When you have worked in a pharmacy for as long as I have, you hear some very odd things over and over again. I thought I would share some of these comments (embellished a little for dramatic effect) with the readers. Even though they may seem humorous, they are important educational opportunities for pharmacists to help clients with the overall success of their treatment.
10) "I missed my drugs this weekend, so I guess I was on a drug holiday since Thursday."
A true "drug holiday" is prescribed by your doctor, on a specific schedule, with a therapeutic goal in mind. Drug holidays are not when a patient decides to take a few days off of drugs and enjoy the weekend. This is how drug resistance occurs and will reduce the effectiveness of your therapy.
9) "I don't know the name of my medicine, but I think it was round and white and looks like an aspirin tablet."
It is very important you know the names of the medications you are taking and what they look like. I can't stress this enough! So many medications look alike and sound alike. You may not always be in the care of an HIV expert. Believe me, there are a lot of medical professionals who do not see HIV patients on a regular basis and are more confused than many of you about these drugs. You have to protect yourself and double-check everything.
8) "The prescription label says 'take three times a day,' so I took all three at once."
Unfortunately, the drugs used in HIV must be taken exactly as prescribed, with very little wiggle room. If the prescription says to take "twice daily," it usually means very close to every 12 hours (8 am and 8 pm, for example). The hardest one is "three times a day." Those drugs should be taken every 8 hours (8 am, 4 pm and midnight). Because this is sometimes hard to do, some people try to squeeze those doses together to 8 am, lunch and dinner. In this example, the patient has three doses between 8 am and 6 pm (10 hours) and no drug again until 8 am the next day (14 hours later). Over time, this may allow for resistance to develop to the drug.
Many drugs are now, or soon will be available as once-a-day dosing. This is great news, but please be careful to note that they may or may not be able to be dosed at the same time. Some drugs are still "empty stomach" and other "with food." Even though they are both once-a-day doses, the two drugs may have to be taken at different times during the day. This is the case with once-a-day Videx EC (take on an empty stomach) and Viread (take once a day with food). Please check with your provider or pharmacist if you need help with the scheduling of your medication.
7) When refilling prescriptions, the pharmacist gives the customer another bag full of drugs and he/she says, "I have enough of these protease inhibitors, you gave me a whole bottle last month."
Usually, a pharmacist gives you a 30 day supply of medication. When 30 days pass, and if you took all of your doses correctly, your bottle should be empty. If you find you have pills left at the end of the month, the pharmacist is concerned that you have missed doses or taken the medication incorrectly. If you can, give the pharmacist a few minutes of your time to help you. Pharmacists can be a great resource of information and tips about adherence and side effect management. We are not the drug police, we are trying to help you.
6) "The bartender I always go to is Thor. Nobody touches my hair except for Fredrique. I just go to any pharmacist because it doesn't matter who fills my prescriptions."
A lot of people get their medications in the mail and others go to large pharmacy chains where you are never sure who the pharmacist is that day. That's no problem if you can try to speak with the same person each time you need them. Find a pharmacy and pharmacist that you are comfortable with and then get their name. When you have questions for them, introduce yourself and ask to speak with the same pharmacist each time. Before you know it, you will be fast friends!
5) "My viral load was undetectable last month, even though I missed a few doses, so I guess it is okay if I miss a couple doses once in a while."
Even though you may get great results from your doctor, the goal of drug therapy is to have the viral load as low as possible for as long as possible. A few missed doses should not be a problem, but repeated adherence problems may shorten the duration of the regimen's effectiveness. A change in the drug regimen may have to occur sooner than you would like when there is poor adherence.
4) "I went to the health food store and bought all kinds of herbal products that the clerk told me would help my immune system."
Be careful with over-the-counter medications, including herbal products, because we don't know enough about how these agents affect HIV or the drugs used to treat HIV. We already know that there are some drug interactions, like St. John's Wort and protease inhibitors. Tell your doctors and pharmacists about these items you are taking. Be honest with your providers about anything you take prescribed from other doctors or that you buy on your own, including the use of alcohol and recreational drugs.
3) "I have a few days of medication left, so I will wait until this weekend to go to the pharmacy and get refills."
Sometimes the pharmacist has to reach the doctor for refill authorization or fix an insurance problem. If you wait until the last tablet is being swallowed on a Friday afternoon, it may take a few days to resolve these problems. Plan ahead so you and your pharmacist will be a lot happier! Usually a phone call to the pharmacy is all that it takes to get the ball rolling.
2) When trying to get prescription refills, the pharmacist tells you that your insurance coverage has changed, and you say "I got a letter from the insurance company, but I didn't pay attention to it."
It seems like insurance plans change all the time, and it is very important to keep up-to-date on this. It may be as simple as a change in the ID number, or it could be a complete change in coverage. Pharmacists spend about half of their time with insurance companies and billing for medications. If there is a change in your plan or benefits, please let us know so you don't get stranded out there without pharmacy coverage. We don't want the insurance companies to be the cause of any missed doses. Be a step ahead of them and read your insurance papers and notices.
1) "I'm going out of town for a year and an half, so could you give me all 18 months of my refill medication today?"
Usually insurance companies pay for one month's supply of medication every 30 days or so. Sometimes they will allow up to three months, but that depends on the insurance company's agreement with your employer or the agency giving the insurance benefit. Be careful if you have a plan for medication paid for only in the state you live in, or through specific pharmacies. This is especially true with Medicaid and ADAP programs. Theses benefits are usually not transportable to other states.
Don't forget to take advantage of a pharmacist's knowledge of drugs. It is usually free and most pharmacists are available at any time to help you with any problems that you may have.
Glen Pietrandoni is director of Clinical Pharmacy Services for the Walgreen Specialty Pharmacy, focusing on HIV, located in the Howard Brown Health Center of Chicago. Contact: Glen.Pietrandoni@walgreens.com.