E-360 Edition 23: Things you probably didn’t know about medications

Home > E-360 Edition 23: Things you probably didn’t know about medications

Most people take some form of supplement or medication, either regularly, as prescribed or when necessary, depending on the type of medication and what it is taken for. People with epilepsy take regular medication, so it is good to know a few things that can affect the medication or your seizures.

Did you know?:

Missing even one tablet can make a difference

Taking your medication as prescribed keeps it at constant levels in your blood. Missing a dose or a day can make it drop – how low depends on the type of medication as some are controlled release so their levels take longer to drop. Sometimes an imbalance like this can take the medication a few days to return to the therapeutic level. This increases the risk of seizures, so be diligent.

Some medications can interact with grapefruit juice

Grapefruit juice contains a chemical that can affect how medications are absorbed. This can cause you to either get too much or too little of what you need, which can be a seizure risk. A single glass of grapefruit juice is enough to increase the bioavailability of some drugs. If the juice is drunk over several days the effects are long-lasting, so simply separating the dose of medication and the ingestion of grapefruit juice does not prevent the interaction. For this reason, grapefruit juice should be avoided completely with certain drugs. With epilepsy one drug known to interact with grapefruit juice is carbamazepine (Tegretol).

Take them with or without food?

Food and its ingredients may have a significant effect on both the rate and extent of absorption of medication after taking them orally. Taking medication with food generally delays drug absorption. However, meals may have a variable effect on the extent of absorption – depending on the characteristics of the meal, the medication and its formulation. For most medicines, especially those used for chronic conditions, a delay in the onset of absorption is of no clinical consequence as long as the amount of drug absorbed is unaffected.

Some drugs have strict guidelines about when they should be taken in relation to meals. Your doctor and pharmacist will advise you whether or not it is important to take your medication with food.

* Note: Taking a medicine with a meal implies taking the dose within 30 minutes of a meal. Taking a medicine on an empty stomach implies taking the dose one hour before or two hours after a meal.

They may lower your nutrient levels

Some antiepileptic drugs change metabolism and absorption of many vitamins and minerals. Therefore, people with epilepsy may be at higher risk of nutrient deficiency and its unwelcome effects. Before jumping the gun and taking vitamins and supplements though, speak to your doctor, ask for a blood test and take what you really need.

Growth spurts can make a difference to how much medication is needed

When children have a growth spurt or go through puberty, their medication may need to be reviewed as often the dose they were taking before the growth spurt is too low for their body needs. For this reason, seizures may occur around the time of growth spurts.

Medication changes may be needed as we age

Ageing can affect the way medicines are absorbed and used. For example, aged related changes in the digestive system can affect how fast medicines enter the bloodstream. Changes in body weight can influence the amount of medication needed and how long it stays in the body. The circulation system may slow down, which can affect how fast drugs get to the liver and kidneys. The liver and kidneys also may work more slowly affecting the way a drug breaks down and is removed from the body.

Because of these body changes, there is also a bigger risk of drug interactions for older adults. Drug-to-drug interactions happen when two or more medicines react with each other to cause unwanted effects. This kind of interaction can cause one medicine to not work as well or even make one medicine stronger than it should be.

Don’t lie down straight after taking your medication

Lying down immediately after you swallow a tablet slows it’s journey to your stomach. This may simply delay how long it takes to work, but some medications may irritate the lining of the oesophagus if they are in contact with it for too long.

Generic drugs aren’t exactly the same as the original brand

A generic product is essentially the same as the original brand. Even though specific guidelines and tests are conducted to ensure the generic medications are the same, a slight degree of variation is allowed. This means that the generic product is not exactly the same as the original brand.

There are a few key differences:

  • The most obvious differences are the tablets appearance and packaging.
  • The formulation itself may not be exactly the same either. The non-active ingredients may differ – these include what is used as a filler, binder, coating or colouring.
  • There are also minor differences in the active ingredient. These are very small because the generic preparation must be similar enough to the original to satisfy strict guidelines. The maximum variability between a generic and original medication is 10%.

Generic or brand formulations are both OK, but you need to stick to whatever brand you always take because even these small differences in antiepileptic medication can trigger seizures in some people who have epilepsy.

Changing your antiepileptic medication

If the doctor has prescribed antiepileptic medication changes, either a new drug or dosage changes, there is a good chance you will need to stop driving. Your doctor will advise you if you need to stop driving and for how long. When changing these medications, it can increase the risk for seizures, so it is a safety measure.

Over-the-counter medicines

Common over-the-counter medicines include pain relievers, laxatives, cough and cold products, and antacids. Some over-the-counter medicines however, can affect the way prescription medicines work or are used by the body. Always ask your doctor about over-the-counter medicines you take and when you are purchasing them at the chemist, speak to the on-site pharmacist first about interactions.

Don’t store your medication in the bathroom

The bathroom is often a damp atmosphere and the additional moisture may affect the stability of the medication and possibly reduce its effectiveness. It is best to store them in a cool, dry and dark place, where the temperature and atmosphere is stable. Don’t forget to keep them out of reach of children.

Don’t mess with the medication

Don’t chew, crush or break capsules or tablets or mix with a liquid unless instructed. Your body could absorb some long-acting medications too quickly if you chew or crush them. Other medications may be ineffective or could irritate your gut or make you sick. If a tablet needs to be crushed, then it may be worthwhile looking at different forms of the medication, such as a syrup form.

Don’t keep old medications

Monitor prescription and over-the-counter “used by” dates and throw away expired ones. Some drugs may become ineffective or toxic after the due date, while others simply lose their potency. Dispose of old medications safely through the Return Unwanted Medicines scheme http://www.returnmed.com.au/

Check your mouthwash

If you do use mouthwash, it’s a good idea to be aware of what is in it. While each mouthwash may be slightly different, most will include the following:

  • Alcohol: or other antimicrobial agents to help kill bacteria and other germs that contribute to tooth decay and bad breath.
  • Detergents: to help dislodge and remove food debris and loose plaque
  • Flavours: and colours that improve the look and taste.
  • Preservatives: that prevent growth of bacteria in the mouthwash
  • Water: to dissolve the other ingredients
  • Some include fluoride to help make teeth more resistant to acid attacks, and defend against tooth decay.

While these ingredients are only in your mouth for 30 seconds or less, it’s probably wise not to use them straight after taking medication.

Further information

NPS Medicine wise https://www.nps.org.au/

Medicine Line 1300 MEDICINE (1300 633 424) Mon-Fri 9-5pm

Mouthwash – See more at: https://www.nationaldentalcare.com.au/does-mouthwash-work/#sthash.11719kQn.dpuf

Vitamin and Minerals https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928610/

Over the counter medications https://www.medicalnewstoday.com/articles/16181.php

Nutritional supplements, foods, and epilepsy: Is there a relationship? https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2008.01678.x