Features April 2007 Issue

5 Questions To help Your Pharmacist help You

Michael Lauer, M.D., a physician in the Department of Cardiovascular Medicine at Cleveland Clinic, has provided

Heart Advisor with the five most important questions cardiac patients can ask their pharmacists.

Question #1: What are the specific instructions for use?

Make sure that you know how many pills to take and how often to take them. Ask if you should take the medication with food or milk, or on an empty stomach. If your medication upsets your stomach, your pharmacist may advise you to take it with food. However, certain pills, like ACE inhibitors, are most effective when taken on an empty stomach, so be sure to follow your pharmacistís instructions.

Question #2: Are there any food interactions?

You may need to avoid eating certain foods while taking your medication. For instance, grapefruit can interfere with the absorption of statins, and you should not eat grapefruit or drink grapefruit juice if you are taking a calcium channel blocker. Foods high in Vitamin K, like broccoli, spinach, and turnip greens, should be limited if you are taking warfarin (Coumadin). Salt substitutes contain potassium and therefore should not be consumed if you are being treated with an ACE inhibitor, digoxin, or an angiotensin II receptor blocker. Mixing a salt substitute with these medicines can increase your potassium levels to a life-threatening amount.

Question #3:

Is it safe to take this drug with other medications, vitamins or over-the-counter supplements?

To avoid any dangerous interactions, tell your pharmacist about all medications and supplements that you take. Vitamins and supplements such as ginkgo biloba, ginseng, garlic, vitamin E, fish oil and coenzyme Q10 can thin your blood, so itís important not to combine them with warfarin. In addition, nonsteroidal anti-inflammatory medications (like Aleve or Motrin) and aspirin cause the body to retain sodium and water, which can decrease the effectiveness of ACE inhibitors, angiotensin II receptor blockers and warfarin. Digoxin has the potential to interact with several over-the-counter medications including antacids, asthma remedies, cold/cough/sinus medication, laxatives, anti-diarrhea medications and diet pills.

Question #4: How should the medication be stored?

Your pharmacist will advise you where to keep the medication, whether it should be refrigerated, and when it expires. For example, nitroglycerin tablets typically expire after three to six months, which means they may not be as effective at improving blood flow to the heart when used after their expiration date. Warfarin should be stored at room temperature away from any moisture. Incorrect storage of the drug can limit its ability to prevent blood clots.

Question #5:

What are the potential side effects?

Some side effects are more serious than others, so itís important to know how the drug may affect you. For instance, is it ok for you to drive or participate in other activities? ACE inhibitors, angiotensin II receptor blockers, beta-blockers and calcium channel blockers can cause dizziness, lightheadedness and faintness, especially when taken with a diuretic. In general, it is always best to wait and see how a drug affects you before driving.