Taking Medications Safely
Before medication is prescribed, tell your doctor:
- If you are allergic to any medications or have had an unusual reaction to any medication, food or other substance
- If you are currently taking any other medications (including over-the-counter medications), or dietary supplements such as herbal preparations, vitamins and minerals
- If you are pregnant, think you might be pregnant or plan to become pregnant
- If you are breastfeeding
- If you are following a special diet, such as a low-sodium or low-sugar diet
- If you have any other medical problems other than the one(s) for which your medication was prescribed
- If you have problems taking any medications.
Medication Guidelines
Note: These are general guidelines. Be sure to ask your doctor or pharmacist for guidelines specific to your medication.
How to Take Your Medications Safely
- Keep with you a list of all your medications and their dosages
- Some medications, such as warfarin (Coumadin) or insulin, require you to wear medical identification in case emergency medical treatment is needed. Ask your doctor if you need to wear medical identification for your type of medicine
- Take your medications exactly as prescribed by your doctor – including at the right times and for the full length of your prescribed treatment
- Do not stop taking your medications unless you first talk to your doctor. Stopping your medication too early can cause the illness to return or make it more difficult to treat
- Contact your doctor immediately if you experience any unusual side effects after taking your medication
- Follow the label instructions carefully -- some medications need to be taken with food, while others should be taken on an empty stomach
- Ask your doctor or pharmacist if there are any foods that should be avoided while taking your medication
- If you are taking medications with water, use a full 8-ounce glass of water. Do not just sip enough water to swallow the pills. Not drinking enough water with some medications can prevent them from working properly and can cause throat irritation
- Do not break, crush or chew medications before swallowing them unless you have been instructed to do so
- In most cases, you should not take any medications with alcoholic beverages. Check with your doctor for specific medication interactions or ask your pharmacist for more information
- Do not take a double dose of medicine
- Do not share your medications with others
When to take your medications
Try to take your medications at the same time every day.
Don't panic if you miss a dose of your medication. Take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your regular medication schedule.
Questions to Ask About Your Medications
Be sure you know the answers to these questions before you start taking any new medication:
- What is the name of the medication?
- Why do I need to take it?
- How often should I take it?
- What time of day should I take it?
- Should I take it on an empty stomach or with meals?
- Where should I store the medication?
- What should I do if I miss a dose?
- How long should I expect to take the medication?
- How will I know it is working?
- What side effects should I expect?
- Will the medication interfere with driving, working or other activities?
- Does the medication interact with any foods, alcohol, other medications (including over-the-counter medications) or activities?
Refill Guidelines
Refill your prescription while you still have at least a 5-7 day supply of medications left. Some sources, such as mail-order pharmacies, have a longer lead time for refills.
Storage Guidelines
- Unless given other storage instructions, store medications in a dry area away from heat and direct light. Do not store tablets or capsules in the bathroom, near the kitchen sink or in other damp places. Do not leave your medicine in your car for a long period of time.
- Do not store medications in the refrigerator unless directed to do so
- Always keep medications out of the reach of children
- If you store your medications in a pill organizer, label it with the medication name, dose, frequency and expiration date
- It is best to keep your medication tightly capped in its original container when not in use
- Do not keep medications that are outdated or no longer needed. Throw away old medicines
Sunburn and sun sensitivity
Many drugs can increase your risk of sunburn when you are exposed to the sun or a sunlamp. If you take a drug, labeled with "sun sensitivity," you should:
- Avoid prolonged periods in the sun
- Protect your skin with clothing and wear a hat
- Use a sunscreen with a Sun Protection Factor (SPF) of 15 or greater on all exposed skin
Travel Guidelines
Keep your medications in your carry-on luggage when you travel. Do not pack your medications in checked luggage, in case the suitcase is lost.
Take extra medication with you when you travel in case your flight is delayed and you need to stay away longer than planned.
Types of Cardiac Drugs
Ace Inhibitors
Angiotensin II Receptor Blockers (ARBs)
Antiarrhythmics
Alpha Blockers
Beta Blockers
Blood clotting Modifiers
Calcium-Channel Blockers
Cardiac Glycosides (Digitalis)
Central Alpha Agonists
Cholesterol-Lowering Drugs
Diuretics
Nitrates
Vasodilators
Ace Inhibitors
The ACE inhibitors are used to treat high blood pressure, and some treat heart failure as well.
How drug works: The kidneys help regulate the blood pressure by releasing a hormone called renin into the bloodstream. Renin, in turn, causes several chemical reactions that raise the blood pressure by contracting the small arteries in the body. The angiotensin-converting enzyme (ACE) inhibitors block one of the key reactions in this system, thereby lowering the blood pressure.
Side effects: The most common side effect is a dry, tickling cough. Some people notice disturbances in their sense of taste, and a very few people are extremely allergic to ACE inhibitors and may experience swelling of the face and throat.
ACE inhibitors cause the kidneys to retain potassium. Therefore, you should not use salt substitutes that contain potassium except on your doctor's orders. Because most of the diuretics cause the kidneys to waste (lose) potassium in the urine, diuretics are often used together with ACE inhibitors. In theory, one will balance the other in their effects on potassium. Also, the two drugs used together have more of an effect than either drug alone.
Angiotensin II Receptor Blockers (ARBs)
The ARBs are used to treat high blood pressure. They are currently being studied in patients with heart failure and some patients may be treated with ARBs if they cannot tolerate the side effects of ACE inhibitors.
How drug works: These drugs work in a similar way to ACE inhibitors. The difference is that ARBs block the effects of a certain chemical that is formed in some patients with high blood pressure. ARBs "plug into" the receptor of this chemical and prevent an increase in blood pressure.
Side effects: The side effects for ARBs are few. The most common side effects are headache and dizziness. These side effects will go away in time or with a dosage reduction. The one side effect that does not occur with these drugs is a dry, hacking cough, which can occur with ACE inhibitors.
ARBs can cause the kidneys to retain potassium. Therefore, you should not use salt substitutes that contain potassium except on your doctor's orders. Many patients will benefit from the addition of diuretics ("water pill") to help lower blood pressure, and many "water pills" cause the kidneys to lose potassium. In theory, these effects will cancel each other out. However, your doctor will periodically ask you to have blood drawn to measure potassium levels.
Antiarrhythmics
How drug works: The heart has its own electrical system that keeps its beat regular. Irregular heartbeats can develop when part of the heart muscle is damaged or when the electrical system is disrupted. The antiarrhythmics make the heart muscle less sensitive to electrical "static" so it can resume a regular beat.
You should take your medication exactly as directed, even though you may feel well. Do not take more medicine than ordered. Do not stop taking this medicine without first checking with your doctor. Stopping it suddenly may cause a serious change in the rhythm activity of your heart. Your doctor may want you to gradually reduce the amount you are taking before stopping completely.
Alpha Blockers
How drug works: The alpha blockers lower blood pressure by relaxing the small blood vessels throughout the body.
Side effects: These drugs may cause your blood pressure to drop when you stand up suddenly, causing you to feel dizzy or even to faint. This is most likely to happen the first time you take the drug. The first dose and any increases in dosage should always be taken at bedtime, and you should not engage in potentially hazardous activities for the next 12 hours.
Other potential side effects are drowsiness, weakness, fatigue, nasal congestion, swelling of the ankles or feet, nausea, irregular heartbeats, and blurred vision.
Beta Blockers
How drug works: Normally, when you are working hard, under stress, or frightened, the body produces a hormone called adrenaline that makes your heart beat faster and more forcefully. The beta blockers prevent this hormone from "plugging into" one type of its receptors. Therefore, they make the heart beat slower and less forcefully. This lowers the blood pressure and also makes heart muscle use less oxygen. This is good, especially if the blood supply to the heart through the coronary arteries is partially blocked.
Side effects: Sometimes, you may notice you can't raise your pulse very much when you want your heart to beat faster, as when you are doing aerobic exercise, for example. If you are taking a beta blocker, the heart has a "speed limit." The result is you may get tired more quickly. The beta blocker forces you to slow down and take it easy.
In people with hypertension (high blood pressure) on beta blockers, the body "wants" to keep the blood pressure high. The body tries to make up for the low pressure by making the small blood vessels in the arms and legs get narrower. Therefore, less blood flows through them, and in the winter, these people may get cold fingers and cold toes.
People with asthma should not take beta blockers because these drugs narrow the small air passages in the lungs. Some beta blockers increase the level of cholesterol in some patients, and some will increase the blood sugar level. People with diabetes need to be careful and stay with their program of testing their urine, controlling their diet, exercising, and taking their medication because beta blockers will hide the warning symptoms that they get when an insulin reaction is coming on. Some people report having strong dreams or being depressed while on beta blockers.
Blood clotting modifiers
Each of these drugs affects how blood clots, which is very important for people with atrial fibrillation, mechanical heart valves, and certain other cardiovascular conditions. Use of these medications often requires special precautions. Please see the individual drug descriptions for more information.
Calcium-Channel Blockers
These drugs are used to treat high blood pressure and also to control angina.
How drug works: The arteries have muscle cells in their walls that can contract or relax to control the blood pressure and the amount of blood flowing through them. When a nerve sends a signal to these cells to contract, tiny pores in the muscle cell wall open up to allow calcium ions to enter, and the calcium entering the muscle cells makes them contract and narrow the diameter of the artery, raising the blood pressure. The calcium-channel blockers keep the tiny pores ("calcium channels") closed, so calcium does not enter the muscle cells, and the artery stays relaxed.
Side effects: Most calcium-channel blockers can cause headaches and swelling of the ankles. However, side effects may be avoided by changing agents, since their structures are distinctly different. Calcium-channel blockers that contain verapamil (Calan, Isoptin, Verelan) produce somewhat different side effects. Many people find that these drugs make them constipated. Also, these drugs tend to slow the heart rate in the same way that beta blockers do. The side effects of calcium-channel blockers that contain diltiazem (Cardizem, Dilacor) are similar to those of verapamil, but milder.
Cardiac Glycosides (Digitalis)
How drug works: The purple foxglove plant has been used for hundreds of years to treat heart failure. The active ingredient, digitalis, causes the heart to beat slower and more forcefully, which improves circulation and helps reduce fluid accumulation.
Side effects: Your doctor may ask you to take your pulse every day before you take your medication, and to notify him or her if the pulse is below a certain number, usually 60. This is to make sure you are not getting too much digitalis. You may become more sensitive to side effects of digitalis if your blood potassium concentration becomes low, which can happen with prolonged vomiting, diarrhea, or if you are taking a diuretic. However, you should not take a potassium supplement or use a salt substitute that contains potassium except with your doctor's permission. Your doctor also may ask you to weight yourself every day. If you are rapidly gaining weight, you may be retaining water. Because sodium (salt) makes the problem of water retention worse, you may have to follow a low-salt diet.
Central Alpha Agonists
How drug works: The central alpha agonists work inside the brain to lower the blood pressure.
Side effects: Common side effects include drowsiness, sedation, and dry mouth. Some people may experience a drop in blood pressure when they stand up suddenly, making them feel dizzy or even pass out. Taking the medicine at bedtime can reduce the impact of possible side effects.
You should not stop taking these medications abruptly because your blood pressure could "rebound" higher than it was before you started taking the medication
Cholesterol-Lowering Drugs
Some people have a genetic predisposition to high blood cholesterol levels. These people may need drug therapy in addition to diet to bring their cholesterol down to a safe level.
Niacin (nicotinic acid) is a B-complex vitamin. The main side effects are flushing, itching, tingling, and headache. Bile-acid sequestrants such as Questran work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulation. Bile is made largely from cholesterol, so these drugs deplete the body's supply of cholesterol. The most common side effects from these drugs are constipation, gas, and upset stomach.
HMG-CoA reductase inhibitors such as Mevacor and Pravachol block production of cholesterol in the liver itself. These drugs can also produce intestinal side effects, as well as damage to the liver itself, and in a few patients, muscle tenderness. These drugs will be more effective if you continue to follow a low cholesterol diet. Your doctor may be able to refer you to a dietician for help in designing a diet especially for you and encouraging you to stay with it.
Diuretics
The diuretics cause the kidneys to excrete more water and are sometimes called "water pills." Besides making you urinate more, these drugs can lower your blood pressure, and in people with heart failure, diuretics can reduce swelling and accumulation of fluid.
There are three types of diuretics:
- The thiazide diuretics are mostly used to treat high blood pressure.
- The more powerful loop diuretics are used more in heart failure and in kidney failure.
- The potassium-sparing diuretics are gentle diuretics, mostly used along with thiazides to prevent the loss of potassium that thiazides cause.
How drug works: Potassium and sodium are minerals. Most people take in too much sodium in the diet in the form of salt and monosodium glutamate. Most commercially prepared foods are loaded with sodium. Too much sodium causes many people to retain water and makes their blood pressure go up. The diuretics work by making the kidneys get rid of more sodium, but the more sodium you eat, the higher the dose of the diuretic you will need. Therefore, your doctor will encourage you to eat foods that are low in sodium. Unfortunately, thiazide diuretics and loop diuretics make the kidneys also excrete more potassium. The concentration of potassium in the blood has to stay fairly constant, or else irregular heartbeats can occur, especially in patients who are taking cardiac glycosides such as Lanoxin. Therefore, your doctor or dietician will encourage you to eat foods that are high in potassium. Fortunately, these tend to be healthy foods such as fruits and vegetables. Some people may need to take potassium supplements; however, do not start using a salt substitute that contains potassium without asking your doctor about it first.
Side effects: Besides lowering the potassium level, thiazide and loop diuretics may increase the levels of cholesterol and sugar in the blood, and they may affect the levels of other minerals in the blood as well. These drugs can cause dehydration, especially in elderly or debilitated patients. The symptoms of low potassium include nausea, numbness, confusion, drowsiness, and weakness. Report these to your doctor immediately if they occur. Some people will be more sensitive to sunburn, and some may develop a rash. If you have gout, your doctor will especially want to measure your level of uric acid, because thiazide and loop diuretics can increase the level of uric acid in the blood.
The potassium-sparing diuretics produce their own set of side effects. These drugs raise the level of potassium in the blood, and too much potassium can be as bad as too little. Therefore, you should not use a potassium supplement or a salt substitute that contains potassium, except on your doctor's orders. The symptoms of too much potassium are similar to those of too little: weakness, numbness, confusion and heaviness in the legs.
Nitrates
How drug works: The nitrates are used to prevent or treat angina (the chest pain that happens when heart muscle needs more blood than the blocked-up coronary arteries can deliver). The nitrates relax the blood vessels all over the body so that the heart doesn't have to work as hard. Nitrates come in several forms: tiny pills that are placed under the tongue, regular pills, aerosol sprays, and patches and pastes that are applied to the skin. Different people may experience angina in different ways. Most describe it as a crushing pain in the middle of the chest that comes on or gets worse with exercise. However, some people feel it in the neck, jaws, or shoulders, and some people mistake it for indigestion. Whatever it feels like to you, you should stop what you are doing as soon as it starts, sit or lie down, and if your doctor has prescribed medicine to take during an attack, take it immediately.
Your doctor will want to know how often you have attacks of angina and what sets them off. Use common sense to avoid activities that will bring on angina (shoveling snow, for example).
Side effects: The most common side effect of nitrates is a headache, caused by relaxed blood vessels in the head. They also cause the blood pressure to drop, sometimes causing dizziness, flushing, or an awareness of the heart pounding. Alcohol makes the side effects worse.
For most people, a nitrate is only part of a total cardiac program that includes gentle exercise, a low-cholesterol diet, and for smokers, medicine and counseling to help them quit.
Vasodilators
How drug works: "Vaso" refers to blood vessels, "dilate" means to open or stretch; the vasodilators cause the blood vessels to relax and open, thus reducing the blood pressure. These drugs are never used by themselves. If they were, in time the body would respond by increasing the heart rate and by causing the kidneys to retain more salt and water. Rather, these drugs are used in combination with other blood-pressure lowering drugs such as diuretics and beta blockers in people who have seriously high blood pressure. The diuretic makes the body get rid of the extra fluid, and the beta blocker keeps the heart rate down.
Side effects: The most common side effects are headache, rapid heart rate, flushing, and sweating. These drugs can also cause symptoms of angina in patients with coronary artery disease. One of these drugs, Loniten (minoxidil), has the side effect of making people grow more hair.
Some people may experience a drop in blood pressure when they stand up suddenly, which would make them dizzy or even faint. Be careful, and stand up slowly. At high doses, Apresoline can cause symptoms of lupus (fever, joint pain, and an all-around feeling of not being well) in some people. If this happens, tell your doctor immediately.
Food and Drug Interactions
Vitamin K-containing foods and blood thinners
Grapefruit and grapefruit juice
Alcohol
It is well known that certain foods may interfere with the optimal results of certain medications. In the past, it was noted that certain medications need to be taken on an empty stomach to assure that the drug will get absorbed. However, it has only been over the past decade that we have a better understanding that certain foods may alter the action of medications by not only interfering with absorption but by other mechanisms. See When to take your medications and what to do if you miss a dose for information on whether medications can or cannot be taken with food. This section describes other potential drug-food interactions.
Vitamin K and blood thinners: One of the most commonly described food and drug interactions is that of high vitamin K-containing foods and Coumadin (warfarin). Coumadin inhibits the body's ability to use vitamin K needed to form proteins to clot blood. The effects of Coumadin can be overridden by increasing the amount of vitamin K in your diet. Foods that are high in vitamin K include: green leafy vegetables, cucumbers with peel, broccoli, brussel sprouts, mayonnaise, canola, salad, and soybean oil. This does not mean that vitamin K-rich foods should be avoided, but rather patients should maintain a consistent dietary intake (keeping in mind moderation). Most problems with vitamin K-rich foods occur when patients change their eating habits and dramatically decrease or increase the amount of vitamin K foods in their diet. This commonly happens in the summer when fresh vegetables are in season.
Grapefruit or Grapefruit juice: Another food that interacts with certain blood pressure medications is grapefruit or grapefruit juice. A chemical in grapefruit juice may adversely affect how certain medications work in the body and should be avoided. Certain calcium channel blockers have been studied for this food-drug interaction and some have shown significant interactions (Procardia, Adalat, Plendil, and Sular), whereas others that have been studied only showed mild to moderate significance (Norvasc, Calan and other verapamil products, and Cardizem and other diltiazem products). Grapefruit juice may also interfere with cyclosporine (Sandimmune or Neoral) by increasing the levels of this medication and should be avoided. Not all drugs have been tested with grapefruit juice, and therefore, this does not include all medications that could potentially be interfered with by the ingestion of grapefruit juice. If you have specific concerns about this type of food-drug interaction ask your doctor or pharmacist or avoid grapefruit juice. Orange juice does not appear to have this interaction because the chemical in grapefruit juice is not present in orange juice.
Alcohol: A commonly asked question "Can I drink alcohol with this medication?" is an important one. Alcohol-containing drinks may interfere with many cardiovascular medications and as a general rule should be avoided. Alcohol interferes with the liver's ability to remove drugs from the body, causes sleepiness (which is also a side effect of many medications), and may lower blood pressure when used with certain medications.
Alcohol & Coumadin: Coumadin is largely removed in the body by the liver, and alcohol can interfere with this process. Alcohol can cause two different interactions with Coumadin, based on the pattern of alcohol use. Patients who use alcohol occasionally are at risk of interfering with Coumadin's removal from the body. This may result in your blood becoming too "thin" and increase your risk of bleeding. Those patients who are chronic users of alcohol tend to remove Coumadin from the body more quickly and may require higher daily doses than those who do not drink. Chronic alcohol drinkers are still at risk of having too "thin" blood if they consume higher than usual amounts of alcohol (just like the occasional drinker). Chronic users of alcohol with liver disease are at high risk of bleeding due to the body's inability to remove Coumadin and may require very small doses of Coumadin. The best recommendation is to avoid alcohol when taking Coumadin.
Alcohol and tranquilizers: Alcohol is sedating, and tranquilizers may worsen this effect. Also, alcohol can decrease the removal of tranquilizers from the body and lead to long lasting sedation when alcohol is also used. Of course, this can be dangerous and increase the risk of falls and injury.
Alcohol, vasodilators, and blood pressure: Alcohol can cause blood vessels to get larger (vasodilate) and lower blood pressure. This could be additive if alcohol is taken with medications that lower blood pressure. Isordil, Nitroglycerin, Imdur, ISMO, Monoket, and any of the nitroglycerin patches may cause significant lowering of blood pressure when used with alcohol.
Alcohol and Aspirin & anti-inflammatory drugs: The combination of alcohol and aspirin greatly increases your risk of developing bleeding in the stomach. It is well known that aspirin can cause damage to the stomach lining, and alcohol can add to the damage. Other medications similar to aspirin like Advil, Nuprin, Motrin IB, Aleve, and others act the same as aspirin on the stomach and also should not be used with alcohol.
It is important if you have questions regarding certain foods that you talk with either your pharmacist or doctor.
Special Considerations for those taking Immunosuppressant Medications for Heart Transplant
Patients undergoing heart transplantation will be on many medications afterwards to help prevent rejection of the heart. Medications will be a major part of your life after transplantation, and it is very important that you take these medications exactly as your doctor prescribes in order to prevent your new heart from rejecting. Many medications used to suppress the immune system are dosed depending on blood levels of the drugs, therefore periodically you will need lab tests to ensure the levels of these drugs are not too low or high. High levels of these drugs may increase side effects and increase your risk for infections. Low levels may increase the risk of rejection.
Because serious infections can develop in patients on immune-suppressing drugs, it is important that you notify your doctor of any symptom that may be related to infection (such as fever, chills, sore throat, blood in the urine, increase in frequency of urination or pain with urination).
Resource:
Every effort has been made to ensure the accuracy of this information in this drug search. But daily changes can occur in the field of medications, so consult your doctor or pharmacist for the latest available data.
This search is not a substitute for medical advice. Check with your physician before taking any medication.
© 2008, revised 2004
Michael A. Militello, Pharm D
Cleveland Clinic
Mandy Leonard, Pharm D
Cleveland Clinic
