Many illnesses, many medicines: one plan works better.
Diabetes, BP, heart disease, joint pain, thyroid: with age, many people have several of these at once, each looked after by a different doctor. The tablets add up, and often nobody sees the whole list. One doctor looking at everything together can often make it simpler and safer.
In plain words.
Taking five or more medicines a day is common, and often every one is needed. But each new medicine adds a chance of side effects and clashes, and a side effect is sometimes mistaken for a new illness and treated with yet another tablet.
What to look for: the same medicine under two brand names from two doctors; medicines that clash, such as painkillers taken with BP tablets and water tablets, which together can harm the kidneys; several medicines that each lower the BP or sugar, causing dizziness, falls or low sugar; and medicines still being taken long after the reason has passed, such as acid tablets or sleeping pills.
Older people feel side effects more: confusion, falls, constipation, dizziness on standing, a poor appetite and sleepiness can all come from medicines. For an older parent, a family member who knows all their medicines is a great help at a consultation.
A medicine review goes through everything you take, including medicines bought over the counter, ayurvedic and homoeopathic medicines, and supplements. It checks that each one is still needed, that the dose suits your age and kidneys, and that nothing clashes. Changes are made one at a time, always agreed with you, and with your other doctors where needed.
Three doctors, one pill box
Each doctor treats one illness and adds medicines. Often nobody sees the whole list, and the tablets add up.
The same medicine can end up in the box twice under two brand names, and some medicines clash. Together they cause more side effects: dizziness, falls, kidney trouble.
With every medicine on one list and checked together, doubles and ones no longer needed can come out safely, one at a time, and always with a doctor’s advice.
Go to hospital now if
- Fainting, severe dizziness, or new confusion or drowsiness, especially after a new medicine or a change of dose: go to hospital now.
- Low sugar that does not improve after taking sugar or glucose, or with drowsiness or confusion: go to hospital now. If the person cannot swallow safely, put nothing in their mouth and call 112.
- Swelling of the lips, tongue or face, or difficulty breathing, after a medicine: call 112.
- Black stools, vomiting blood, or bleeding that will not stop, in someone taking blood thinners or painkillers: go to hospital now.
- Too many tablets taken, by mistake or on purpose, especially by a child or an older person: go to hospital now, with the strips. Call 112 if the person is drowsy.
- Very little urine, with vomiting or loose motions, in someone taking BP tablets, water tablets or metformin: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
Ask for a medicine review soon if
- You take five or more medicines, or see more than one doctor for them
- You have had a fall, dizziness or new confusion in the last few months
- You are not sure what one of your medicines is for
- A new doctor added a medicine without seeing your full list
- Your medicines were changed during a hospital stay
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Kidney function (creatinine and eGFR) | Many doses depend on how well the kidneys work, and some medicines can harm them. |
| Sodium and potassium | Water tablets and some BP medicines can push these too low or too high. |
| HbA1c and home sugar readings | Show whether sugar medicines are too strong, causing low spells, or not strong enough. |
| Liver tests | Some medicines are checked with them, and a liver problem changes which medicines are safe. |
| Lying and standing BP | A drop in BP on standing points to too much BP medicine. |
| ECG | Some medicines, especially taken together, affect the heart’s rhythm. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Never stop a medicine on your own, even if you think it is causing a side effect: some, such as BP and heart tablets, blood thinners, steroids, medicines for fits, and antidepressants, can be dangerous to stop suddenly. Ask your doctor first, and change one medicine at a time.
A video call can
- Go through your full list, strip by strip, over video
- Spot doubles, clashes, and doses too high for your age or kidneys
- Make one simple plan, and share it with your other doctors
- Follow up each change with home readings and blood tests
- Look after an older parent’s several illnesses together, with family on the call
Needs a visit in person
- Falls, fainting or sudden confusion: these need an in-person check, sometimes in hospital
- An examination, when a side effect needs to be seen or felt
- Blood tests, which a lab near you can do
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759