Promoting Safe Use Of Medicines Through Disposal Of Unwanted Medicines Programme

drugsThe feedback from the Cocoa Clinic Disposal of Unused on Unwanted Medicines Programme (DUMP) is the need for increased patient education about the safe use of medicines.

The DUMP has clearly demonstrated that clients do use all the medicines given to them at the pharmacy. We, therefore, took the next step in increasing patient education at the clinic.

The enhanced interactions with clients have been most revealing! I will for the purposes of this piece relate a few concerns of clients.

A client with high blood pressure asked whether it was necessary to take the high blood pressure medicine every day. The client was worried about the daily use of medication and, therefore, intentionally missed doses.

High blood pressure is a chronic disease condition. We do not cure it. We manage it so it is important to take the medication every day.

Indeed many of the stroke cases presented at the clinic were persons who had been diagnosed with high blood pressure but had for some reasons stopped taking them because they felt better.
A common complication of uncontrolled high blood pressure is stroke. High blood pressure is also a major cause of kidney disease.

Another asked whether it was wrong to take multiple doses of his/her scheduled medicines for high blood pressure if he/she missed doses for about two or three days?

For instance if he travelled out of town without his/her high blood pressure medicines why can’t he just take the number of doses he/she missed while out of town. It is completely wrong to take multiple doses of the medication to make up for the missed doses.

You may suffer from the consequences of medicine overdose and the effects could be fatal! Just take your scheduled dose and report to the health care facility for a review.

Another male client confessed that he stopped taking his high blood pressure medicines because some friends warned him about the negative effects of the medicines on his potency.
He went on further to say “what shall it profit a man if he lowers his high blood pressure and compromises his potency in the process?”

It is a situation we face regularly in the course of our practice as health care providers. There is so much myth and misconception about the use of high blood pressure medicines in males in the country.

We had a case of a sailor back on land after many months on high seas with a very, very high blood pressure at the time of reporting at the clinic. He had come to get some treatment for his headache!
The irony was that he had been diagnosed as having blood pressure over eighteen months ago! But he fell prey to peer pressure and stopped taking his medications.

It is important to realise that high blood pressure itself could cause erectile dysfunction. It is therefore important to control the blood pressure to prevent the problem.

Besides, modern medicine has presented us with several options to manage high blood pressure. It is always far better to go back to your health care provider for a review than to stop taking the medicine altogether.

Another complained about the difficulty in taking some medicines four times a day, particularly antibiotics. If he/she is an adult and requires a total of four capsules a day, can’t he/she, for convenience take two capsules in the morning and two capsules at night?

It is important to take all medications as prescribed and directed. For antibiotics, it is very important because you are dealing with germs which could easily develop resistance if not attacked aggressively.
You need to attain a certain minimum inhibitory concentration (MIC) of the medicine in the blood necessary for clearing the germs. This is achieved through scheduled dosing of the medicine.

Another also wondered why the pharmacy asked them to take some medications before food and others after food? Some medicines are affected by the presence of food in the stomach and, therefore will require one to take it on an empty stomach for better effect of the medicine.

Other medicines work better after food and, therefore, require that they be taken after food. The presence of food in the stomach also reduces erosive effects of medicines such as Ibuprofen, Naproxen, Diclofenac, etc on the mucosal lining of the stomach.

On malaria, someone suggested that we should do something about the dosing of the artemether + lumefantrine (Artefan, Danmether, Malar 2, Coartem, etc). I was told by the pharmacy to take the second dose 8 hours after the first dose but it is 6:00 p.m. now,” a client said, adding. How am I expected to comply and take the next dose at 2:00 a.m.?

Meanwhile I was told to take the medication with food.” This is true especially with artemether plus lumefantrin combination therapy. It is one of the medicines for the management of uncomplicated malaria as specified by the country’s Malaria Drug Policy. The dosing is 0, 8, 24, 36, 48, and 60 (hours).

It is very important to take the first two doses 8 hours apart. This real situation is handled on case by case basis. The client under discussion could be asked to take the first dose at say 9:00 p.m. and take the second dose at 5:00 a.m. The client is then advised to take the medication with some snack for better absorption and effectiveness of the medicine. The subsequent dosing frequencies are as specified above (24, 36, 38, 60 hours from the first dose).

Still on malaria, a client said she was regularly on blood tonics because of her heavy menses. She is just been told by the pharmacy not to take the artesunate/artemether preparations together with iron preparations and other vitamins such as Vitamin C, E and Zinc.

Yes, this is true even though it is often overlooked. The effectiveness of the artemisinine (artesunate, artemether) depends on its integrity before getting into the blood.

Agents such as Iron, Vitamin C, Vitamin E and Zinc (which are all anti-oxidants) compromise the integrity of the artemisinine in the stomach and therefore reduce its potency. It is advised that clients complete the three day course of the artemisinine based preparations before taking these agents.

Another asked whether it was necessary to continue taking medicines even when he/she felt better? “I reported at the clinic with a boil in my armpit. And the doctor prescribed antibiotics for me” another client that said, adding the pharmacy indicated on the label that I had to take the medicine for seven days but after two days I felt much, much better and decided to save the rest for another time. Is this wrong?”

It is important to continue taking the medication even when you appear to feel better. The germs may still be in your system. You should remember that these doses, frequency and duration are all arrived at after extensive research.

The increasing resistance of germs to antibiotics is partly due to such misuses of the products. I recall that the first returned medicine when Cocoa Clinic started DUMP was an antibiotic!
DUMP started off as an initiative to dispose off unused/unwanted medicines but it is increasingly becoming a potent force in promoting safe use of medicines.


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