An estimated 1.5 million people are sent to the emergency room each year due to medication errors, while up to 75% of patients take their prescriptions incorrectly. Atheer Kaddis, vice president of pharmacy services at Blue Cross Blue Shield of Michigan, shared guidance on preventing drug interactions, handling missed doses and ensuring safe storage.
Medication interactions vary based on the specific prescription, food, beverage or supplement involved. Understanding proper administration schedules, expiration dates and storage requirements can prevent adverse side effects and ensure treatments remain effective.
Food interactions can alter how the body processes medication. For example, cholesterol medications can interact with grapefruit juice or grapefruits by slowing down drug metabolism, leading to potential side effects. “There’s a lot of variability, of course, based on the medication that the patient is taking,” Kaddis said. “That give you some examples for, for example, cholesterol medication, that can interact with grapefruit juice or grapefruits. Where it could slow down the metabolism of the drug and could result in some side effects from the medication.”
Older blood thinner medications present additional risks when combined with certain foods. Coumadin, a common blood thinner prescribed for patients with cardiovascular disease or stroke risk, interacts with vitamin K found in dark leafy green vegetables like spinach. “Spinach, dark, leafy, green vegetables can interact because of vitamin K,” Kaddis said. “It vitamin K interacts with that drug and it makes the drug ineffective. So that could be a major adverse outcome for a patient if you know they have cardiovascular disease or risk for stroke and that blood thinner is not working.”
Dosing errors remain widespread, with many patients unsure how to handle a missed dose. Kaddis noted that doubling up on medication is generally not recommended, especially with pain medications such as opioids, which can cause breathing problems when taken in excess. Other medications can cause heart rhythm problems if taken improperly. “Most people take their medication incorrectly, unfortunately,” Kaddis said. “It’s been noted that up to 75% of patients take their medication incorrectly.” He added that doubling up can be hazardous. “There are some medications where you can double up on the next dose, but generally it’s not recommended, especially pain medications,” Kaddis said. “You know, some pain medications can result in breathing problems. When you take too much medication, like, opioids are a good example of that. So it can be very dangerous to double up on doses.”
Monitoring expiration dates is another essential safety measure, as outdated drugs can lose effectiveness or trigger major side effects. For medications dispensed in pharmacy vials rather than original packaging, a general rule of safety is to discard any medication that is more than a year old from the dispense date. “All drugs have expiration dates on them,” Kaddis said. “Very important to pay attention to the expiration dates because some drugs lose effectiveness when they’re too old. Some drugs can actually result in major side effects when they become too old.”
Proper storage helps maintain drug stability over time. Most oral medications should be kept in a cool, dry place and kept away from hot or humid areas like bathrooms, sinks or kitchen ovens. By contrast, many injectable medications require refrigeration to stay fresh. “Most medications you should store in a cool, dry place,” Kaddis said. “Should not store medications in the bathroom, you know, about a sink or above a oven, you know, in your kitchen or something like that where it gets too hot or too much humidity.”
Patients looking to review their prescriptions can request package inserts from their pharmacist or research brand-name drugs online. Kaddis highlighted pharmaceutical manufacturer websites as reliable sources that provide easily digestible information for patients alongside technical details for health care providers. “Pharmaceutical manufacturer websites are solid sources of information,” Kaddis said. “There’s lots of facts there. And what they do is there’s information for health care professionals and there’s information for patients. So patients can get the information that’s easily digestible, you know, easy to understand.”
For patients seeking to dispose of unused cancer treatments, an organization named YesRx accepts non-expired chemotherapy medications. The program redistributes the donated medications to other cancer patients to help reduce out-of-pocket costs.