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Tips on Adhering to a Medication Regimen For the Dialysis and Kidney Transplant Patient
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As a dialysis or kidney transplant patient, you know that taking medication the way it is prescribed is one of the most important things you can do to help keep yourself as healthy as possible. Even though you know how important it is, medication is not always the easiest thing to swallow. A Challenging Endeavor Being both a former dialysis patient and a recent recipient of a second transplant, I understand how challenging taking medications can sometimes be. Most people want to be adherent to their medication regimen, but busy, distracting lives often get in the way. By the time you juggle all of your other daily responsibilities, it's easy for something like medication to get overlooked. Just remember that, even though you may not feel any different when you don't take your medication, you're putting your health in jeopardy when you take it incorrectly or forget to take it all together. My job as a pharmacist is to help people take their medications in the most effective way they can so they get all the benefits they have to offer. This includes helping people with ways to make taking medication as simple and convenient as possible. If medications require too much effort, no one is going to want to hassle with taking them... and medications don't benefit anyone if they're left just sitting in a bottle. Dialysis and transplant patients already have enough inconveniences to deal with, so something as important as taking medication shouldn't be one of them. Hopefully, some of the following suggestions will help make taking your medications more convenient and, in turn, improve your overall health. What About Medication Boxes? Chances are you already have, and are using, one of those medication boxes that have separate compartments for different days of the week and different times of the day. I am a huge fan of these med boxes. I help some of my patients fill them every week, and I recommend them to all my patients who take a lot of different medications. One of the greatest features of med boxes is that they allow you to keep all your medications in one container. When it's time to take your medication, you have them all together in one place and don't have to look for separate bottles in different parts of your house or apartment. Kidney patients often have a lot of medications and many different bottles of drugs to open. With a med box, you open one compartment and immediately have all the pills you need to take. When you have to open five or six or more different bottles to get all the medication you need, it takes a lot longer. And the more bottles you have to open, the more chances you have to miss a bottle or to take the wrong amount of a medication! With med boxes, you open up the bottles one day a week when you fill the box, saving time and reducing the chances of taking something incorrectly or missing it entirely. And if you can't remember whether or not you've taken your medications, you can find that out right away by looking at the day of the week on the med box.
Make It Your Daily Routine Another suggestion I give to patients is to make use of things that will remind them when it is time to take their medications. Keep the med box in a place where you'll see it everyday. Make taking medication a natural part of your daily routine by learning to associate medication times with something you already do everyday at that time. If you start making it a habit to brush your teeth in the morning and then immediately take your medication, after a few weeks the two events will seem inseparable, and you won't be able to look at a toothbrush and not think about taking your medication. Visual and Auditory Reminders Visual and auditory reminders can help make taking medications easier. While the med box is a nice example of a visual reminder, there are also other things you can try. You may find it helpful to put a sticky note on the door you leave through each day or a post-it note on the refrigerator. Items like alarms or timers can be nice auditory reminders. Digital watches or cell phones can be programmed to beep when it's time to take your pills. Some newer medication boxes even have timers on them and can be set like a digital watch to sound when it's time to take a particular medication. Phosphate Binders Dialysis patients have an added challenge in being adherent to taking their medications. It has to do with those wonderful phosphate binders that are so much fun to take. Taking these binders is one of the more difficult things for me to do. I find them hard to swallow, and they don't taste good. And the biggest problem of all is that I never seemed to have them with me when I needed them. As I watched my phosphorus level climb higher and higher, I decided I had to do something to make sure I never found myself anywhere without binders. I found it helpful to keep little containers of binders everywhere. If you're constantly finding yourself without binders, I suggest you try this, too. Keep little a container of binders at work, some in the car, and more in your coat pocket or purse. Invest in a key chain pill container, and keep some binders on your car and house keys. If you have binders everywhere, you'll never be anywhere without them. (Unfortunately, though, I still haven't figured out how to make them easier to swallow.) Immunosuppressant Medications As a transplant patient some of the most important medications that you take are the ones that keep you from rejecting your transplanted kidney. These medications, known as immunosuppressants, require some extra attention in order to make sure you are taking them correctly. While it’s important to take most medications at approximately the same time everyday, typically there is some room for variation in your schedule from day to day. With Immunosuppression medications however, consistently taking them at the same time everyday is very important. In order to be effective, you need to keep a consistent level of the drug present in your body at all times. Taking them at the same time every day, helps to insures that this happens. Allowing too much time between doses could cause the level of drug in your blood to be so low that there is not enough of it present to keep your body from attacking your kidney. Taking doses of these medications too close together could create levels of the drug that are too high, which can also be dangerous to your kidney. The levels of the drugs are usually tested when you have labs drawn. Taking these medications at the same time everyday insures that these lab results are as accurate as possible, and any adjustments that need to be made to the amount of medication that you take are done correctly. Know Your Meds The next few recommendations are really more reminders of things you should already be doing. If you're on dialysis, especially hemodialysis, some of the medications you need are given to you during your dialysis treatments, making it that much more important to never skip dialysis sessions. Know the name of each medication you take at home, what each one looks like, why and how you are taking it. Keep a current list of this information, and bring it to your doctor or clinic visits. If a medication gets added or changed, write those changes on your list immediately instead of waiting to get home and risk forgetting about the changes. Conclusion All the reminders in the world will do you no good if you don't have the medications you need to take on hand when you need to take them. Therefore,make sure you never completely run out of any of them. Call your pharmacy for refills a few days before your bottles are completely empty. Sometimes the pharmacy will run into problems getting your refills ready, and, occasionally, they may need to call the doctor's office for refill authorization or need to resolve some issue with your insurance company before they can provide you with the refill. It often takes 24-48 hours for a doctor's office to return a pharmacist's phone call. Insurance companies often require pharmacists to fill out forms and get doctor's signatures before they will authorize payment for a medication, and this process can take a couple of days. If you call in your refills a few days before the medication is completely gone, you won't have to worry if the pharmacist runs into a problem and has to take some extra time to get your refill ready. Everyone is different, and you may find some of these suggestions more helpful than others, or you may have your own ideas for making it easier to be adherent to your medication schedule. The important thing is that you figure out what works best for you and try your best to stick to it. Taking medication will probably never be the most fun part of your day, but it's another thing you can do to make yourself as healthy as possible so that you can live your life to its fullest. About the Author Tiffany Strohmeyer, PharmD, began peritoneal dialysis treatments when she was 15. While working on her Doctorate in Pharmacy at the University of Kansas, she received a kidney transplant from her mother. Tiffany returned to PD in 2005 and received a second transplant this past June. She works as a pharmacist and is returning to school to complete a PhD in clinical psychology. Last updated March 2007
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