Alert doctor if you’re bad with pills

I am a lousy pill taker. If I have to take a medicine four times a day, it just ain’t gonna happen. I am not proud of this. We doctors call this poor compliance.

Why do we have to take some medicines four times a day, while others are OK once a day? It has to do with how long the medicine stays active in your body. Some antibiotics require every six hour dosing in order to keep the antibiotic concentration high enough to fight the infection. In the case of antibiotics, slacking off the recommended timing and duration of therapy (you feel better, so you don’t take all the medicine you were given) can lead to nasty germs that are resistant to the antibiotic in question. You should never have leftover antibiotics. The combination of ‘long term’ and ‘bugs that are resistant to everything’ is not good.

Sometimes forgetting a dose can have some pretty serious consequences.

Let’s say you’re a woman taking birth control pills to prevent pregnancy. Research tells us that when taken exactly as directed, that is every day at the same time each day, the pill is 99.5 effective. But with typical use, it’s more like 93 percent effective. That means that out of every 100 women taking the pill for a year, seven will get pregnant with typical use. And that’s with simple once-a-day dosing.

Studies of patient compliance show us that the more times you have to take a pill a day, the less likely it is to happen. Not surprisingly, if you’re taking pills to control bad symptoms, you’re more likely to stick with the schedule. A woman taking hormones for severe hot flashes gets reminded pretty quickly if she forgets her daily pill. A man taking a high blood pressure pill may slack off because he doesn’t feel any different on or off the medication. Or worse yet, he may have side effects from the medicine, and feel worse on the drug.

Then there are people who just can’t afford their medications. More and more of us are living with chronic diseases requiring long-term therapy. Twenty years of high blood pressure medicine may be cheaper than a heart attack, but we’ve still got to figure out how to pay for it along the way.

So how can we be better at taking our medications? Work with your doctor.

Ask if there is a less expensive generic medicine that will get the job done.

Ask if there is a substitute that requires fewer doses a day. Yes, sometimes these types of medication are more expensive, so this is a trade off. But medicines won’t work if you forget to take them.

Tell your doctor if you’re having trouble taking your pills. She might think the medicine isn’t working, when that’s not it at all. Don’t be shy about this. We’d much rather have our patients be truthful about their difficulty, because then we can work out a plan together. Are you having miserable side effects? Are you troubled by too many senior moments? Don’t worry, we’ll find a way.

There are things you can do on your own, too.

Keep a few pills stashed at work, or in your purse. If you dashed out of the house because you overslept, you can still get your daily dose.

Use those yucky plastic boxes they sell at the drug store, the ones that have a place for each day’s pills. If you have to take pills more than once a day, they have boxes for multiple dosing. That way you can tell if you remembered your afternoon dose.

My favorite strategy comes from a fellow OB-Gyn. She recommended that women keep their birth control pills in their panty drawer. I know they always tell you to keep them by your toothbrush, she said, but after a while you just don’t see them there anymore. But pills really don’t belong with your underwear – you’ll notice them right away.