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Before Following Pill Bottle Warnings, I Want to Know Why

November 5, 2011

pill bottle with warning text

Photo used under CC Some Rights Reserved license; by jypsygen

When you have a medicine with an instruction like, “do not take with alcohol?” or “tell your doctor if…,” do you really know why, or how serious the consequences of not following the instruction could be? The drug label and insert are unlikely to offer further detail, but I always wonder just how seriously I need to take those warnings. Knowing why I’m being warned, and how likely and severe problems might be, would go a long way in convincing me to actually follow the instructions.

To use a common example, a new medicine, whether over-the-counter or prescription, that instructs “do not take with alcohol.” I want to know – is it because I might feel stronger effects of the alcohol and need to moderate my drinking? To me, that’s a different issue than, “3 out of 10 patients will have irreversible, severe liver damage.” I might just assume the first, less bad consequence is the real one, and only follow the “do not” instruction until I feel that I know how the combination of the medicine and alcohol affects me. If I knew that a more serious consequence was a reality, I might take the directive more seriously.

I need details. I want to know, “What’s excessive sunlight? How much water is plenty? By ‘take with food,’ do you mean a snack, or a meal? What are the consequences if I ignore this, and how serious are they?”

What if the medicine is short-term (like a week of antibiotics) vs. longer-term (like an antidepressant or birth control)? Sure, you might follow a “do not” instruction for a week, but for months or years? I personally can’t tolerate simply following an instruction without context – it’s a characteristic that has gotten me into more than a little trouble over the years.😉

Yes, I know – drug labels are already confusing, and adding more information to them as they are designed right now maybe wouldn’t help matters. Perhaps something clear on the insert – the little brochure that comes with your medicine – would be a good alternative. In general, I’m all for redesigning drug labels, packaging, and instructions (especially when more than one medicine is needed) so they are more useful and less confusing. There are some serious issues around language, literacy, and design that might make adding more information problematic, but it’s a worthwhile challenge if it results in people actually having a better understanding of instructions and their relative importance.

And, yes, that’s what pharmacists are for, and perhaps people should ask them these questions more often. So often, though, you have to make a special request to actually talk to a pharmacist, and the question – “Hey, can I ignore this and have a margarita at happy hour?” – might not be one that most people are comfortable asking. It’s also rare to have real privacy when speaking to a pharmacist – those little plastic nowhere-near-a-walls don’t quite do it for me.

The bottom line is that I’m inclined to ignore any instruction that doesn’t come with an explicit rationale and some indicator of how seriously I should take it, and drug labels are one important place where that’s a problem. Anybody else similarly inclined? What would you like to know about the various warnings that come on OTC and prescription drugs?

8 Comments leave one →
  1. A'Llyn permalink
    November 5, 2011 10:24 am

    Definitely I wonder about these! Not so much if it’s short term, like antibiotics–as you said, it’s easy enough in those cases to just say “fine, no alcohol for a week” or whatever.

    But if it’s something you’re taking every day forever, like my thyroid medication, you start to wonder. OK, take first thing in the morning on an empty stomach with a full glass of water. How big a glass, exactly? How long does your stomach have to stay empty? What happens if you forget and eat something first–should you still take it, or do you have to wait for your stomach to get empty again, and how long does that take? It probably depends on what you ate, right? Is there a formula for working this out?

    And now I’m taking a prenatal vitamin that also says to take on an empty stomach–can I take them both on the same empty stomach, or does one invalidate the empty stomach for the other?

    If I get motivated, I look it up on the NLM Drug Information Portal or something. (It turns out that you shouldn’t take them together because one interferes with the absorption of the other, so I have to take the prenatal vitamin at night instead of in the morning, and my stomach is not really empty except in the morning because I am EATING ALL THE TIME, so probably I’m not fully absorbing everything in that pill, but the thyroid hormone is supposed to be important for the developing brain, so, bah, you just have to make a call.)

    I totally get that they can’t explain every detail of every question anyone might have on one label, but yeah, the simplistic little yellow warnings are not always helpful.

  2. November 5, 2011 10:40 am

    I take enough meds at this point to be fanatical about reading everything I can about the drug, its chemical compositon, how it works and what the side effects may be. Because the little CYA stickers from the pharmacy don’t mean jack. They’re there so the pharmacist can fill multiple Rx without explaining the drug in detail.
    I know not everyone has a lot of chemistry in their background but I still wish theyd at the very least read up on the med at drugs.com or someplace similar.

    • November 5, 2011 10:51 am

      Right, but not everybody has regular internet access, awareness of those sites, or the literacy levels or matching language background to get them. I guess I’d like a middle ground between useless CYA stickers and expecting people to get to the right sites, understand them, and be able to translate what they read into a regular plan of action. I’ve already mentally ruled out physicians doing more education about prescribed and OTC products, so I feel like the pharmacy/packaging level is one place where an intervention is possible for all users, moreso than the spotty coverage accomplished by motivating and equipping with skills for each individual to look things up in more detail independently.

      • November 5, 2011 11:32 am

        Good point. I should have thought that thru.

        Honestly, though, I’m still stuck on it being the job of the pharmacy to REALLY explain the drug. Not to just staple an info sheet to the bag and say “do you have any questions?” I really do blame Walgreens & CVS for placing volume sales ahead of patient education.

      • November 5, 2011 1:24 pm

        Agreed.

  3. November 5, 2011 3:21 pm

    Um interesting and I’m with you on this. Have to say never really any serious thought into this until your entry here. You are right on this for sure.

  4. Tracy permalink
    November 7, 2011 10:59 am

    This. OMG, this! Right down to the no real privacy afforded when talking to the pharmacist, assuming you are willing to even ask the tough questions. OTC medications are a whole other layer. Just think about all those livers out there potentially damaged because people don’t bother to pay attention to how much Tylenol they’ve taken lately.

    What if a medical professional tells you something slightly different from the package or teeny tiny sticker on the bottle? When told I should take a particular medication before eating — I’d be curious if there is consensus on “take with food” or “before eating” means a snack or full meal, even among medical professionals — the doctor told me 20-30 minutes, but the pharmacy information said 1 hour. Which is it? Does it matter? I shouldn’t need an advanced degree in Pharmacology to parse all this out.

    The scary part is that I’m lucky to have the ability and skills to find the correct information, understand it, and apply it, and I still have confusion. What must the average patient go through? (And that’s not even getting into health literacy issues…)

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