Are you taking your meds wrong? Many patients make these common mistakes.

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Q: I’m taking more medicine as I get older. But it’s hard to keep track of all the prescriptions and the instructions for taking them. Is this common? What should I do?

A: A surprising number of people struggle to take their medications correctly.

For instance, a systematic review of over 13,000 patients with hypertension from 15 countries found that about half did not consistently take their medication.

This is a real danger – it comes as no surprise that taking your medications consistently is associated with a lower chance of hospitalization and even dying.

Our health care system shares substantial responsibility for this. Physicians need to do a better job explaining the importance of any therapies. Insurance companies and pharmacies have their own work to do in terms of access and costs.

But as a patient, you can also take steps to stay on top of your medication regimen. Start by avoiding these common mistakes:

– Using your inhalers incorrectly. Around 9 out of 10 people using metered-dose inhalers, commonly prescribed for asthma or chronic obstructive pulmonary disease, err in their technique – such as failing to fire the canister entirely or not holding their breath long enough. At your next visit, show your doctor how you use it just to make sure.

– Taking heartburn meds at the wrong time. The majority of primary care physicians who prescribe proton pump inhibitors like omeprazole don’t inform patients they need to take the medication 30 minutes before their meals. (Pro tip: If you take omeprazole right before bed, believe me, it won’t work as well.)

– Taking medications you don’t need. Sixty-five percent of older people may be on medications they don’t need, which puts them at higher risk for adverse effects. Having a high number of prescriptions has been associated with impaired cognition and a higher chance of falls. Rethinking your medication list can get lost in the hustle of a primary care visit – so make it your priority to ask every time you go.

– Taking pills at all times of day. Do you take medicines twice a day? Adding in a new medicine you’ll need to take three times a day is more complicated than adding one more pill to your existing routine. It won’t always be possible, of course, but in many cases, there may be alternatives your doctor can consider.

– Taking more pills than you may need to. In the case of hypertension, for example, researchers have found that a single pill that contains a combination of medications is more effective than taking multiple pills containing the exact same doses. Why? Because more people are more likely to stick with it. Ask your doctor if there are combination options that simplify the number and frequency of pills you have to take.

– Paying more than you have to. Mail-order pharmacies are often cheaper for patients, and because the medications come directly to your door with automated refills, it’s one less thing on your to-do list. Some fancier online services do that and also package your pills by date and time of day. I’d recommend reading the Food and Drug Administration’s guidance on choosing an online pharmacy to make sure you avoid scams. If you prefer your local pharmacy, technology can still be your friend with automatic pill dispensers and smart pill boxes.

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What should I do if my medicine is too expensive?

I think of high drug costs just like any medication side effect: If it’s intolerable, we need to find you an alternative.

If expense is the reason you’re not taking your medicine, re-engage with your physician and tell them so. Sometimes we can appeal to your insurance company to have expensive medications covered. Other times, we can connect you with resources to allay costs or find the cheapest pharmacies.

And here’s a little secret: I hardly ever buy brand-name drugs. If there’s a cheaper generic or drugstore version of the same medication, by all means, get that one instead.

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The tangled web of prescriptions

The path between the moment when doctors like myself sit at a computer and prescribe a medication and when that medication actually makes it to your body can be a very tangled web.

Consider this study published in JAMA Internal Medicine in 2018 about anti-platelet medications.

For decades, doctors have recommended anti-platelet medications like clopidogrel (brand name Plavix) to people who get a procedure to open a blocked coronary artery after a heart attack. In 2009 and 2011, two new anti-platelet drugs were approved by the FDA. Both boasted major randomized clinical trials that demonstrated their superiority to the generic medication clopidogrel.

By 2016, prescriptions for clopidogrel had plummeted while those for the new drugs soared. After all, the data showed they were the best option for patients.

But then something unexpected happened. The group of people who didn’t pick up their anti-platelet medications from the pharmacy just about tripled. And they became more likely to experience a second heart attack than people who did.

Why did so many people not fill lifesaving medications after almost dying? It turns out the out-of-pocket costs for the new drugs were more than twice as high for patients.

The lesson here: A medicine that is slightly less effective but you can afford may be better than the one that is the most effective but you can’t afford. That goes for heart medications just as much as it does for laxatives.

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What I want my patients to know

It’s important to be honest with your physician. I’ve seen this scenario play out before: Patients are prescribed higher doses of medications for conditions such as blood pressure or high blood sugar because it seemed like they weren’t responding to lower doses. In reality, there was some reason they weren’t taking the medication to begin with.

Then one day, they get hospitalized, they’re given all those treatments, and it’s overkill. Their blood sugar, blood pressure or whatever it is that we’re treating tanks from all the unnecessarily high doses of medication. This dangerous scenario could be avoided if we worked with you on the underlying issues early on.