In the last 10 years of my experience as a practicing neurologist, I can honestly say that I may have helped just as many people if not more by taking them off medication as I have by putting them on medication. Unfortunately, far too often I see patients in my office who don’t even know what medications they are on or why they are on them. Medications are chemical substances with both short-term and long-term side effects which can lead to significant health problems. Arm yourself with information regarding your medications and ask your doctor questions! Here’s a list of 5 questions you can ask your doctor about your medications before your next visit.
1. Is this medication treating my actual problem or just my symptoms?
Doctors use medication for three different purposes: to reduce symptoms you currently have, to prevent certain medical conditions from happening, or to actually cure you of the problem you have. Why is this important to know? Well if the medication is being prescribed for the sole purpose of controlling symptoms it may not be necessary. A medication called gabapentin or Neurontin that neurologists often use to treat pain associated with neuropathy is an excellent example. I have seen many patients in my office who believe that because they were diagnosed with neuropathy, they have to take gabapentin. They are under the false impression that the medication will treat the neuropathy itself. I sometimes see patients who are on gabapentin for their neuropathy who complained of little to no pain at all. This is especially unfortunate if the patient has also gained weight or developed other common side effects from this particular medication.
2. How do I know if this medication is still working?
This question is primarily relevant if the medication being prescribed is intended to only reduce symptoms. Several times I have seen patients continue to be on medications used to the reduce the frequency and intensity of headaches despite going years with mild, infrequent headaches. The reason the headaches are mild and infrequent is not necessarily because the medication is working. There are many reasons why chronic headaches can improve without medications. Physicians should constantly be reassessing the need for medications used for symptomatic management only. In my practice, if I am unsure a medication is effectively controlling symptoms, I always consider slowly tapering the medication off to confirm. Many times, I find that the medication is no longer necessary or the medication was having such a minimal effect that it was no longer worth prescribing.
3. Are there any contraindications to taking this medication?
It is very important that your physician is aware of any medication you are on including any over-the counter medications as well as all medical conditions you have prior to prescribing any medication. The reason for this is because there may be a reason you shouldn’t be prescribed a certain medication. Because office visits are often 15 minutes or less, sometimes important information is not communicated. It could only help you to ask about contraindications to the medication prescribed.
4. What are the short and long-term side effects of this medication?
There are common side effects to ALL medications. Many times these side effects dissipate after a few days of being on a medication or are not experienced at all. Your local pharmacist may also be a very good resource for this particular question. Long-term side effects can creep upon you slowly and leave both you and your physician unaware of the connection between your drug-induced symptoms and the medication. Recently I saw a patient in my office who had been on Reglan for 5 years due to her stomach’s inability to empty it contents properly. Reglan is a medication that is very often used to treat nausea and can also help with increasing gastric motility. When I saw her in my office, she was moving very slowly, had slurred speech and a very pronounced tremor in her upper extremities. These symptoms had a very gradual onset and progressed slowly over 5 years. Fortunately, they were completely reversible once the Reglan was discontinued.
It is important to note here that as we age medications can affect us differently. You may begin to tolerate a medication less as you age due to changes in body weight or the ability to metabolize the drug. Medications therefore very often need to be reduced or discontinued for this reason. You can read more information regarding this topic on Medscape.
5. What are my other options, if any?
Unfortunately with many conditions, medication management may be the only therapeutic option. However, as in the case of pain and headaches, there are definitely plenty of ways to manage medical problems in non-pharmacological ways. Headaches, for example, can be treated conservatively and aggressively without the use of medications. Conservative approaches include biofeedback therapy, avoidance of dietary triggers, trigger point massages, and exercise. Interventional approaches include procedures such as peripheral nerve blocks, Botox injections, and occipital nerve stimulation.