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First thing’s first… don’t panic!

Every medication may vary but in general terms, you should never double up your dose to make up for a missed dose unless you have been specifically told to do this by your doctor.

If you have missed a dose, it may mean that the drug levels in your body have fallen so that they are no longer therapeutic (doing their job).  However, some drugs hang around in the body for a longer period of time, so missing one dose may not affect it so much. Having an extra tablet will not necessarily make up for the missed dose and may just increase the risk of the levels going too high and causing unwanted side effects.

Missing one dose is unlikely to have any serious ramifications. However, if you frequently miss doses, this can be problematic – speak to your doctor or pharmacist about ways to minimise this and to help you remember.

If missing a dose could be particularly detrimental, such as aperson with epilepsy missing their anti-seizure medication or someone at high risk of a stroke missing their anticoagulant (blood thinner), then this was hopefully highlighted to you when you first started the medication as the outcome could be sudden and quite serious (ie, causing a seizure or a stroke).

The customer medicines information (CMI) is a leaflet that is often given to you by your doctor or pharmacist when you start a new medication – it addresses missed doses for that specific medicine. However, the CMI is often quite general. If you have thrown it out or you never received one, ask your pharmacist to print one out for you.

For most medications, if you have missed one dose (it is nearly time for your next dose) just carry on and have your next dose when it’s due (do not take extra to compensate).

If you remember and your next dose is still not due for a few hours, then usually it is okay to take the missed dose when you remember and carry on with your next dose as per usual.

This is not always the case, however, and it will also depend on how frequently you are taking the medication (ie, once a day or five times a day).

There is a fine line between missing a dose and taking too much of the medication in a short period of time. In any case, if you are ever unsure, call your pharmacist for advice.



In the hospital setting, patients who are acutely unwell may have a pharmacist review their medications on a daily basis while they are unstable. This is because it’s likely their condition and medications are frequently changing.

Ideally, a person’s medications should be reviewed by a pharmacist every time there is a change in their state of health or medication regime. However, this is not always practical or feasible.

In Australia, currently there are restrictions on how often you are entitled to a medicine review (excluding in hospital) and this is purely for money saving reasons and to prevent people from playing the system. It also means the ones at highest risk of medicine misadventure are targeted.

Currently, you are entitled to a medicine review if your GP thinks you would benefit from one. You are then not entitled to another medicine review for 12 months (6 months if you are in a care facility) unless there is a good reason for another one. For example, if you were recently discharged from hospital or if there have been significant changes to your medications or health.

If a person’s condition changes, this may also affect how their medications work. For example, if an elderly patient becomes significantly dehydrated through a bad bout of gastro, this could potentially throw their kidneys out and a medication that would normally be cleared by the kidneys may build up to dangerous levels, becoming toxic or causing unwanted side effects. Or, if someone with diabetes becomes unwell and is not able to eat, then their blood-glucose-lowering medications would need to be reviewed and potentially held until they are eating again.

GPs are fabulous at prescribing and are very knowledgeable about drugs, however, their focus is on treating the condition and doing no harm. Pharmacists are the medication experts and there are a lot of other things to consider when starting, changing or stopping medications, such as possible interactions, side effects, withdrawal symptoms, or additional monitoring. Pharmacists must also keep up to date with all the new medication therapies available that GPs may not be familiar with yet.

Pharmacists are a second pair of eyes for GPs to help ensure medications are being used safely and effectively. In an ideal world, pharmacists would be there at every interface when medication changes take place to intervene at the most critical time – before problems arise.

Your GP will determine when and if your medications need to be reviewed again. If you have any concerns about your medications and feel you would benefit from another medicine review or think a medicine review would give you peace of mind, then by all means ask your doctor for the referral.


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Knowing as much as possible about your medications and medical conditions is invaluable and can be life-saving.

If you were rushed to hospital and couldn’t tell the emergency doctors what medications you were taking because you didn’t know, you may miss days of essential medications while the doctors try to contact your GP to get a medication list. Even then, this list is not always up to date and accurate.

If you came in with a serious bleed and couldn’t tell the doctor what blood thinner you were taking, this could delay treatment and result in catastrophic outcomes. Or the doctors could unknowingly put you back on a medication you had a severe reaction to.

If you know your medications well, you may be more prepared in the case of an allergic reaction or side effect. If it was a serious side effect, recognising it early and knowing what action to take could potentially save your life.

Carrying a medication list with you can be incredibly useful, however, if you don’t know what’s on there or if it’s even up to date, then it can be useless and potentially detrimental.

When you go to see other healthcare providers, if you can tell them what you are taking and what it’s for, it can make their job a lot easier. Having this important information can allow them to make the best decisions about your care.

Doctors and healthcare professionals have gone through rigorous training and have every good intention but don’t always get things right. It is human nature to make mistakes and while every effort is made to avoid making them, they can still happen. If you are blindly following orders, you could be blissfully unaware of potentially serious medication errors.

Knowing what you are taking and how to take them are all very important but knowing the purpose of the medications and how long you should be taking them for can be just as important. For example, if you saw a specialist who started you on a medication that was intended to be taken only temporarily or short term, if this was not communicated back to your GP and you didn’t pay attention, then you could potentially end up taking it (and paying for it) for years more than you were meant to. This means you are exposing yourself to a medication unnecessarily, potentially putting yourself at risk of side effects or other problems.

It is well recognised that people who are properly educated on their conditions and medications are more involved in their medical decision making and tend to take responsibility for their health. Information is power and the more you know, the more you become empowered to take the necessary steps to control your health and to get the best results.


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A home medicine review is exactly as it sounds – a review of your medications done in the comfort of your home. First, your GP needs to make a referral to an accredited pharmacist and then the pharmacist will contact you to make an appointment to visit.

If you have heard of a good pharmacist from a friend who does medicine reviews, you can request that your doctor makes the referral to them, otherwise your GP may recommend a pharmacist they have used in the past. The pharmacist may work for a community pharmacy, another service provider or they may just work for themselves as private consultants.

With the referral, the pharmacist will also receive a medical summary from your GP with your medical conditions, current medications and other relevant information. The pharmacist may speak to your GP or other health care providers to clarify any information before seeing you.

Once they have all the information they require, the pharmacist will book an appointment time that suits you to visit you at your home. If you have someone that helps you with your medications, it would be essential to have them there during the review. It would also be ideal to have your spouse, carer or loved one present, as they spend the most amount of time with you and can also offer invaluable information.

You will need to gather all your medications together for the pharmacist, including any over-the-counter medicines or natural or herbal medicines. They want to know about ALL the medications you take, including injections, inhalers, eye drops, creams or ointments, pessaries, patches etc. even if you only use it once in a while. It can sometimes be helpful to pull out all your scripts in case there is something you may have forgotten because you haven’t used it in a while. Don’t forget about your medications in the fridge.

The pharmacist will go through them with you one by one to find out what you take, when you take them, how you take them and what you think they are for. It is not a test, they simply want to get an idea of what you know and how you manage your medications so they can give you the best advice.

Most people think they are taking their medications correctly when in actual fact they are not, or there could be something else interfering with how they work. The pharmacist is there to help identify and address any issues.

Even though they have read your medical summary, they still need to go through it all with you to confirm that everything is correct and nothing is missing. You would be surprised at how often there is missing information, incorrect information or outdated information. So don’t think the pharmacist is playing dumb by asking you questions they may already know the answer to.

If there is anything in particular that is concerning you, it is a perfect opportunity to bring it up. Your pharmacist can help allay any fears or misconceptions, suggest alternative treatments, provide useful tips on how to take your medications and manage your conditions or they can just help to make sense of things.  No question is a silly question.

Once the pharmacist has gone through everything with you thoroughly, they will write a review to your GP discussing all the issues they identified, suggesting possible solutions or alternatives.

You will then need to make another appointment with your GP so they can address any issues identified in the review and to make changes, if necessary.


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Polypharmacy is a relative term that has been used for years in the medical world to describe the use of multiple medications in an individual. It is relative because there is no set number that defines polypharmacy. There have been countless clinical studies looking at polypharmacy, all with slightly different definitions and with cut-offs ranging from 4 to 15.

One thing that can be agreed on is that, as the number of medications you take increases, so does the risk of adverse events, side effects, interactions and potentially inappropriate prescribing.

Polypharmacy is all-encompassing and includes not only prescription drugs but also non-prescription drugs such as over-the-counter medicines and natural or herbal medicines because they all come with risks associated with taking them either alone or in combination with other medications.

People at risk of polypharmacy are people with multiple medical conditions, people who see multiple doctors or specialists and people who take non-prescription or over-the-counter medications.

Side effects of medications can sometimes closely resemble symptoms of a disease and can be misdiagnosed as such. This can lead to unnecessary and inappropriate prescribing adding to the polypharmacy burden.

There risks are not only associated with certain combinations of medicines – being on a large number or medications with complex regimens can increase the risk of errors and can interfere with the patient actually taking their medications. If someone finds taking their medications onerous, they may become selective about what medications they take, which may be just as bad.

People taking multiple medications warrant a medicine review to see if any of their medications could potentially be reduced or modified, withdrawn or ceased altogether. Sometimes a trial off a medication can help determine whether they are really necessary or if they are potentially causing other unwanted effects.

Granted, medications are prescribed for a reason, so if the purpose for each medication is justified and no serious interactions are identified, then it may actually constitute best care for that patient.

It is important to remember that people’s conditions can change over time, as well as their situation, so a medication that was prescribed for a particular purpose may no longer be useful or the risk of taking it now outweighs any potential benefits.


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When most people see their doctor with a problem, they expect the solution to be in tablet or medication form. You trust your doctor to prescribe medications in your best interest and they will usually give you a quick run down on what the medication is and when to see them next.

You then go to your pharmacy to get it dispensed and hopefully the pharmacist will pick up on it being a new medication, so you should, at the least, get a CMI (Consumer Medicines Information) leaflet. The pharmacist may take you aside and counsel you on the new medication (when and if they get a free minute), making sure it is not going to be a problem with your other medical conditions or medications.

CMIs are written by drug companies, so essentially it’s like a legal document for them. They need to put EVERYTHING in it to cover their butts, so often there is a lot of information and that can be overwhelming for the patient. It also doesn’t list all the possible uses for the medication, which can be confusing for the patient if some of the advice doesn’t apply to the condition for which they are being treated. Although CMIs can sometimes be useful, they are not ideal. Unfortunately, they are often all we have.

So yes, it’s great if the pharmacist has picked up that it’s a new medication and taken some time to counsel the patient. Some people will take the CMI home and read it thoroughly and store it away for a rainy day, others will throw it straight in the bin. Either way, whether they get some education or not, it is a lot of information to digest and most people will have forgotten it the next day.

All too frequently, when questions arise later on about their medication, a lot of people will turn to Dr Google – and that is the worst thing you can do. Apart from there being a lot of misleading, inaccurate and irrelevant information on the web, people will often read into things and think the worst.

I believe everyone (who is mentally capable) should know at least the basics about their medical conditions, know what medications they are on, what they are for and why they are important. Understanding all of this often empowers them to take control of their health and take responsibility for their conditions. It can also help improve their care, as this important information goes with the patient into every appointment or consultation with other health professionals who can then make informed decisions based on this information.

I wanted to create a program that could print out and email personalised CMIs so the information you are handing out to your patients is more relevant, helpful, reader friendly and can be accessed electronically at a later date (when they may be tempted to visit Dr Google).

We decided to start with a book containing profiles on the top 100 most commonly prescribed drugs, information on common disease states, and other useful medicines information. The book is intended to educate people about medications, whether it’s them, a loved one, a patient or a resident taking the medication.


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As a pharmacist, when you ask someone about their allergies, they will often tell you about medications that caused them to experience unpleasant, unexpected or intolerable effects. We of course want to know about these types of reactions, however, technically they are not allergies.

An allergy is an immunological reaction to an allergen. An allergen is a molecule that triggers an allergic reaction. Examples of allergens include pollen, peanuts, eggs, cat fur, sulphur, shellfish and some medications. Allergens are molecules or substances that are mostly harmless to the general population.

Your immune system is your body’s natural defence mechanism to fight off invaders, such as bacteria and other pathological bugs, to prevent infections. When your body identifies something as an allergen, it considers it an invader and reacts in a way to try to rid the body of it. The immune system then becomes hyperactive against this otherwise harmless ‘invader’.

This immunological reaction causes symptoms of an allergic reaction such as redness or hives, itching, swelling, shortness of breath, and nausea or vomiting. In extreme cases of anaphylaxis, your body can go into shock or you can experience swelling of the face, tongue or throat, which can block your airways.

Your immune system can become sensitive to the allergen, meaning subsequent exposure to the allergen can lead to more reactive and intense reactions. This is not always the case, as some people who developed mild allergies as a child to things such as antibiotics seem to grow out of the allergy and can tolerate them later as adults.

We can sometimes predict whether someone will have an allergic reaction to a medication if we know their medical history (ie, if they have eczema, hayfever or asthma that are usually triggered by allergens), their family history (ie, if anyone in their family has allergies) and whether they have had allergic-type reactions to anything in the past. Some medications have similar structures and if you are allergic to one you may also be allergic to another.

An adverse effect (also known as an adverse event or reaction) occurs when the desired effect of a medication or an inadvertent side effects causes a harmful, unpleasant or undesirable effect. For example, a blood-glucose-lowering medication used for diabetes may cause excessively low blood-sugar levels (known as hypoglycaemia), which could lead to a seizure or dizziness associated with a blood-pressure-lowering medication, which could then lead to a fall.

Adverse drug reactions can also be unpredictable or unexplained – eg, severe skin reactions or liver failure. These are often serious but rare. Unfortunately, it is unknown what triggers these reactions or why they occur and for this reason it is hard to predict who might experience one.

Some adverse effects can be more predictable and potentially avoidable. For example, some people may be more sensitive to the effects of certain medications due to their age or other medical conditions, or they might be taking other medications that have similar effects, making the adverse event more likely.

Side effects of medications are again slightly different to adverse effects. Medications are taken specifically to hit a target and cause a desired effect (also known as a therapeutic effect), while a side effect is another effect caused by the medication hitting ‘off’ targets. These side effects aren’t always detrimental or harmful and can in some cases be beneficial. For example, an antidepressant causing sleepiness can also be useful in someone with sleeping difficulties. A side effect can become an adverse effect when the outcome is unpleasant, harmful or detrimental. For example, a medication causing drowsiness in an elderly person could lead to them falling and hurting themselves.

So an allergy and an adverse effect are not the same but they are both just as important. Make sure your doctor and pharmacist know about all reactions you have had to medications or other substances, as this may influence how they treat you.


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Dosage administration aids (DAA) come in all shapes and sizes and can be particularly useful for some people, however, it is a personal choice and not a recommendation that everyone uses one.

The most common DAAs are dosettes, which are refillable/reusable, and webster packs, which are discarded once completed. Sachets have more recently become available, but like webster packs, your pharmacy has to prepare them. Automated dispensing devices are also available.

DAAs can be handy for a number of reasons. Some advantages include:

  1. You (or someone else) can conveniently pack them at the beginning of each week so you don’t need to worry about pulling all the original containers out each day to take each dose.
  2. Saves you time and worry thinking about when each of your medications is due.
  3. They can help you keep track of when your last dose was and when your next one is due.
  4. When you get distracted with other things it is easy to forget if you have actually taken your dose, especially if you are not in your normal routine. If you did not take it, you would know because it would still be sitting in your DAA.
  5. For people who get muddled with their medications, it may be safer if someone else prepares their medications for them.
  6. If you are going away for 1 or 2 weeks, you can take the packed DAA so you don’t need to take the whole bulk of your medications with you.
  7. If you suspect a loved one is not taking their medications, you can sometimes use a DAAs to check (you can see if the packs still have medications in them).
  8. Some DAAs are specifically designed for blind people and have Braille on them.

 

They are not always right for everyone. A number of disadvantages include:

  1. If someone else is packing your medications for you, it is easy to lose track of what you are taking and why. This can also be problematic if you need to stop a medication suddenly and you don’t know which tablet it is.
  2. Not all medications can be packed in a DAA as it may affect how they work. This can create problems if you are stable on a medication, if there is no alternative, or it is packed unknowingly.
  3. Some medications shouldn’t be taken together, so if you are unaware of this it could also create problems.
  4. Some people can get confused about the order in which they should be taking their medications.
  5. Medications can be taken out of reusable DAAs without you knowing.
  6. If a mistake is made packing the DAA, the mistake may be carried on for days before someone picks it up (if they pick it up).
  7. When there are changes to your medications there can sometimes be a delay in getting a new updated pack (from your pharmacy) or there might be confusion about which packs are old and which are new.
  8. They can only manage oral medications and do not help with the management of other medication forms such as patches, inhalers, injections, eye drops etc.
  9. Some people find them hard to use because of arthritis, poor eyesight or other physical issues.
  10. It is possible with some DAAs for tablets to fall out, potentially without you knowing.
  11. It can add to the cost of your medications.
  12. If someone wasn’t taking their medications regularly but then started taking them regularly because they started using a DAA they could experience unintended side effects or problems that weren’t anticipated.

 

These are just some of the advantages and disadvantages of DAAs.

Some people see DAAs as a quick fix to make taking their medications easier but this is not the best way to view them. If you want to use a DAA for convenience then you should ideally be packing it yourself so you know what you are taking. Also, if you or someone else (not a pharmacist) is packing your medications, always check first that they can actually be packed and if they are okay to be packed together.

If you are wanting to use a DAA because you think you are taking too many medications and you want to simply things, there may be another solution. Having your medications reviewed can help to identify whether there are combination products or alternative therapies with less tablets to take or more convenience. In some cases, some medications could even be ceased.

If you tend to get confused about your medications, a medicine review done by an accredited pharmacist could help you demystify your medications. Your pharmacist can make you a list that clearly specifies what to take and when, so you can follow it and continue packing your DAA yourself. If you still get muddled or don’t feel confident packing it yourself, it would be best to get someone else to pack it for you.

Before you or a loved one commits to using a DAA, it is important that you know all your available options, including the pros and cons for each. Your pharmacist can help you decide what would be most suitable for you.


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Taking your medication isn’t as simple as just taking it out of its container, putting it in your mouth and swallowing it. There is an abundance of things to consider, especially given all the different formulations medicines can come in these days. It is crucial that the person taking or giving the medication is aware of all the most important information regarding that medication.

Incorrect use of your medications can be dangerous. A lot of people are blissfully unaware that they are not taking their medications correctly and could actually be putting themselves at risk. A medicine review can help identify and address any potential problems.

Medications should be taken correctly not only to prevent harm but also to get the most out of them. There is no point taking a medication every day, religiously, if it’s not going to be doing what it’s meant to because it’s not being taken or used correctly. Similarly, if a medication needs to be taken regularly for it to be effective, intermittent use or always forgetting to take it makes its use futile.

Taking medications, especially when you are taking a number of different ones, can get quite confusing. Often, brands can change without you knowing and this may add to any confusion. Your medications can change over time and it can be hard to keep track of all the changes and why they occurred. A medication review can help demystify your medications so you feel reassured that you are taking all the right medications.

Have you ever thought you ‘rattle’? You may be taking a complex medication regime with lots of tablets to remember every day when this could be simplified and result in saving some money!

It is not uncommon for people to see more than one GP or specialist and if communication falls short between your treating doctors, which is often the case, missing information can lead to conflicting advice, more confusion and uncertainty. There is also frequently a lot of confusion around medication changes after hospital admissions. A medicine review can help pick up all the pieces, consider all the information and get everyone back on the same page.

Medications can interact with each other in various ways and these may not always become apparent straight away. Interactions can also occur with over-the-counter medicines, natural and herbal products and even food and drink. A medicine review can help pick up any potential interactions with your medications for your GP to then monitor closely or consider changing or modifying therapy.

Your GP may also consider a medicine review as a valuable way to filter through your medications so they can work out if they are all still indicated or if treatment could be simplified or ceased. Sometimes medication side effects can be confused for worsening disease states or other conditions. Your doctor may refer you for a medicine review to help identify whether your symptoms could be related to an arising or worsening condition or due to the effects of your medication.

Understanding what you are taking and why you are taking them helps to make sense of your condition and to appreciate the importance of treatment. This not only makes you more likely to take your medications but also improves your overall care. Important information goes with you to all of your appointments with your treating healthcare professionals so they are able to make the best and most informed decisions about your care.

Pharmacists are the medication experts and are a second pair of eyes for GPs. Community pharmacists often don’t know your medical history or background, so they can give only limited advice. Accredited medicine review pharmacists get the full picture and can make meaningful recommendations.

Medications can be very effective if taken correctly but potentially harmful if taken incorrectly. A medicine review can give you piece of mind that what you are taking is safe, correct and will lead to the best outcomes.


© MyMedsHealth 2017