There are no statistics that show how often men triple-dose on pain medications, toss their antibiotics before finishing the bottle, or use an energy drink to wash down a sleep aid. But ask any pharmacist on the front lines of medicinal mayhem about the sorts of shenanigans men pull, and you'll hear a litany of sordid tales like these. "Guys tend to ask fewer questions about drug interactions and how to take a medicine," says Greg Collins, Pharm.D., a pharmacy supervisor for CVS. "They also struggle with taking their prescriptions consistently if they don't 'feel' the medication working."
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Such bungling costs this country $177 billion a year, according to the Journal of the American Pharmaceutical Association. But we can't blame simple male obstinacy for the problem; drugs are complex and confusingly marketed. We need as many tips from the back of the store as pharmacists can provide. And fortunately for us, a pharmacist looks at the side effects, uses, and costs of pills the way Brett Favre reads Charles Woodson's break on a Percy Harvin slant. Not only can a great pharmacist help steer you away from making a bad situation worse, but he or she also knows how you can use pills smarter—for your health as well as your wallet.
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We asked these highly trained drug specialists to jump over the counter and give us their unvarnished opinions about the ways men are most likely to fumble or be stymied by their pharmaceuticals. (Of course, their tips should supplement your doctor's advice, not replace it.) Read on for your pharmacist-endorsed action plans.
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Pricey pills: Be a cutup
To bring down your monthly cash outlay, start slicing and dicing your pills. Viagra, for instance, costs the same—$10 to $18 per pill—whether you buy it in 50-or 100-milligram form, says Josh Pacosa, Pharm.D., a pharmacist in Asheville, North Carolina. "Have your doctor prescribe the 100-milligram pill, and then cut the pills in half," he says. This can save you hundreds of dollars a year.
Your doctor or pharmacist can help you determine which other pills can be similarly divided, and even how far you can stretch one. The brand-name hair-loss drug Propecia, for example, comes in 1-milligram tablets and rings up at about $60 a month. But its active ingredient, finasteride, is also found in the generic version of Proscar, a drug used to treat enlargement of the prostate. Finasteride comes in 5-milligram tablets and costs $70 a month. "I tell people to quarter the generic tablets with a pill cutter and take a quarter once a day," Dr. Pacosa says. "It would be about the same as taking a 1-milligram Propecia tablet. This can save you roughly $500 a year."
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OTC: Not all-you-can-eat
It's hard to believe, but the FDA actually trusts us to read the labels on drugs sold over the counter. Big mistake. "Guys often assume that because a drug is available without a prescription, it's not dangerous," says Vincent Hartzell, Pharm.D., of Hartzell's Pharmacy in Catasauqua, Pennsylvania. Painkillers are the most problematic. Taking too much ibuprofen (Advil) can cause acute kidney failure—the maximum daily dose is 1,200 milligrams. Too much acetaminophen (Tylenol) can mess up your liver, so never take more than 4,000 milligrams in a 24-hour period. (Acetaminophen also shows up in several common prescription pain meds, including Vicodin, so be careful about combining them.)
What's the best way to combat your pain? Dr. Pacosa prefers ibuprofen to acetaminophen because of its anti-inflammatory effects. For long-lasting pain, he recommends naproxen (Aleve). "If you've hurt your back and it's going to be bothering you for a couple of days, take Aleve," he says. "For a headache, take Advil."
Cold meds: Mix-and-match madness
Potions for coughs and colds take up miles of pharmacy aisles, but all those formulations hide a mundane reality that can baffle customers: They simply recombine the same drugs—pain relievers, antihistamines, decongestants, cough suppressants, and expectorants. This meager trove of weapons means drugmakers will routinely combine ingredients that have opposing side effects—assuming the company can make a new claim for a cold remedy.
Take nighttime formulas. The decongestants in these meds make you peppy, while antihistamines make you sleepy. You wouldn't think the combo would make for a good night's sleep, but this formulation is nevertheless considered sleep-inducing. "The sedating effects of the antihistamine are greater than the stimulating effects of the decongestant," says Dr. Pacosa. This sort of push-pull is a good reason to take these cocktails only in the short term. "I'm a Nyquil-Dayquil guy," Dr. Pacosa says. Neither mixes an antihistamine with a decongestant.
Sometimes these blends can work against you, as with remedies that both loosen phlegm and suppress coughs. "It's common to see cough suppressants paired with expectorants, like Mucinex DM," says Dr. Pacosa, "but it just doesn't make sense. What good is making your mucus loose with an expectorant when you can't cough it up because of a suppressant?" Instead, use the expectorant in your kitchen faucet. "If you can make yourself drink a lot of water, that's just as effective as the expectorant," he says. "If you're looking for an overthe-counter cough medicine for a dry cough, don't worry about expectorants. Plain old cough suppressants should be enough."
Heartburn cures: Don't overdo it
Proton-pump inhibitors (PPIs), which reduce the release of gastric acid, are the third-bestselling class of medication in the United States. Prilosec, Prevacid, Nexium, and others pulled in $13.6 billion in 2009. "These are effective and generally safe," says David Stanley, R.Ph., a pharmacist in Monterey, California. "But they are probably overprescribed. And now that Prilosec is available over the counter, it's quickly becoming overused by a public convinced that it must have the latest and greatest drug."
The fact is, Prilosec or Prevacid could be the wrong choice to treat your heartburn if your symptoms appear only occasionally. "The main problem with long-term PPI use is acid rebound when you stop," Stanley says. "People end up never being able to quit them, because every time they try, they get an acid wave in their stomach. And they think the meds are harmless anyway." They aren't: There's a correlation between long-term PPI use and bone fractures, possibly due to decreased calcium absorption, he says, as well as an increased chance of a nasty infection by Clostridium difficile, a diarrhea-causing bacterium that can lead to colitis. The drugs are best for chronic heartburn, ulcers, or gastrointestinal bleeding. Almost everyone else can get by just fine on Pepcid or even basic Tums.
Rx partnerships: Ask first
As if health insurance weren't sufficiently complex, insurance companies now often select one brand of drug over the others in any given class, granting "prior authorization" to one and making you call for permission for all others. This "preferred formularies" practice essentially means the pharmacist has to call your doctor to discuss the prescription. If your physician is gone for the day, you could be hit up for potentially pricier meds. "All because one drug manufacturer talked to an insurer about its product being a preferred drug," says Steve Williams, who has overseen billing snags at Eagle Drug in Rochester, Minnesota, for the past 25 years. "Read your insurance policy; the information is written in very small print." To avoid being stuck with the bill, find out—before your doc writes a scrip—which brands your policy will pay for; and make sure your doctor knows the deal.
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Brand loyalty: Ditch the label
Once a drug goes off-patent, the floodgates open, and then any company can make and sell a generic, usually for a lot less. As a result, there's no reason to buy a brand-name medication if you can find the same active ingredient at the same strength in generic form. "The only things that differ from the brand are inactive ingredients, like fillers and dyes," says Dr. Hartzell. "But the medication has to be the same."
In Pennsylvania, Dr. Hartzell is permitted to sell the generic form of a drug if it's available and if the doctor has not specified otherwise. "I don't see many physicians who choose a brand when there is a generic; it may happen if the patient can't tolerate the generic, or if the drug has a narrow therapeutic window," he says. Mostly, though, it's the patients who want brand names. "Some people just feel more comfortable doing that," he says. His advice: Ask yourself if paying extra is really worth it.
Free samples: Not so free
If a drug dealer gives out a free sample, that's illegal. If a doctor hands out a freebie, it's good marketing. But free drugs should set off an alarm if you'll eventually be paying for them out of pocket. "I don't like drug coupons or freebies from doctors," Dr. Pacosa says. "You'll notice that there are never offers for the inexpensive medicines."
Problems arise when the doctor cuts you off. "I had a patient who got free samples of the antidepressant Lexapro," Dr. Pacosa says. "He took it for a month and came to see me because the doctor was out of freebies. But it was going to cost $100 a month." By now his customer was used to Lexapro, even though the nearly identically acting brand-name drug (Celexa) is available in generic form, citalopram, for $15 a month or less. "I sympathize with him—it's hard to change an antidepressant when you've been on it for a while," Dr. Pacosa says. "If your doctor hands you a fistful of pill packets, don't take them right away. Ask about alternatives, or, well, go talk to your pharmacist."
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