Don't Overlook the Value of a Pharmacist
This month is National Sleep Awareness Month and the web is filled with all sorts of advice about how to deal with sleep challenges and disorders.
Most of it is of the "been there, done that" variety. Go to bed at a decent hour. No blue light at bedtime. Avoid coffee after 3pm. We all know these things (even if we don't always practice them).
But one piece of advice still sticks with me, and it has applications beyond the world of sleep medicine.
Identifying drug interactions and side effects
Don't overlook the value of your pharmacist to help you identify drug interactions and side effects. In the context of sleep health, this is great advice.
So many people have sleep problems which can be directly tracked to the mixing and matching of substances: over-the-counter formulas, prescriptions, nutriceuticals, and vitamins and supplements.
Dosages matter, so does the time of day when these substances are taken, and whether alcohol, illicit drugs, caffeine, nicotine, or marijuana are part of the picture. Even how these substances are taken can influence sleep at night and wakefulness during the day.
So, too, can people with MS experience strange side effects and uninvited interactions that are related to their medications.
Regarding specialty pharmacies
When it comes to disease-modifying treatments, the pharmacist you will get the best help from is the one you work with to acquire the medication.
Most people I know using DMTs receive their drugs through a specialty pharmacy. Often these are services offered by your insurance payer and/or pharmaceutical assistance program, and requests are handled by way of phone or email, with shipments of medications sent directly to your home.
My own experience with them has been quite good. A phone call or text sets up the next delivery of my Tecfidera, and I am always prompted with questions about symptoms and side effects. In addition, a nurse has been assigned to me, someone I can call at any time to ask questions about my medications and their potential side effects and interactions.
Day-to-day medication concerns
But even for those who don't use these high-end therapies, but use a variety of other things, the challenges can still be formidable.
What is the right dosage for me? When is the right time to administer this medication? Is oral, injected, or sublingual the right form? How can I avoid or prevent side effects?
And to further complicate matters:
- One doctor might give you a medication for a condition you have separately from MS (such as a prescription for RA).
- Another doctor might recommend increases in certain vitamins or supplements to address deficiencies
- You might live in a marijuana-legal state and wish to try a cannabinoid product for pain or sleeplessness
- You might be pregnant, on top of it all, or going through menopause, or coming back from a month of the flu
Of course, the best thing you can do is start with your doctor (or doctors) to get the advice you need.To maximize that communication, you'll need a list.
Keeping a medication list
To maintain the best communication between yourself and any healthcare provider you encounter, you should really consider providing a complete list of all substances you regularly take every time you see any doctor for any concern (even the dentist!).
This should list (by dosage and frequency taken) all active prescriptions for all health conditions (acute or chronic), vitamins, supplements, nutriceutical blends (such as herbal teas used for medicinal purposes), and an estimate of use for legal substances such as caffeine, nicotine, marijuana, and alcohol.
Not only is this a time saver for you at every doctor's appointment, it makes reviews of medications easier for those who need to see the Big Picture.
If you have a concern about side effects or interactions, and it falls between trips to the doctor, you can dash off an email, with this list attached, to your prescribing doctor, primary care physician or neurologist (if this option is available).
Or, you might need to make an appointment to get the help you need. Which is never a bad idea, but you may need to wait awhile to get the answers you need.
Meanwhile, you can also pay a visit to your neighborhood pharmacist.
Regarding neighborhood pharmacies
The local Rx can take a look at your list of substances, listen to your concerns and suspicions, and play detective, if you ask. Most are delighted to help out.
This is not to say that a pharmacist's word is better than your doctor's. However, pharmacists are in the business to know everything there is to know about medications, and that includes their side effects and potential interactions.
Doctors, on the other hand, may be unaware of the adverse effects of newer medications, or unaware that the familiar prescriptions they grant may have alternatives on the market which are easier to tolerate.
This isn't because doctors are unprofessional, wrong, or uncaring. It's because they're busy, and changes and updates in pharmaceuticals come rapidly. Research is released every day. It must be hard for them to keep up.
However, that is precisely the pharmacist's job.
Granted, turning to your neighborhood drugstore may or may not save you time. Stopping by the pharmacy may be pointless, if the flu is still rampant in your area, as the lines these days can be despairingly long, filled with people seeking treatment for viral infections.
But it's worth a shot.
The value of a pharmacist as a "second opinion"
If your pharmacist handles all of your prescriptions, they can be especially invaluable. They know your medication history and have access to all kinds of resources to cross check for problems with the substances you routinely take.
- They might find a discrepancy on your list—remember, the one I described above?—such as a potential contraindication based on the pharmaceutical profile they have for you in their database
- They might have a concern about a medication that might be giving your side effects which you previously thought were MS symptoms
- Maybe they know about a newer or improved version of your current medication, with fewer risks
- Or they might have special knowledge of herbal supplements and their risks, in case you're thinking about trying one
In any of these cases, they can't prescribe or change prescriptions independently, but they can reach out to your prescribing physicians, as necessary, to clear up any concerns or make suggestions.
If they see that you are taking an over-the-counter medication or supplement that they know can lead to certain problems, they can also do you a favor by raising an eyebrow and letting you know of their concerns.
If the vast majority of your prescriptions come to you through mail order, you can still approach them through their online consultants by phone, live chat or email (depending on what services they offer). They should be able to answer any questions you have.
At any rate, you stand to benefit by keeping in touch with your pharmacist— wherever they are—every time you fill a prescription, wish to try out a new medication on the shelf, or have been told all about the virtues of a new supplement.
As the old saying goes, It never hurts to ask. Also, seeking the opinions of more than one healthcare professional is part of what it means to be a proactive self-advocate.
Personally, I consider my neighborhood pharmacist and my specialty pharmacy as two integral parts of my MS team, and I think you should, too.
A good pharmacist has opinions that are both enlightened and framed by professional training. They could help you get to the bottom of a problem you haven't been able to correct otherwise and save you and your doctors a lot of future problems.
How many specialists did you see before finding "The One"?