Ten questions to ask before starting a prescription regimen
By Kristen Gerencher
Knight Ridder Newspapers
Prescription drugs have become a staple of modern medical treatment. But for all the good they can do, it pays to step back and ask a few simple questions when a doctor reaches for the prescription pad.
Consumers and doctors alike have received a wake-up call in the last few months, beginning with Mercks recall of the painkiller Vioxx in late September after a study linked it to increased risk of heart attack and stroke. Now theres subsequent concern about the U.S. Food and Drug Administrations ability to protect consumers from harmful side effects that may only emerge once newly approved drugs are in wider circulation.
In late November during Senate testimony, Dr. David Graham, associate director for science and medicine in FDAs Office of Drug Safety, broke ranks with the agency to warn about the safety of five available drugs: Astra Zenecas cholesterol drug Crestor, Abbott Laboratories weight-loss drug Meridia, GlaxoSmithKlines asthma drug Serevent and Pfizers painkiller Bextra. Graham said all were too risky to be prescribed.
Since that time, Bayer has come under fire for allegedly withholding evidence of a deadly muscle-disorder side effect caused by its cholesterol-lowering drug Baycol. A study published in the Journal of the American Medical Association (JAMA) recently accuses the company of being too slow to pull Baycol off the market in 2001.
To be sure, doctors and consumer advocates are pushing to improve the drug-safety process and to reduce conflicts of interest. The editors of JAMA are calling for an independent office to evaluate drugs safety after theyre released.
It is unreasonable to expect that the same agency that was responsible for approval of drug licensing and labeling would also be committed to actively seek evidence to prove itself wrong, the JAMA editorial said.
In the meantime, consumers may want to examine their own assumptions before making their next trip to the pharmacy. Patients need to ask several questions when the doctor hands them a free sample or recommends a new drug, or if theyre tempted by a direct-to-consumer advertisement that begs them to ask their doctor about a particular brand of therapy, medical experts said.
Every patient ought to ask: How long has this drug been out on the market? And if its a relatively new drug, the question is, does it have some advantage over the existing alternatives that would make me want to use it? said Dr. Jerry Avorn, author of Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs and a professor of medicine at Harvard Medical School.
Patients ask more questions about medications than they did three or four years ago, said Dr. Edward Langston, a trustee on the board of the American Medical Association and a family physician in Lafayette, Ind. The most common question is, Is it on my drug plan?
Boosting doctor-patient dialogue on the risks and benefits of prescription drugs is a healthy development, he said. Medication has its own set of risk factors. Its not everything you see on TV.
What to ask
Among the things to ask a doctor before starting a new prescription, according to experts:
1. What exactly is this drug for and how will I know if its working? It may sound basic, but setting expectations is a reasonable place to start, Avorn said. I see an awful lot of patients on 20 pills and theyre not altogether sure what each does. Dont be embarrassed to take notes if needed.
2. What are the risks and benefits of starting this drug and do you think the benefits of my taking this medication outweigh the risks?
3. Is it best to go with a new drug or an old standby to treat the condition? Based on my particular situation, do you think one of the new ones is indicated or should we continue to use some of the more established medications? Langston suggested. Thats a very fair question to ask.
4. Is there a generic alternative that is either identical or nearly identical to the brand that would work as well at a lower cost?
5. Will any of the other prescription drugs, over-the-counter medicines or supplements Im taking interfere with this medication?
6. Dont panic if a drug youre taking becomes the target of a safety inquiry, but call your doctor right away to determine how to proceed, said Bill Soller, clinical professor of pharmacy at the University of California-San Francisco School of Pharmacy and director of the Center for Consumer Self-Care. Some drugs arent designed to be stopped cold turkey, he said. Be prepared to tell the doctor exactly how youre taking the medicine, including whether you follow the recommended doses at the recommended times. This is no time to fudge, Soller said. You have to be honest about how youre taking the medication.
7. Are there alternatives to this medicine, such as making lifestyle changes, and should I try these first?
8. What side effects should I look out for and when should I call you about them?
9. Some medications are more difficult to adhere to than others and may require asking specific questions about how to monitor their effects, Soller said. On some of these blood-pressure medications and other medications, they say monitor your blood pressure regularly, he said. My question to the doctor or pharmacist if I have to have it monitored regularly and we know everyones (blood pressure) changes throughout the day is, when do I measure it and how often?
10. Can we set up an appointment in two or three months to see how Im doing on the new drug?