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It's Your Health: Use Your Medications Safely

By Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D.

Women consume a larger number of medications and use more medications than men.^1,2 Despite this fact, women have been underrepresented in clinical drug studies.^3,4 Mounting evidence, however, shows that women respond differently from men to certain medications.⁵ A great deal is still to be learned about the optimal, safe, and effective dosing of medications in women.

Numerous reasons have been given to explain the differences between women and men in the response to medications. Women have lower body weight, smaller organ sizes, and a higher proportion of fat compared with men.^6,7 Differences in metabolism (e.g., functional variations in liver and kidneys and slower gastrointestinal metabolism) and hormone levels affect the way medications are processed, absorbed, and eliminated by the body.⁷

A woman's response to medications may change according to her stage in life, and hormones have been blamed for this. For example, hormonal levels have been implicated in the fact that women are at increased risk of developing potentially fatal irregular heartbeats (arrhythmias) in response to certain drugs compared with men.^8,9 The blood levels of certain medications may drop or be elevated immediately before the menstrual period, making the medications less effective. During pregnancy, blood volume expands, which can dilute and reduce the effects of medications.¹⁰ In addition, medications taken within the first trimester of pregnancy are associated with the greatest risk of causing birth defects.¹¹

Little is known about how responses to medications are affected by menopause, but, in general, medication-related problems in older adults, including women, are widely experienced.^12,13 The results of aging (e.g., loss of functional capacity of the kidneys and liver) and the subsequent impact on drug metabolism cause increased sensitivity to the effects of some medications.¹⁴ The aging effects frequently are coupled with concurrent use of multiple medications because of the presence of multiple chronic diseases. This leads to an increased risk of developing an adverse drug event, that is, any harmful, unintended, or unwanted effect of a medication that can lead to illness or the need for hospitalization or a visit to the emergency room.^9,15

The concurrent use of multiple medications also increases the risk of developing interactions between two or more medications (including over-the-counter [OTC] drugs, dietary supplements, and herbal products) or between medications and certain foods or beverages.^16,17 Other factors could also cause negative medication use outcomes. These include self-medication with outdated or shared medicines, failure to comply with medication regimens because of lack of or limited access to medications or poor understanding of the treatment, and confusion resulting from the use of multiple medications.^18,19

Moreover, women have multiple roles in society. As family caregivers and professionals, women may have little time to dedicate to themselves. Their health issues, including the use of medications, may be jeopardized by their increasing responsibilities.

For these reasons, it is critical that women across all life stages be alerted to the benefits and risks of medications and their proper use. In particular, women should:

Be proactive, take responsibility for their own health, and actively participate in decisions related to their healthcare by asking healthcare professionals questions about diagnosis, treatment, and medication use.
Be aware of the fact that medications can be both helpful and harmful. By using medications safely, the likelihood of positive outcomes is significantly increased.
Understand the need for each medication. If more than one medication are being taken at different times of the day, it is essential that women take them correctly at the right dosage and time.
Ask their doctor or pharmacist about side effects, particularly those requiring immediate medical attention.
Ask their doctor or pharmacist about potential interactions with other prescription medications, dietary supplements, herbal products, food, and beverages.
Ask their doctor or pharmacist about the need to stop taking medications before surgery, as certain medications (including herbal products) can interfere with anesthesia or blood clotting.
Ask their doctor or pharmacist about medications that should not be crushed. Certain medications if crushed may have their effectiveness reduced.
Keep track of medications. Maintain a current list of all prescription medications, OTC drugs, dietary supplements, and herbal products being used.
Inform their doctors and pharmacists about all medications being taken (e.g., prescription medications, OTC drugs, dietary supplements, herbal products) and make their current list of medications available to doctors during checkups, regular office visits, hospitalizations, and emergency situations.
Inform their doctor and pharmacist about any allergies to medications.
Inform their doctor if they are pregnant or intend to become pregnant in the near future. Because women generally see more than one doctor, communication is important to help ensure proper medication use.
Inform their doctor and pharmacist if they feel their medications are working differently during different parts of their female cycle.
Learn how to do their own research to retrieve reliable information about the medications they are taking and the safe and appropriate use of medications in general. A wealth of information is available on medication use during a woman's life stages, including childbearing age and older (>65 years). Women should not rely on a single source of information.
Read the Food and Drug Administration (FDA)-approved drug package inserts for all prescription and nonprescription medicines. Be aware that herbal products are not FDA approved.
Have a reliable medication reference book and choose reliable internet sources for consultation (e.g., MEDLINEplus®, FDA-approved drug packages).
Be wise consumers. What you don't know can hurt you. Prevention is also a medication.

References

1. Roe CM, McNamara AM, Motheral BR. Gender- and age-related prescription drug use patterns. Ann Pharmacother 2002;36:30.

2. Correa-de-Araujo R, Miller GE, Banthin JS, Trink Y. Gender differences in drug use and expenditures in a privately insured population of older adults. J Wom Health 2005;14:73.

3. Harris D, Douglas P. Enrollment of women in cardiovascular clinical trials funded by the National Heart, Lung and Blood Institute. N Engl J Med 2000;342:475.

4. Wizeman T, Pardue M-L, eds. Exploring the biological contributions to human health. Does sex matter? Washington, DC: Institute of Medicine, 2001, Report No. ASBN 0-309-07281-6.

5. Anderson GD. Sex and racial differences in pharmacological response: Where is the evidence? Pharmacogenetics, pharmacokinetics, and pharmacodynamics. J Wom Health 2005;19.

6. Carlson KJ, Eisenstat SA, Frigoletto FD Jr, Schiff I. Primary care of women, 2nd ed. St. Louis, MO: Mosby, 2002:8.

7. Legato MJ. Principles of gender-specific medicine. San Diego, CA: Elsevier Academic Press, 2004;2:825.

8. Anthony M. Male/female differences in pharmacology: Safety issues with QT prolonging drugs. J Wom Health 2005;14:47.

9. Wolbrette DL. Drugs that cause torsades de pointes and increase the risk of sudden cardiac death. Curr Cardiol Rep 2004;6:379.

10. Edouard DA, Pannier BM, London GM, Cuche JL, Safar ME. Venous and arterial behavior during normal pregnancy. Am J Physiol Heart Circ Physiol 1998;274:H1605.

11. Uhl K, Kennedy DL, Kweder SI. Risk management strategies in the Physicians' Desk Reference product labels for pregnancy category X drugs. Drug Safety 2002;25:885

12. Hanlon JT, Schmader KE, Ruby CM, Weinberger M. Suboptimal prescribing in older inpatients and outpatients. J Am Geriatr Soc 2001;49:200.

13. Perry BA, Turner LW. A prediction model for polypharmacy: Are older, educated women more susceptible to an adverse drug event? J Women Aging 2001;13:39.

14. Turnhein K. Drug treatment in the elderly. Pharmacokinetic and pharmacodynamic considerations. In: Mallarkey G, ed. Drug treatment considerations in the elderly. Auckland: ADIS International, 1999:35.

15. Hare GT, Reinhard SC, Brick JH, et al. Polypharmacy. Reducing adverse events among the elderly in NJ. NJ Med 1999;96:35.

16. Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: Prospective analysis of 18,820 patients. Br Med J 2004;329:15.

17. Huang SM, Lesko LJ. Drug-drug, drug-dietary supplement, and drug-citrus fruit and other food interactions: What have we learned? J Clin Pharmacol 2004;44:559.

18. World Health Organization. Drugs for the elderly, 2nd ed. Copenhagen: WHO, 1997:5.

19. Blenkiron P. The elderly and their medication: Understanding and compliance in a family practice. Postgrad Med J 1996;72:671.

Rosaly Correa-de-Araujo is the Director of Women's Health and Gender-based Research, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.

Internet Citation:

Correa-de-Araujo, R. It's Your Health: Use Your Medications Safely. Article originally published in Journal of Women's Health. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/medication.htm