pharmacies are designed to catch harmful interactions if you are their customer. It’s just another safeguard in the system.”

For those of us who use more than one pharmacy, Lorenzen suggested taking a list of all medications and supplements and asking for one-on-one time with the pharmacist.

“The law states that the pharmacy staff has to ask every patient, ‘Do you have any questions about your prescription today?’” Lorenzen added. “You may have to wait a few minutes, but seize that opportunity to ask the pharmacist to review your list of medications and supplements. Ask [the pharmacist] to consider the prescription you are there to fill. [He or she] will let you know if there is something of concern.”

How should I store this medication?

PRESCRIPTION MEDICATIONS that are subjected to extremely hot or extremely cold temperatures can lose their effectiveness prior to their expiration date. That’s why you should avoid leaving medications in your car or on a windowsill in direct sunlight. 

The ideal location to store your medication is in a cool, dry environment, out of the reach of children.

“Store your medications in a place where the temperature and humidity doesn’t vary,” Lorenzen said. “The bathroom is not the best place to store medications because bathrooms can get hot and steamy.”

Although some medications need to be refrigerated, most should not. Check the information sheet or ask your pharmacist how to store your meds.

Is there a different form of this medication?

BEING UNABLE TO SWALLOW TABLETS or capsules is not uncommon. Some patients resort to crushing or dispersing their meds in water, which is safe most of the time, but not in all cases.

“The question is: can they safely swallow the medication?” Lorenzen said. “This is especially important in children. They often have a tough time swallowing medication. A pharmacist can identify either a different form of the drug that doesn’t pose a risk of choking, or perhaps an alternative medication that can be more easily swallowed.”

Should I take this medication with or without food?

SOME MEDICATIONS should be taken with food and others without. Al McConnell, a CVS pharmacy manager in Crabapple, said that there are different reasons for this. “Some medications are absorbed better into the body if there is food present in the stomach,” McConnell said. “And some medications can trigger stomach upset, but food can often help to prevent this.” Prednisone, lithium, aspirin and  nonsterodial anti-inflammatory drugs (or

“Some medications are absorbed better into the body if there is food present in the stomach,” McConnell said. “And some medications can trigger stomach upset, but food can often help to prevent this.” Prednisone, lithium, aspirin and  nonsterodial anti-inflammatory drugs (or

Prednisone, lithium, aspirin and  nonsterodial anti-inflammatory drugs (or NSAIDs, for short) are examples of medications that should be taken with food or just after you eat. Claritin, Ampicillin and Bactrim are examples of medications that should be taken on empty stomachs. If your pharmacist recommends taking your medication with food, a sandwich or a large glass of milk is often enough.

If your pharmacist recommends taking your medication with food, a sandwich or a large glass of milk is often enough.

Should I take this medication in the morning or evening?

MCCONNELL ALSO NOTED that for a medication that instructs, “take once a day,” the time of day you take it may be important.

“A person’s body responds differently to medications throughout the day,” McConnell said. “That’s why some medications are best taken in the a.m., while others should be taken in the p.m.”

For example, statins and certain blood pressure-lowering medications seem to be more effective when taken in the evening. Conversely, patients taking certain decongestants and allergy relievers are more comfortable when they take these meds after breakfast.

Are there any foods I shouldn’t eat while I’m taking this medicine?

MOST PEOPLE DON’T REALIZE that some foods may interact with particular medications. For example, some drugs interact negatively with grapefruit and grapefruit juice while some may result in potentially fatal side effects. Grapefruit and a few other citrus fruits contain furanocoumarins, which block an enzyme that normally breaks down certain medications in the body. When it is left unchecked, medication levels can grow toxic in the body.

A patient taking statins that lower cholesterol (like Lipitor) should not consume grapefruit, for instance.

What does the black-box warning on my medication’s documentation mean?

ALL MEDICINES CAN CAUSE side effects, but some side effects are more serious than others. A black-box warning is the strictest warning put in the labeling of prescription drugs or drug products by the Food and Drug Administration (FDA) when there is reasonable evidence of an association of a serious hazard with the drug.

Having a bold black box around the medication’s warning means an adverse reaction to the drug may lead to death or serious injury. The warning is based on clinical data or, when there isn’t clinical data available, serious animal toxicity data. In other words, this is not a label to be taken lightly.

While it only takes a quick Google search to find examples of scenarios when prescriptions have had adverse reactions, we found multiple Atlanta-area residents suffering permanent damage from fluoroquinolone medications. These persons require ongoing, often expensive care for their injuries and are disabled. Of them, one reader agreed to share her experience in her own words:

“As I left the gastroenterologist’s office in late July 2015, I did so with hope. I’d been experiencing unexplained nausea and bloating for a few weeks and, while hospital test results showed normal white blood cell counts and I had no fever, I was sent home with antibiotics as a ‘ just in case.’

I’d be better in no time; I just knew it.

The following day, I experienced numbness in my hands and feet, but was encouraged to continue my course. I did so, but the following weeks saw multiple trips to the emergency room, presenting with increased and body-wide symptoms.

No doctor could figure out what was wrong. The symptoms continued to pile on, and I was baffled. Neither I nor my doctors made the connection to the ciprofloxacin antibiotic I’d been given.

I was hospitalized by mid-August, given more antibiotics, iron and steroids.

I have been disabled ever since.

Prior to taking the ciprofloxacin, I was a 34-year-old newlywed and world traveler whose career was going so well, I decided to strike out on my own. But that bout of nausea — which was later resolved by a simple proton pump inhibitor — and that fateful prescription for antibiotics set me on a course of 24/7, 365 pain that has not resolved.

 

The numbness became excruciating, burning nerve pain in my hands and feet. I spent all day in bed, covered in ice packs. Overnight, my previously perfect vision became light sensitive and blurry, and I developed a rare condition called visual snow. Head pressure, ear pain and popping became a ceaseless tinnitus. I was suddenly unable to sleep. At all. Ever.

At the same time, my blood pressure became unpredictable. My heart rate and body temperature vacillated wildly. When I stood, my heart rate would spike, and I would feel dizzy or faint.

I saw countless specialists, but none could help me. Most did not believe what was happening to me. I didn’t want to believe it either, but the evidence was all there: dozens of studies detailing the potentially permanent, debilitating side effects of Cipro and other antibiotics in the fluoroquinolone class. But I, like so many others, was never warned.

In March 2016, the body-wide joint, tendon and bone pain began. Suddenly, it became painful to walk, type or lift even light objects. My skin, eyes, nose and mouth became impossibly dry. My hormone levels were all over the place. My hair fell out by the handful. I was horrified. What kind of medication continues to affect you six months after you take it?

The answer: fluoroquinolone antibiotics.

In November 2015, the FDA held hearings with people like me who have become permanently affected, and, in some cases, profoundly disabled, from fluoroquinolone antibiotics. This year, the FDA issued a warning that these drugs should not be used except as a last resort where other antibiotics have failed. Risks cited include permanent musculoskeletal, nerve and central nervous system (brain) damage, for which there is no cure. What I, and many others, suffer from is called Fluoroquinolone Associated Disability.

Up to July 2015, I was a woman with no significant diseases or health problems. Today, I am a 36-year-old woman who has filed for Social Security Disability because I was given what I thought was a run-of-the-mill medication.

I tell my story to spare others the pain I continue to endure, and to encourage medical researchers to seek a cure.”