Medications can prevent illnesses, relieve symptoms, cure diseases and save lives. But they can also cause side effects, especially when taken in certain combinations, and they can be costly. If you’re taking multiple medications at once, you might be wondering how to reduce that number.
First, a word of caution: Do not stop taking any medicine or decrease the dose without first talking to your doctor. Changing a medication suddenly could make matters worse, says UNC Health family medicine physician Sarah Ruff, MD.
Sometimes, lifestyle changes—such as improving your diet and exercising more—can reduce your need for medication. But not always.
“For some people, the cause is hereditary,” Dr. Ruff says. “Even if they lose weight, lower their salt intake and exercise, they will still have high blood pressure and will need medication.”
It’s important to discuss your medications and doses at every doctor visit. The type or dose you need may change over time as your body changes. Your weight, stress levels, exercise and sleep all affect how medication works for you. Age is a factor, too.
“Taking a lot of different medicines can be a big risk for people 65 and older,” Dr. Ruff says. “When you’re older, certain medications may cause worsening dementia or incontinence. Sometimes drugs can cause an increased risk of falling. We need to review their medication list carefully.”
Generally, medications are listed in your electronic medical record (EMR), which is common among medical practices these days. Anytime a provider gives you a prescription—whether it’s your regular provider, a specialist or an urgent care professional—your provider should update your EMR. It’s the same situation for any medications you started or changed while you were in the hospital.
One exception is over-the-counter medicines. Your EMR won’t include these unless you let your doctor know what you are taking.
“The best thing is to bring a bag of all the medicines you’re taking to your doctor’s appointment—prescription, over-the-counter and supplements,” Dr. Ruff says. “You may have multiple medicines and different doses. Even with the EMR, it’s important to verify exactly what the patient is taking.”
If you don’t want to bring the bag, you can keep a list with the name, dose and frequency of each medicine, or take photos of the bottles or packages. Be sure to include the list of ingredients for supplements or nonprescription medicines.
“It helps to make sure we’re all on the same page,” Dr. Ruff says.
Medications for Anxiety and Depression
When people with anxiety and depression start feeling better, they may want to stop taking the medications that treat these conditions, Dr. Ruff says, but stopping too soon or too suddenly could cause symptoms to rebound.
If the causes of the anxiety or depression have gone away or lessened or you are managing it successfully through counseling or lifestyle changes, then it might be appropriate to taper off the medicines. Your doctor can help you plan a strategy to safely stop taking them.
Medications for Blood Pressure and Cholesterol
Some people have high blood pressure, some have high cholesterol levels, and some have both. Different medicines treat these two conditions.
High blood pressure and high cholesterol levels both increase the risk of heart disease and stroke, and fortunately the same lifestyle changes can be beneficial, Dr. Ruff says.
“Improving your diet and exercise levels can help reduce blood pressure and cholesterol, but it can also improve your overall health and help prevent some medical problems,” she says. Other ways to reduce blood pressure and cholesterol levels include not smoking, limiting the amount of alcohol your drink and getting enough sleep.
“That still may not be enough to completely control your blood pressure or cholesterol,” she says. “Many people have to be on medications their whole life, and there’s nothing wrong with that.”
Talk to your doctor about any medications you are prescribed to control pain, Dr. Ruff says. These include opioids, which should be taken with great care.
“Ideally, prescription pain medicines are used for short periods of time after surgery or a serious injury,” she says. “A lot of times, patients are allowed to take these medicines as needed. You’ll have some patients who will undertreat their pain because they’re afraid opioids will be addictive. Other patients overtreat their pain.”
Some over-the-counter medications—such as acetaminophen (Tylenol), ibuprofen (Advil) and naproxen (Aleve)—can help relieve pain, she says, and they aren’t associated as much with addiction. But taking too much of these medicines for too long can damage the kidneys or stomach.
Medications for Sleep Problems
More than the occasional sleepless night, sleep disorders include conditions such as sleep apnea and chronic insomnia. Although these disorders may require medication or equipment to manage, many people can improve their sleep with lifestyle changes, Dr. Ruff says.
“Sometimes the problem is their work schedule or too many things going on,” she says. “Calming down their schedule may be more helpful than medication to sleep well.”
Other suggestions include:
- Keeping a consistent sleep routine—go to bed and get up at the same time each day, even on weekends
- Getting at least seven hours of sleep per night
- Not working or watching TV in bed
- Reducing fluid intake before bed
- Turning off electronic devices at least 30 minutes before turning in
- Not eating large meals before bedtime
- Avoiding caffeine in the afternoon and evening
Supplements and Other Drugs
Supplements such as vitamins, fiber, magnesium, stomach acid reducers, herbs and CBD all may have benefits, but sometimes they interfere with prescriptions or hide other problems your doctor should know about.
“Most supplements are not regulated,” Dr. Ruff says. “There’s not really good medical evidence for how they work. They’re not well-studied or regulated. But if a patient is finding them helpful, then they can be OK. Just make sure you talk with your doctor about them.”
Bring the bottle to your appointment, she says, so your doctor can review the ingredients. For example, a multivitamin and another supplement you’re taking both may contain iron, and too much could cause constipation.
Also, be honest with your doctor about how much alcohol and caffeine you drink, as these drugs might interfere with other medications you’re taking.
“Alcohol doesn’t interact with most medicines, but it does react with some,” Dr. Ruff says. “And drinking too much caffeine can cause heart palpitations.”
All in all, as our bodies change, our medication needs may change, especially as we age and our overall health improves or declines. Your doctor can help you keep things in balance if the provider has a full picture of the medications and supplements you’re taking. “Just make sure you keep your doctor in the loop,” Dr. Ruff says.
If you want to reduce the medications you’re taking, or if your health has changed, talk to your doctor or find a healthcare professional near you.