A-Z

Living with multiple health problems

Dealing with multiple medicines

The more health problems people have, the more medicines they might be using. “Medicines” include tablets, capsules, liquids, creams, inhalers, eye drops, and injections (e.g. insulin for diabetes). The people we spoke to were typically taking multiple medicines; some were taking as many as 30 tablets a day. Some medicines, such as inhalers or pain relievers were only taken ‘as needed,’ whereas other medicines had to be taken regularly once, twice or three times a day. In addition to their prescribed medicines, some people also took vitamins or food supplements that they bought over the counter. Not everyone knew which of their medicines were treating which symptom or condition.

Living with having to take multiple medicines can have a similar impact on how people feel about themselves to that of living with multiple health conditions (see ‘The personal impact of multiple health problems’). Both Madelon and Andrew seemed to view taking lots of medicines as a natural consequence of having health conditions in the context of ageing and didn’t seem bothered by it. Rosemary only wants to take drugs that her doctor advises her to.
 

Madelon has had many health problems and takes a variety of medicines. However, she has got used to this over time and manages taking her tablets using a dosette box.

Madelon has had many health problems and takes a variety of medicines. However, she has got used to this over time and manages taking her tablets using a dosette box.

Age at interview: 93
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
And you mentioned there that you take a number of different medications.

Yes.

Are they just for the strokes and diabetes or do you take things for other conditions as well?

Yes, well, I’ve had cancer twice.

Right.

On the stomach.

Right.

So I have to have tablets for that. I have a B12 injection every three months. I have to have that for that reason.

Okay.

And I’ve had arthritis as well. I’ve had both my knees done. So a bit of a record to give you [laughs].

Right. Okay. And how do you do you find it taking all of these tablets?

Yeah, I’ve got used to it after all this time. I’ve got a little thing to put a week’s supply in and it just seems to make the weeks go quicker, you know. I fill them up and think, I’ve only just done that [laughs]. And they’re all gone again, yeah.
 

Rosemary finds her GP surgery helpful in getting repeat prescriptions. She speaks of an open and trusting relationship with her GP and only takes medicines her doctor advises her to.

Rosemary finds her GP surgery helpful in getting repeat prescriptions. She speaks of an open and trusting relationship with her GP and only takes medicines her doctor advises her to.

Age at interview: 67
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Oh yeah and always very good, you know, they, you know, always, they’re always helpful and, as I say, you’ve always got a specialist nurse or another nurse is available, when you can’t see the consultant to get, you know, you could ring up for advice. 

I mean like my GP, I said recently I saw him, first time for nearly a year because he’s given me, you know, he’s told me what to do. And when I need a repeat prescriptions, he gives me them because he knows, you know, I have to take them. I don’t take any tablet unless I’m told to by him. You know, I don’t go to the doctors and say, “I’ve got this. I’ve got that.” Because I won’t. I just, you know, stay at the basics, the specifics, you know, just get, “What can I do about this, doctor?” And he’ll say, well, either I go on medication or what other else to do, and when he signs the repeat prescriptions, he knows I need them.
 

Andrew lists some of the medicines he takes on a regular basis. He concludes, “So I rattle around if I jump up and down.”

Text only
Read below

Andrew lists some of the medicines he takes on a regular basis. He concludes, “So I rattle around if I jump up and down.”

Age at interview: 65
Sex: Male
HIDE TEXT
PRINT TRANSCRIPT
The other thing that I sort of, I mean these things pile on as you get older because, of course, all of those bump along and you have the medication for all of them, you know. You have paracetamol and codeine because your gut doesn’t behave terribly well, and doesn’t behave terribly well because of the aftermath of the pancreatitis, and so you get used to controlling that that way a little bit. You end up with a cocktail of drugs for ischaemic heart disease. I have ramipril. I have diltiazem. I have, trying to think what else there is, well, I have omeprazole for the, to control the gas as well. I have, oh yes, I have bendroflumethiazide I think is how it’s pronounced, one of those every morning, a sort of water tablet and I also have furosemide, I can’t remember, they change it actually but whatever that’s called which I have a couple of tablets of, but that’s really to do with the water build up that you get with the steroids. So, you know, but it presumably also helps with the with the heart thing. So I have all that and then then I have a statin and I have, somewhere there was a research to the effect that the largest dose of statin, atorvastatin, eighty milligrams I think a day, big, fat horse pill, this one field study said that that actually reduces the problems with ischaemic heart disease, that it actually, the atheroma is reduced. I don’t think there’s much to back that up but that is one study, so I said to the GP or the cardiologist or somebody about it and they said, “Yeah, fine. Go for it.” And I also have ezetimibe, which is, which is used conjunctively with atorvastatin. It increases the protection so I have all that every day. So I rattle around if I jump up and down. 
None of these people seemed to be bothered too much by the quantity of medicines they were taking and managing medicines did not seem to have a major impact on their lives. However, medicines did cause others difficulties. For example, some people with diabetes have to regularly test their blood and then adjust the dose of insulin accordingly. Lottie found that the work involved in managing both diabetes and epilepsy (among other conditions) had reduced spontaneity in her life. Mohammed, along with other people we interviewed, was concerned about the potential side effects of prescribed medicines (see ‘Side effects of medicines’ for more about this topic).
 

Mohammed thinks that side effects from medicines are inevitable. However, he is concerned about whether such side effects might be making his underlying conditions worse.

Mohammed thinks that side effects from medicines are inevitable. However, he is concerned about whether such side effects might be making his underlying conditions worse.

SHOW TEXT VERSION
PRINT TRANSCRIPT
In terms of medication, or just living with the conditions, do you find, do you notice any interactions at all between the two?

Not so much interaction between the two but maybe slight signs of side effects, but they are clearly indicated in your packaging as well as by your GP, it’s certain there will be some. They are of concern and the concern is, is that side effect making the condition worse or is the medication treating but the side effect is something you have to learn [to live] with. That tends to be the concern, yeah. For example, you know, is a medication you are taking to treat an illness, it has a side effect. Is that side effect making the illness worse? I don’t know. That is for you people in the industry to look into and but that would be the only slight concern in my mind, to worsen. 
 

Lottie finds managing medicines for her conditions has reduced spontaneity in her life. She wonders what life what would be like if she were not weighed down in this way.

Lottie finds managing medicines for her conditions has reduced spontaneity in her life. She wonders what life what would be like if she were not weighed down in this way.

Age at interview: 37
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I think one of the hardest things is just constantly having to take medication to the fact that your life kind of you can’t be spontaneous, because you’ve got to suddenly think, “Ooh, we, you know, do I need to take this with me? Do I need to have this with me?” Or you can’t just kind of go off. Daft things, we, when we went on holiday last year, I think we probably spent more time trying to sort out travel insurance, letters confirming that I did need needles, the insulin, the drugs and all of that and it’s just, it weighs you down. You kind of think, I just, it would just be so nice just to walk out of the door and just go and do whatever.
Unsurprisingly, people made judgements about whether medicines were worth taking or not according to whether they were seen to work (see ‘Different views on medicines’). Lottie had tried a number of epilepsy treatments since being diagnosed but had not yet found a medicine that completely stopped her seizures. It was difficult for her to judge whether the epilepsy medicines were having any effect or not. Nigel found that adding a new medicine to his prescription might impact upon his blood sugar level, which would have knock-on effects on his diabetes treatments (see ‘Interaction between different symptoms, conditions and medicines’ for more information).
 

Nigel takes over thirty tablets a day. Every time another tablet is added it might affect his diabetes and change his insulin dose

Nigel takes over thirty tablets a day. Every time another tablet is added it might affect his diabetes and change his insulin dose

Age at interview: 58
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
And were you, your medication changed as a result or?

My medication was changed and then, because your medication changes, that affects your blood sugars, so then you have to start adjusting your insulin to affect the change they’ve give you in your tablets, because every tablet that they give you has a side effects, obviously, and that alters everything else. I’m on over thirty tablets a day now.

Okay.

For all my different conditions.
 

Tammy has been taking epilepsy medication for nearly 20 years and wonders what difference it would make if she stopped taking her medication, as mostly it doesn’t seem to be effective.

Tammy has been taking epilepsy medication for nearly 20 years and wonders what difference it would make if she stopped taking her medication, as mostly it doesn’t seem to be effective.

Age at interview: 45
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
The side effects of all these cross drugs, yeah aren’t sort of connected, at least they weren’t then and again, you know, I suppose I feel disappointed in that or wished I’d looked it up and known more, you know, that kind of thing. But yeah, that’s the side effects. I have been on anti-epileptic drugs for so long, you know, I should imagine it would be really weird not to be on them and the theory is, I’d have more seizures. But I sometimes I wonder, you know, I do think, “Gosh, just to come off them all and remain the same, see what happens.” But that’s not necessarily a good idea. I was always kind of warned that my seizures could turn into, you know, general seizures so that’s always been a sort of a deterrent for me to come off…

Right.

…medication but I don’t know, you know. When it’s at its worst, I sort of think or, you know, I’m prescribed a new drug that doesn’t work, then I’ve had it. I want to get rid of all of them then but I don’t and I haven’t got that far yet.
Some people who had been on a large number of medicines for a long time, wondered whether they should still be taking some of them, especially when new medicines had been added along the way. Whether or not individual tablets were thought to be providing any benefit was important to people. A detailed assessment of an individual’s prescribed drugs is called a ‘medications review,’ and we found that such reviews had been triggered by doctors, pharmacists and by the actions of patients themselves.
 

When Val was taking lots of pain killers they didn’t seem to bring relief. Following advice from a pharmacist, her GP undertook a staged withdrawal from her medicines.

When Val was taking lots of pain killers they didn’t seem to bring relief. Following advice from a pharmacist, her GP undertook a staged withdrawal from her medicines.

Age at interview: 70
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Yeah. The pain meds were for what, at that point, was the osteoarthritis and the fibromyalgia. So, I was taking amitriptyline at night as a muscle relaxant, to help with the pain so that I could sleep. I was taking citalopram in the morning for a similar, sort of, reason. I was taking pregabalin, which the pain clinic had suggested might help with the fibromyalgia. Oh god, what else was I taking, there was something else, I can’t remember what it was. But none of them were helping with the pain, and my perception of it was, that every time they added another Smartie to the box, they didn’t take a Smartie away. And they don’t work from a baseline, so they don’t say, okay, at the moment you’re not taking anything, so we’ll try x and see if x works, and if it does great, if not, we’ll withdraw it and we’ll try y. They just keep adding and adding and adding. They’re all toxins, they may or may not be good drugs, I don’t know, but the combination of all of the drugs seems to me to be not a good thing to be taking into your body without thinking about it.

And the pharmacist was the one who said, well, if it’s not helping with the pain why are you taking it? So then, I went to the GP and said what the pharmacist had said, and we agreed that I would do a staged withdrawal from all the drugs.

And, how do you feel compared to when you were on all the drugs?

Ah well, it’s interesting, because, some of the pain that I wasn’t feeling as much before, so the neck pain is worse, so I think the drugs were actually helping with the neck pain. And, the lumbar back pain is worse, and so I think the drugs were helping with that. But, the muscle pain in the arms and the legs, I haven't got any at the moment. But, you see, that is complex as well, because it always does fluctuate, so sometimes it’s bad and sometimes it’s not bad. So, with something like fibromyalgia, you don’t know whether it’s just decided that it’s going to have a few days holiday, or what’s going on. So, I don’t know whether it’s the drugs that have made a difference to that.
 

Lee attended an appointment with a new GP who reviewed her medicines and reduced the dose of one drug. She links the recent reduction in her medication list to losing weight and exercising.

Lee attended an appointment with a new GP who reviewed her medicines and reduced the dose of one drug. She links the recent reduction in her medication list to losing weight and exercising.

Age at interview: 49
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
I had my initial new patient appointment in January, in which I went through all the drugs I was on. The GP did blood pressure and weight check and promptly reduced the dose of blood pressure medication that I’m on. 

Right.

So that was that was quite good because I had only come off another blood pressure drug, so the diuretic side of it, I was taken off that in in October when I no longer needed it and I was getting some funny electrolyte levels, which.

Right.

The, if you don’t need the diuretic it can do that so I was taken off that, to have the ACE inhibitor dose reduced was really quite positive. I haven’t been followed up for that since, however, I don’t I have no reason to think my blood pressure has gone up since then because, of course, I’m still I’m still losing the weight and keeping up the exercise.
 

When Anne Y started with a new consultant she took in all the medicines she was being prescribed. She has found benefit from having tablets dropped or changed to alternatives.

When Anne Y started with a new consultant she took in all the medicines she was being prescribed. She has found benefit from having tablets dropped or changed to alternatives.

Age at interview: 61
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Whereas now, the consultant, you know, I’ve been seeing him for quite a few years.

So I feel better with him and I, it worries me sometimes that he’ll go and then who will the next one be? But. 

Right. Okay, so that continuity…

[mm]

Is important?

Yes, I, yeah, I yeah, I find that is that is important now, you know. At one time, when the nurse left, he did think he would be getting a replacement nurse and, of course, that’s just drifted on and he hasn’t got another one. So but as I feel at the moment, seeing him is fine and I did like it when the nurse was there because that was quite a quite a while but, you know, it’s fine as it is now. So I think better, I feel better with him because, when they changed me to him, because I was taking so much medication, I took it all in in a big carrier bag, when I, when they first gave me my first appointment.

Right. 

And said to him I was concerned about taking so much medication so, of course, from then, it’s when he started trying to change things and make my amount of tablets less and different and that’s when, you know, things started to get a bit better. So it’s taken a while.
When people talked about the medicines they were prescribed, they referred to a sort of trade-off between the positive effects of the tablets and perceived unwanted side effects. In general, people seemed willing to tolerate side effects if a medicine was having its desired effect, although in the context of multiple health conditions it was not always clear whether symptoms experienced by people were caused by illnesses or their treatments.
donate
Previous Page
Next Page