MEDICATION ADHERENCE

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Medication adherence means taking your medication as directed by your healthcare provider. “Drugs don’t work in patients who don’t take them,” is a famous quote attributed to former US Surgeon General C. Everett Coop. But simply taking your medication is not enough – you have to take it correctly. Taking your medication exactly as prescribed is essential for the medication to work as intended, and for you to have the best possible treatment outcome.

Unfortunately, medication non-adherence is a global problem. Typically, adherence rates of 80% or more are needed for medication to be effective. The World Health Organisation found that in developed countries, only 50% of patients adhere to their medication regimens. In developing countries, adherence is even poorer, with some countries reporting below 20% adherence.

Not taking your medication properly can lead to serious issues like more severe symptoms, poor quality of life, hospitalisation, and even death. It can also cause complications with your treatment.

GETTING IT RIGHT

To get maximum benefit from your medications, take them exactly as prescribed. To get this right, follow the 5 R’s: the right drug, the right dose, the right time, the right way, and the right duration.

Right Drug:

Always check the label and bottle. It can be easy to mix up medications when there are many people in your household on different regimens. Medications can often look the same, and it is dangerous to take medication that is not prescribed for you. Make sure the name on the label is for the person taking the medication.

Right Dose:

Different people are prescribed different doses, as dosage is influenced by a person’s weight, age, kidney and liver health, your medical condition, etc.

If you take more than the recommended dose, you risk causing severe harm to yourself. Overdosing can have severe consequences and is a common cause of hospitalisation and even death.

Underdosing can be just as dangerous. Underdosing can mean not taking enough medication at one time, or missing doses entirely. This can result in the medication not working effectively, leading to your symptoms getting worse, a poor quality of life, and possibly hosptalisation.

It’s worth double-checking the label if you have any doubts about dosage. Getting the dose right can be challenging in young children who can’t swallow pills. Measuring liquid medication is best done with an oral syringe and not a household teaspoon. If the medication does not come with a dosing cup or syringe, ask your pharmacist for one.

Right Time:

Many medications need to reach a certain level in your blood stream before they work as intended. They also need to be taken at specific times, such as every morning, in order to maintain that level in your body. Although most medications are taken once a day, some are prescribed to be taken two or even three to four times a day.

Taking a dose too soon could cause the levels in your blood to be too high and can be very dangerous, and missing a dose could mean the levels in your body fall too low and the drug stops working properly.

Timing also refers to WHEN you should you take your medicine:

- Before a meal: some medicines are better absorbed when taken on an empty stomach
- After a meal: having food in your stomach can prevent stomach irritation from the medication
- With a meal: some medicines work better, and are better absorbed, when taken with your first mouthful of food
- In the morning: if the medication keeps you awake, or causes you to need the toilet frequently, taking it in the morning helps to avoid sleep disturbances
- At night: some medicines have the best effect at night
- Only when necessary: only take your medication when you need to; do not take it regularly

Right Way:

Medicines come in a number of forms, like tablets, creams, suppositories, liquids, etc. Different preparations have different instructions for how to use them. This is to ensure that the medicine acts directly and effectively for the specific health condition for which it was made.

If you do not take your medicine in the right way, not only will it not work properly, but it may also have severe side-effects, for example, the ingredients used in some creams are poisonous when swallowed, and mistaking ear drops for eye drops can cause red, burning eyes, as well as swelling and blurry vision.

Some common ways to take medication:

- Oral: the medicine is swallowed
- Ocular: the medicine goes into the eye
- Otic: the medicine goes into the ear
- Nasal: the medicine is taken through the nose
- Sublingual: the medicine is put under the tongue
- Inhaled: breathe in the medicine
- Transdermal or Topical: the medicine is applied to the skin
- Rectal: the medicine is absorbed through the rectum
- Vaginal: the medicine is absorbed through the vagina

Right Duration:

How long you need to take your medication depends on what condition you have, and how severe it is. Some medicine may only be needed in the short term, and after you are cured, you can stop taking it. It is important to finish the course of medication that has been prescribed to you, even if it is only for a short period to ensure the condition clears fully.

However, medication for chronic conditions may require you to take it for the rest of your life. If you stop taking your medication before you are supposed to, not only could your medical condition get worse, but you could also experience severe side effects or withdrawal symptoms, and sometimes death.

BARRIERS TO MEDICATION ADHERENCE

In South Africa, patient non-adherence to medical treatment is a widespread problem, with far-reaching health, economic and social implications.

SELF ADVOCACY

The ultimate person responsible for your health is you! Make sure you understand your prescription before you start taking any medication:

Why do you need this medication?
How and when must you take this medication for the best outcome?
How must this medication be stored?
Are there any side-effects you can expect?
Are there any other medications / foods you should not take at the same time?
Keep a list all medications that you take, including prescriptions, over-the-counter drugs, vitamins, and supplements. Make sure your healthcare provider knows what other medications you take so they can check for adverse reactions. Make sure they also know about any allergies you have.
What might happen if you don’t take the medication as prescribed?

Don’t hesitate to ask your health care professional to repeat anything you do not fully understand, and write down the instructions if there is a chance you might forget them.

STORAGE

Use a schedule or medicine log if you have multiple medications or doses you have to take. This will avoid you taking the wrong dose or missing a dose. You can also set your cell phone alarm to remind you every time your next dose is due.
Keep a physical schedule with the medication so that both parents and other caregivers can know when and how to administer any medication, and also check off when a medication was administered so that there is no double-dosing.
Keep your medication in the boxes in which it is supplied. This avoids mixing up medications and keeps the prescription information and expiry dates intact. Never take expired medication. Never combine different medications in one bottle, as you risk taking the wrong one by mistake.
Most medicines should be stored in a dry, cool place, out of direct sunlight – although some, especially liquids, do need to be refrigerated, so be sure to check with your healthcare provider. If you don’t store your medication correctly, you run the risk of it losing its effectiveness.
Make sure your medicines are kept out of reach of children. Educate your children about medicine safety.

WHAT TO DO IF SOMETHING GOES WRONG

If you are having trouble with adhering to your medication prescription, speak with your healthcare provider. Your doctor or pharmacist can help you with advice from how to remember when to take your medication to managing side-effects. They may even recommend a different medication. Make sure they explain to you clearly when, how, how much, and for how long, you need to take your medication.

If you have accidentally taken the wrong medication, or taken too much of your medication, call your healthcare provider for advice. Should you be experiencing severe side effects, call a medical helpline immediately. If you have missed a dose of medication, do not take a double dose when next needed. Speak to your healthcare provider about how to manage this.

If you have lost the medication leaflet, inform your pharmacist. You can consult SAHRA’s online OTC Medication Information page for information on dosage and directions for of use, etc.

Accidental poisoning is unfortunately common, and children especially drink or eat medications thinking they are food. If anyone in your household has been poisoned, it is essential that you take emergency action: call the Poisons Information Helpline on 0861 555 777. This is a free 24-hour service that will provide you with expert advice on the substance, its side effects, and what to do. If a child has been or may have been poisoned, given the wrong medicine or wrong dose of medicine, do not wait for symptoms to occur. Do not try to make the child vomit as this can do more harm than good.

MEDICATION ADHERENCE

MEDICATION ADHERENCE

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

GETTING IT RIGHT

BARRIERS TO MEDICATION ADHERENCE

MEDICATION SAFETY

SELF ADVOCACY

STORAGE

WHAT TO DO IF SOMETHING GOES WRONG

FURTHER READING