Do you forget to take your med pills?

[Carnelian]

For a while now, I forget, or don't want to take my metropol tartrate twice a day and my aspirin. I take it at least
once a day. Sometimes I look right at the vial and still don't take it. I dont know why. I tried taking them at different
times, at night and during the day I tend to forget or perhaps don't care. Doc says for the rest of my life. My health is all right.
I just wish I didn't have to. I don't mind taking my cholesterol med and anti-depressant.

Do you do this?

 

[pellicle]

Hi

Do you do this?

No

I have a multilayer system to avoid even accidentally not taking the drugs that keep me from harm

 

[pellicle]

I just wanted to add something else

before I was on drugs I wanted to avoid drugs. This was essentially because of a simple stupid unconscious view of it being an indicator of me being "old" combined with my personal desire to be self sufficient. In reality both positions are illogical, stupid (and potentially dangerous).

I have never eschewed my taking warfarin or indeed any medication that was deemed needed (although there is one exception to that).

I consider the medication and its effects seriously. If the effects are not what is required (aka not helping) I'll report this to the Dr who's treating me and we'll work through it to find what's needed. It may be that nothing works (but that's another story).

However if its depression, anxiety or other psychoactive drugs this is a-whole-nother picture (similar grammar here to to abso-fcuking-lutely).

If we're talking warfarin here then:

• set alarms on your phone to fit your lifestyle times and take the drug on the alarm
• do not just open a bottle and take it, in advance dish the pills out into a pill box and leave the lid open when you've taken it
• leave the pill box in a clear visible place that you pass often in your day so you can check visually if you've taken them on time with a glance.

Anything else is not wise.

 

[jeffp]

[*]do not just open a bottle and take it, in advance dish the pills out into a pill box and leave the lid open when you've taken it

I thought I was the only one doing this. Many a time I thought I took the meds, but found that it was probably yesterday’s memory. Or I think I forgot to take them, but discovered I did. Likely it’s partly due to getting old, but I tell myself it’s because of being busy and having too much going on at once.

Honestly, I’ve missed a dose now and then, maybe a dozen times in 18 years, and none the worse for the wear.

Having a system or routine of some kind is of great help.

 

[pellicle]

Honestly, I’ve missed a dose now and then, maybe a dozen times in 18 years, and none the worse for the wear.

superman does this method too ... if its working for you then great, but for most people the odds are not good

Sadly the facts are pretty clear on this, both in my own experience of helping others and in studies. For instance this study [7] published in 2015 says:​

​

Poor adherence to warfarin is common with one in five doses taken incorrectly even in the setting of a dedicated anticoagulation clinic (Platt et al., 2010 [8])... A study showed that up to 92% of the patients could not adhere to warfarin therapy and had “under anticoagulation” control. For each 10% increase in non-adherence to warfarin, there was a 14% increase in the risk of under-anticoagulation and caused significantly higher rates of morbidity and mortality (Kimmel et al., 2007[9]).​

(emphasis mine)​

​

Then there is this study: The influence of patient adherence on anticoagulation control with warfarin: results from the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study (link [9])​

​

We performed a prospective cohort study at 3 anticoagulation clinics to determine the effect of adherence on anticoagulation control. Patients treated with warfarin with a target international normalized ratio of 2.0 to 3.0 were monitored with electronic Medication Event Monitoring System (MEMS) medication bottle caps. Detailed information was collected on other factors that might alter warfarin response…​

​

Among 136 participants observed for a mean of 32 weeks,​

• 92% had at least 1 missed or extra bottle opening;
• 36% missed more than 20% of their bottle openings;
• and 4% had more than 10% extra bottle openings.

In multivariable analyses, there was a significant association between underadherence and under-anticoagulation.​

​

For each 10% increase in missed pill bottle openings, there was a 14% increase in the odds of under-anticoagulation (P<.001);​

​

participants with more than 20% missed bottle openings (1-2 missed days each week) had more than a 2-fold increase in the odds of under-anticoagulation (adjusted odds ratio, 2.10; 95% confidence interval, 1.48-2.96).​

​

Participants who had extra pill bottle openings on more than 10% of days had a statistically significant increase in overanticoagulation (adjusted odds ratio, 1.73; 95% confidence interval, 1.09-2.74).​

​

Conclusion: Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control.​

if someone says they are having INR control problems its the first question I ask.

 

[jeffp]

In multivariable analyses, there was a significant association between underadherence and under-anticoagulation.​

We’ll, duh. If you don’t take yer meds, youse won’t get the desired effect.

Yeah, I get it 100%. Very few of my patients on chronic meds had good compliance. I always had them bring their prescription bottles in, and at the end of the 30 days, somehow they frequently seemed to have 10 days or so left.

Note to all of us here… set up some kind of a system that's easy for you and that works. Then stick with it.

 

[pellicle]

Hi

We’ll, duh. If you don’t take yer meds, youse won’t get the desired effect ... I get it 100%. Very few of my patients on chronic meds had good compliance.

Personally I don't advocate for things I then say "but I don't bother doing that"

Mine is where I charge my phone

Myself I started doing this 12 years back because I couldn't prove to myself I hadn't missed or mistaken the correct dose. Until I could totally eliminate that from the equation I couldn't go further.

YMMV

 

[dick0236]

I take all my Rx when I wake up each morning and have a seven-day pill box. I don't miss the morning doses more than 1-2 times a year and usually catch my error before the day is over. I have recently added a "water pill" 2X a day (morning and mid-afternoon. I miss the afternoon pill at least once a week even tho I keep a separate 7-day pill box for only that one pill.

It's a habit that, after a while, becomes a normal part of my day.........and is very important for drugs like Warfarin.

 

[Protimenow]

"I don't need no stinking pillbox' (taken from a classic film quote).

Actually, I used to have a pillbox -- sometimes two - but worked out a method that works for me:

I have a few medications that I take twice a day. When I've taken my morning dose. I turn the bottle upside down. I can tell at a glance whether or not I've taken it. When I take my second dose. I flip the bottle up. It's simple and it works.

I take my morning dose when I'm warming milk for my wife's hot cocoa. My bedtime dose is done at the end of the day after my wife has taken HER pills. There's one more pill that I take in the afternoon and at bedtime -- I use the 'flip - unflip' method to know that I've taken my dose.

If there was a pill that I took three times a day. this simple method won't work.
I take my warfarin at the same time EVERY DAY after my wife takes her medications.
It's habit -- I haven't missed a dose of Warfarin for a LONG time -- but a seven day pill box or some other method may work better for you. Use whatever works for you.

Compliance is essential -- needing medications isn't a sign of weakness -- but failing to take meds can be a sign of something much worse -- YOU fill in the blanks here.

 

[Superman]

For a while now, I forget, or don't want to take my metropol tartrate twice a day and my aspirin. I take it at least
once a day. Sometimes I look right at the vial and still don't take it. I dont know why. I tried taking them at different
times, at night and during the day I tend to forget or perhaps don't care. Doc says for the rest of my life. My health is all right.
I just wish I didn't have to. I don't mind taking my cholesterol med and anti-depressant.

Do you do this?

Sounds like you might resent/disbelief in your heart meds so have a little willful disregard of them vs your cholesterol and anti-depressants?

I do mine with the meal plan. Morning pills with my orange juice. Evening pill with water at dinner. I don’t sip my juice until I have pills to swallow. I have other morning routines that go with it. Let the dogs out. Feed the pond fish. Take my pills. Drink my juice. All kind of flows together.

Pellicle is correct. I don’t use a pill box. For me, it seems like one more thing to remember. An empty day would not give me confidence that I’ve taken my meds. It’d make me question if I remembered to fill it.

 

[pellicle]

It’d make me question if I remembered to fill it

I fill the whole thing on Sunday, after my INR test, so I then know my dose for the week ahead.
I take the first one on Sunday evening.

Fool proof

 

[tom in MO]

For a while now, I forget, or don't want to take my metropol tartrate twice a day and my aspirin. I take it at least
once a day. Sometimes I look right at the vial and still don't take it. I dont know why. I tried taking them at different
times, at night and during the day I tend to forget or perhaps don't care. Doc says for the rest of my life. My health is all right.
I just wish I didn't have to. I don't mind taking my cholesterol med and anti-depressant.

Do you do this?

No I don't do that. I take my meds, why buy them and not take them?

You might want to discontinue that practice. Per the drug information for metoprolol from NIH: Advise patients to take metoprolol regularly and continuously, as directed, with or immediately following meals. If a dose should be missed, the patient should take only the next scheduled dose (without doubling it). Patients should not discontinue metoprolol without consulting the physician.

 

[Al3x]

Hi


Personally I don't advocate for things I then say "but I don't bother doing that"

Mine is where I charge my phone
View attachment 889368
Myself I started doing this 12 years back because I couldn't prove to myself I hadn't missed or mistaken the correct dose. Until I could totally eliminate that from the equation I couldn't go further.

YMMV

I have an almost identical system, along with multiple alarms on my phone and watch. I also have a small marble that goes in Tuesday's pot to remind me to do an INR test, and a pill carrier on my keyring that contains a full dose in case I'm out and about at pill time.

I haven't yet missed a test or dose and I can't comprehend how anyone could be blasé about the process.

 

[Eva]

For a while now, I forget, or don't want to take my metropol tartrate twice a day and my aspirin. I take it at least
once a day. Sometimes I look right at the vial and still don't take it. I dont know why. I tried taking them at different
times, at night and during the day I tend to forget or perhaps don't care. Doc says for the rest of my life. My health is all right.
I just wish I didn't have to. I don't mind taking my cholesterol med and anti-depressant.

Do you do this?

If you forget, above suggestions should make it easier to remember.
What I do: I have an alarm on my watch and I keep snoozing it until I take my medication.
My Thyroid medication which needs to be taken on an empty stomach is on my night table. I take it as soon as I wake up.

But if you don’t want to take the medication:
1 - if you skip them and you're not having an adverse reaction, it maybe ok if this happens once in a while. But you still need to clear it with your doctor. Or
2 - maybe you're not feeling well after taking them! So, your body/mind doesn't want to take them…your subconscious is telling you there is no need for it!
this maybe the case. But, again, discuss this with your doctor who can confirm if/maybe you no more need the afternoon pill!
keep us informed.

 

[Timmay]

My surgery was ~14 months ago. I have NEVER missed my warfarin dose. Ever. Like pellicle, I have a multilayer system in place to ensure this doesn’t happen. And no, that’s not the only meds I take …

Synthroid
Amlodipine
Livalo (Pitavastatin)
Warfarin
Aspirin
Magnesium (twice a day)
Potassium (twice a day)
1/2 Multivitamin (twice a day)
K2
D3

Pill box, phone alarm, FitBit alarm, and an extra vial of Warfarin on my keychain.

At one time I was caught up on the thought of “I don’t want to take so many pills. This is horrible! I’m so young and only old people do this! I’m better than this!!”. But, at least for me, I came to terms with my health and ACTUAL well being being more important than rampant, inaccurate, and negative thoughts of feeling “less than” simply because I take pills. Yes, I take pills. Yes, I have a huge pillbox. Who cares! I also have big muscles and a big personality

Don’t take the above as me saying I just take whatever pills they give me. I don’t. I fought my doctor for quite a bit on the statin. And then when I did accept it, I told him that I was only going to take half of the dose and then we can reevaluate. I was on metoprolol at one point to. I did my research and worked with my doctor and now I am no longer on it. I might have to go back on it one day and that’ll be fine. But that time has not come. Lol.

 

[Superman]

Fool proof

Well, it does work for the likes of you, so there’s evidence supporting that claim.

Low hanging fruit. Couldn’t resist.

 

[pellicle]

Good morning (slurps coffee)

so there’s evidence supporting that claim

so if you don't mind answering a few questions:

• what is your daily dose (and if its not the same each time, please mention what each day is)?
• does that or its administration order (for different doses) ever change?
• what is your testing frequency (and is it the same day)?

When I started out my dose was not only uneven. It started out as 4mg wed & sat; 5mg other days then went after a few weeks to: 6mg wed & sat; 5mg other days

Sometimes this even include an instruction to hold a dose (due to INR being something like 3.5!!)

Managing these instructions and needing to double check exactly what I was doing on what day was onerous and time consuming and error prone (as indeed Jeff has mentioned above with his patients). Perhaps instead of telling people how he just remembers, if he'd encouraged systems of things to engender compliance then his patients may have stood a better chance of being compliant.

So if my dose was 5mg per day, every day, I may not have developed the pill box habit. But as I needed to take a 5mg one day and a 5 + 1mg on another day and actually be sure to remember and not mistake one day for another I might have had no reason.

Further at the time my work schedule was changing because of cost cutting (and personal needs) I changed to 2.5 days per week (3 one week, 2 the next). My dad was ill (turned out to be cancer) and I was involved with lots of issues around him, doctors, moving him into a nursing home ... so my life wasn't exactly routine.

My grandmother used to always remind me that laziness was pointless unless it was thoroughly carried out; meaning if being 'lazy' resulted in more work then it was counter productive. This combined with the fact that my INR was a YoYo and as I've been a keen documenter since I was at Uni doing biochemistry and microbiology labs (you must develop that habit if you want to pass) made it a no brainer to remove my brain from the equation and develop a system.

Because this fool had a busy life post OHS and it wasn't a Groundhog Day life either.

I don't understand why anyone argues against being organised. Especially when we know that most people (based on the studies that Jeff just dismissed and scoffed at at first) showing us that most people are not compliant. Perhaps encouraging good compliance for those who aren't Superman or perfect is actually a good goal in a place like this?

Damn ... somebody drank my coffee (nice espresso latte it was too).

Ok, sun is coming up, time for my walk to my gym for stretching and exersize in the early morning winter sun.

 

[pellicle]

Back home now

 

[Superman]

All in good fun. I’m all for anyone doing what works for them. I more make fun of my own lack of organization than anything.

• what is your daily dose (and if its not the same each time, please mention what each day is)?
• does that or its administration order (for different doses) ever change?
• what is your testing frequency (and is it the same day)?

6 mg daily. I’ve been rock solid for a long time. Sometimes I’m 5 mg two days a week, so I just pick a couple non-consecutive days for fives. When I have done random 5’s I’ve never been too particular about which days. I test every other Tuesday or whenever I get a reminder call, whichever comes first.

 

[pellicle]

6 mg daily. I’ve been rock solid for a long time. Sometimes I’m 5 mg two days a week,

Those are really easy numbers. I know people who take

• 12.5
• 7.5
• 1.25
• 15

so in their cases it's important to know what to take (I'm 6.5 and even that varies).

It's always the same edge cases, management is needed.

Ultimately I'm only writing this for the newbies and lurkers