20 Things Pharmacists Want You to Know About Your Medications

Your pharmacist can be one of the most useful resources available when you have questions about a medication. Their professional education focuses heavily on drugs, including how medications work, how they interact, how they should be taken, and what side effects or safety problems to watch for.

In the United States, pharmacists earn a Doctor of Pharmacy, or PharmD, from an accredited pharmacy program. Admission requirements vary: some programs require a bachelor's degree, while others admit students after they complete required pre-pharmacy college coursework. The professional PharmD curriculum is typically equivalent to four academic years, although accelerated and other program structures exist. To learn more about the pharmacist's perspective, 24/7 Tempo spoke with Kelly Moore, a hospital-based pharmacist in New York. Hospital pharmacists commonly work alongside physicians, nurses, and other clinicians to review medications, recommend drug therapies and doses, monitor treatment, and help prevent medication-related problems.

That expertise can be especially valuable when several medications, supplements, or over-the-counter products are involved. Pharmacists routinely check for drug interactions, duplicate therapies, allergies, inappropriate doses, and other potential problems. Medications can be enormously beneficial when used properly, but even familiar prescription and over-the-counter drugs can cause serious harm when taken incorrectly.

Here are 20 things pharmacists want you to know about your medications:

Make sure your pharmacist knows about prescription drugs, over-the-counter medications, vitamins, and dietary supplements you take. “You may be taking an over-the-counter medication that is not in your profile,” Moore said. Products purchased without a prescription can contain ingredients that interact with prescription medications, and supplements can cause clinically significant interactions as well.

It is possible to accidentally take too much of the same active ingredient by combining different products. Acetaminophen, commonly sold under the Tylenol brand, is found in hundreds of prescription and over-the-counter products, including many cold and flu medicines. Taking more than the recommended amount can cause severe liver damage and may be fatal.

Some cold and allergy medicines also contain decongestants such as pseudoephedrine, which may be inappropriate for people with certain conditions, including high blood pressure or heart disease. Dietary supplements deserve attention, too. St. John’s wort has numerous documented drug interactions, while goldenseal can interfere with the way the body processes some medications. Tell your pharmacist about supplements and herbal products just as you would prescription drugs.

Being available without a prescription does not mean a medication is safe for every person in every situation. Medical conditions such as high blood pressure, diabetes, kidney disease, liver disease, glaucoma, and heart disease can affect which OTC products are appropriate. Age, pregnancy, allergies, and other medications can matter as well.

If you have a chronic medical condition, take other medications, or are unsure whether an OTC product is appropriate, ask a pharmacist or other health care professional before taking it. Reading the Drug Facts label is also important, particularly when combining cold, pain, allergy, or sleep products that may contain overlapping ingredients.

Pharmacists generally do not determine the retail price or insurance copay for a medication, but they may be able to help identify a lower-cost option. FDA-approved generic medicines are required to provide the same clinical benefit and have the same risks as their brand-name counterparts. They must also match the brand-name drug in areas including strength, dosage form, route of administration, safety, effectiveness, stability, and quality. Depending on the medication, prescription, state law, and insurance plan, a pharmacist may be able to dispense a generic or discuss alternatives that you can ask your prescriber about.

Some manufacturers offer savings cards or copay assistance for certain brand-name medications, and pharmacies may be able to point patients toward other discount options. Eligibility varies, however. Manufacturer copay coupons generally cannot be used for drugs paid for by Medicare, Medicaid, or other federal health care programs. Check the terms of any savings program and compare the resulting price with your insurance copay or other available options.

Health plans use formularies, or lists of covered prescription drugs, and the amount you pay can vary considerably between medications used for similar purposes. Before paying a high copay, check your plan's formulary or ask the insurer whether it prefers another medication in the same drug class. If there is a less expensive covered alternative, your prescriber can determine whether switching would be medically appropriate.

A pharmacist's job involves more than putting the correct number of tablets into a bottle. Before a prescription is dispensed, pharmacists may need to verify the drug and dose, review a patient's medication profile, check for allergies or interactions, resolve insurance problems, contact the prescriber, and make sure the medication is labeled correctly. Those safety checks are one reason a prescription may take longer than expected.

Drive-thru pharmacy windows can make picking up medication more convenient, but they do not turn the prescription process into fast food. The same verification, safety, insurance, and counseling requirements still apply whether a customer is inside the store or waiting in a vehicle.

Wait times vary by pharmacy, prescription, staffing level, insurance issues, and whether the medication is ready when the patient arrives. If speed matters, checking the prescription's status through the pharmacy's app, website, or phone system before heading to the store may save a trip.

Some pharmacy drive-thrus are designed only for customers in vehicles and may not serve people who approach the window on foot. Policies vary by chain and location and may reflect safety, traffic, building design, or local requirements. If you are not in a vehicle, use the store entrance when available or contact the pharmacy to ask what pickup options it offers.

Splitting tablets can sometimes be an appropriate way to adjust a dose or reduce costs, but not every tablet is designed to be divided. FDA says patients should talk with a health care professional before splitting a tablet. A scored tablet may be approved for splitting, but even a score line does not mean every medication should automatically be divided.

Most sustained-release, controlled-release, and timed-release tablets should not be split unless the drug's labeling specifically allows it. Breaking the wrong tablet can change the way the medication is released or make it difficult to get an accurate dose. Never cut pills simply to stretch a prescription without first talking with your pharmacist or prescriber.

The FDA recommends a drug take-back location or prepaid medication mail-back program as the best way to dispose of most unused or expired medicines. Pharmacies, hospitals, clinics, and law-enforcement facilities may have permanent collection boxes, and the Drug Enforcement Administration also holds National Prescription Drug Take Back Day events.

If a take-back option is not readily available, check the medication instructions and FDA guidance. Certain particularly dangerous medicines appear on the FDA's flush list and may be flushed when a take-back option is unavailable. Most other medicines can be put in household trash after being removed from their containers and mixed with something undesirable such as dirt, cat litter, or used coffee grounds, then sealed in a bag or container. FDA specifically advises not to crush tablets or capsules.

Searching the internet can be useful, but medication information varies enormously in quality. Reliable information is freely available from sources such as the U.S. Food and Drug Administration, National Library of Medicine's MedlinePlus, National Institutes of Health, and other government and major medical organizations. A pharmacist can also help explain how information found online applies to a specific prescription.

Water is commonly recommended with tablets because enough liquid can help a pill move through the esophagus and into the stomach. Some medications can irritate or injure the esophagus if they become lodged there. However, instructions differ by drug: some medications should be taken with food, others on an empty stomach, and certain medicines interact with specific beverages or foods.

Alcohol can also create dangerous interactions. Combining alcohol with opioids and other medicines that depress the central nervous system can increase the risk of severe sedation and dangerously slowed breathing. Grapefruit juice interacts with certain prescription and OTC medications as well. Follow the directions that come with the specific drug and ask a pharmacist when you are unsure.

Pharmacists should never guess when something on a prescription is unclear. They can contact the prescriber to clarify questionable directions, doses, or other information. Electronic prescribing has greatly reduced the role of handwritten prescriptions, although paper, oral, or faxed prescriptions remain permissible in some circumstances.

New York has required practitioners to electronically prescribe both controlled and non-controlled substances since March 27, 2016, subject to specified exceptions and waivers. Those exceptions include circumstances such as temporary technological or electrical failures and certain prescriptions intended to be filled outside the state.

Insurance coverage can make a major difference in what you pay for a prescription. Plans frequently divide drugs into different formulary tiers, require prior authorization for certain medications, or prefer one medication over another in the same class.

If cost is a concern, check your insurer's current formulary or contact the plan before your appointment or before filling an expensive prescription. Your doctor and pharmacist may then be able to discuss covered alternatives when medically appropriate.

Formularies can change, so information from an old bill or previous prescription may no longer reflect what your plan currently covers.

Diet, exercise, weight management, sleep, smoking cessation, and other lifestyle changes can play an important role in preventing or managing many chronic conditions. For high blood pressure, current guidelines recommend heart-healthy eating, regular physical activity, limiting sodium, maintaining a healthy weight, managing stress, and reducing or avoiding alcohol.

That does not mean medication is unnecessary for everyone with mild or newly diagnosed hypertension. Current treatment recommendations depend on a person's blood pressure, cardiovascular risk, and other medical conditions. Some people need medication in addition to lifestyle changes. Never reduce a dose or stop a prescribed medication because your numbers improve without first discussing it with your health care professional.

An old medication may look and smell perfectly normal, but that does not mean it should be used indefinitely. The expiration date reflects the period during which the manufacturer has established that the drug will remain stable when stored as directed.

FDA recommends that consumers not use medications after their expiration dates. Chemical changes or loss of potency can affect safety or effectiveness, and some treatments require reliable dosing to work properly. If you find an expired prescription, ask a pharmacist whether you need a new supply and how to dispose of the old medication safely.

Doctors and pharmacists have different but complementary areas of expertise. Physicians diagnose and manage medical conditions, while pharmacists receive extensive education in medications, including pharmacology, dosing, interactions, adverse effects, and safe medication use. That makes pharmacists an important resource when a patient receives prescriptions from several different specialists.

Ideally, the patient's prescribers and pharmacist work together. A pharmacist may identify a medication-related concern and contact the prescriber or recommend that the patient discuss a possible change with the medical team.

Using one pharmacy for most or all of your prescriptions can give the pharmacist a more complete medication record and make it easier to identify duplicate therapies or potentially dangerous drug interactions. The American Heart Association, for example, recommends making sure all health care professionals know what others have prescribed and notes that using one pharmacy can help avoid interactions.

If you do use multiple pharmacies, make sure each pharmacist knows about the other prescription drugs, OTC products, vitamins, and supplements you take. A pharmacist can identify potential medication problems and, when appropriate, work with you and your prescriber on possible solutions.

It is a misconception that pharmacists simply put pills into bottles. Pharmacists are trained medication experts and can answer questions about how to take a drug, common side effects, possible interactions, storage, missed doses, and other medication-related concerns. If something about a prescription does not make sense, asking the pharmacist is often a good place to start.