I’d like to share with you some high­lights of the stim­u­lat­ing inter­view I recently con­ducted with Bar­bara Par­rillo, a phar­ma­cist in New Jer­sey. From first-hand expe­ri­ence, she urges read­ers to develop a rela­tion­ship with a local phar­ma­cist they can trust.

Bar­bara, why is it impor­tant to find a good phar­ma­cist to work with regularly?

It’s most impor­tant to bring all your pre­scrip­tions to the same phar­macy because then they have a record of every­thing you’re tak­ing. Your phar­ma­cist can coun­sel you if there are pos­si­ble inter­ac­tions or over­laps between the drugs you’re taking. She can consult with your physician when there are any problems.

It’s important that your pharmacy keeps a profile on you that’s current.  They need to know the diseases you’ve been diagnosed with and any allergies you have.

It’s a good idea to have your whole family go to the same pharmacy.  This gives the pharmacist a chance to get to know all of you, and she has a full medical history to do her job effectively.

It’s com­mon for peo­ple to go to many different doctors and they may get similar prescriptions for the same ailment.  By using one pharmacy the pharmacist is able to catch this and call the doctor to avoid duplication.

Also, there are times when a patient isn’t fol­low­ing the right dosage sched­ule for his drugs. When it comes time for a refill, your reg­u­lar phar­ma­cist can read­ily see if you’re tak­ing your med­ica­tion too fre­quently or not fre­quently enough.

Sometimes we see a patient (usually a senior, though it could be any­one) who takes a lot of dif­fer­ent pre­scrip­tions and is on a tight bud­get.  He might try to stretch out his pre­scrip­tions – take a pill every other day instead of every day. Or fill one pre­scrip­tion one month and a dif­fer­ent one the next month. Your phar­ma­cist can pick up on that when it’s time for a refill and may observe that you’re not feeling well and advise you that it’s because you are not taking your meds correctly.

Also, drug­stores can be busy places. If you’re a regular customer they will recognize you at the counter and may find a couple of extra minutes for you.

What are other issues a phar­ma­cist can help you with?

Many peo­ple now take a vari­ety of “nat­ural” health prod­ucts. But not all herbs or sup­ple­ments are free of poten­tial side effects or inter­ac­tions with pre­scrip­tions you might be tak­ing. Phar­ma­cists can help you with herbal inter­ac­tion counseling.

Phar­ma­cists can also help you min­i­mize your use of pain med­ica­tions – give you alter­na­tives and strate­gies with dos­ing sched­ules to help you steer clear of medication dependence.

Your phar­ma­cists can advise you when to call your med­ical doc­tor – for example, if  your symptoms persist for longer than expected.  Also, he can assist you when it’s safe to treat yourself.

Your pharmacist can help you pick out the proper over-the-counter drugs for you and your family.   He can look at you drug profile see what meds you are on and what disease states you’re being treated for and then you both can make an educated choice on what to take.

She can also tell you how to use these OTC’s correctly.  One major area of misuse is nasal sprays.  Patients overuse them and then can have a hard time stopping the medications.

How do you find a good pharmacist?

It’s like any­thing else — you shop around. You can try more than one. Go into a phar­macy and poke around – you can see if they spend time with their patients. Set up an appoint­ment to talk to one of the phar­ma­cists. You can review your med­ica­tions with them and ask some questions to see if the pharmacy can provide the services you are looking for.

But don’t go into a pharmacy at their busy times and expect a pharmacist’s undivided attention.  (8 am, noon, or 5 pm are usually the busiest times).  They can answer a question or two but if you need to have a discussion with them the off hours are better.

The pharmacies that are not as busy will have phar­ma­cists that can spend more time with you than the busier stores.  You can usually tell which pharmacies have overworked phar­ma­cists.

Many people are concerned with getting a good price these days, and chain pharmacies want you to think they’re cheaper.  They usually are.  But be aware – not all their drugs are cheaper.  Some pharmacies have specials on a popular diuretic or blood pressure pill to get you in and then you’re their regular customer.  You’re led to expect that all your prescriptions will be low-priced.  But that’s not always the case.

These bigger stores also want to draw you in with low drug prices so you will shop in the rest of the store, so just make yourself aware of prices.  I recommend if you are in the market for a full service pharmacy then pick it for the pharmacist. But if you are also looking for the best price then it’s a little harder to find both in one place,  They’re out there – you just need to do your homework before making your decision.

Word of mouth is also a good way to find a good phar­ma­cist. Ask your neighbors, ask your doctor.

What about drug side effects you should talk to your phar­ma­cist about?

Every drug comes with a list of side effects.  The pharmacist now gives you a pamphlet of information about the drug you are taking.  Use this as a point of reference but remember – not everyone gets these side effects.

You know your body, so if anything seems different after you start a new drug you should call your pharmacist or doctor (depending on the severity).  Sometimes a solution could be as simple as changing the time you take the medication or whether you need to take it with food.

Rashes are a com­mon aller­gic reac­tion. Peo­ple are devel­op­ing fre­quent aller­gic reac­tions to antibi­otics – some­times they’re severe. These should always be reported to your doctor and pharmacist.

Is there a par­tic­u­lar class of med­ica­tions more prone to side effects?

Any drug could poten­tially have a side effect.

One exam­ple of a drug that should be closely mon­i­tored is Coumadin. It’s pre­scribed as a blood thin­ner. The generic name is war­farin.   War­farin (Coumadin) can have seri­ous side effects if you take too much for your body – you can bleed.  Or, if you’re not taking enough it will not be effective.

You need to be aware of foods to avoid while on the medication (your pharmacist can help you here, too) and also pay attention to your body. If your gums start to bleed, or you get a lot of bloody noses or black add blue marks, call your doc­tor.  You may need to follow up with a blood test sooner than usual.  Always follow your doctor’s orders and get the blood work on the days your doctor has scheduled. This is the only way to ensure your drug is working correctly.

What about a parent’s con­cern with teenagers abus­ing drugs from the med­i­cine cabinet?

Abuse of pre­scrip­tion drugs by teenagers has become a major con­cern for par­ents. You have to know your chil­dren. Coun­sel your kids about the risks.

You can hide your med­ica­tions. But the best solu­tion is to lock your med­ica­tions up. Espe­cially pain meds.

It is also important to monitor your children’s prescriptions for ADHD.  They tend to find their way into other teens’ hands.

It used to be that you could flush unused pills down the toi­let, but that isn’t rec­om­mended any more. Many phar­ma­cies have a pro­gram to dis­pose of unused drugs – call up your phar­macy and see if they have a drop-off day.

A big prob­lem today is when your kids are visiting grand­par­ents (or the grandparents are visiting you.) Older peo­ple have pills every­where – Xanax, Val­ium, sleep­ing pills. Older kids could have a field day.

As a phar­ma­cist, do you get an idea of the pre­scrib­ing pat­terns of physi­cians in your area? Do you ever develop a sense of the par­tic­u­lar doc­tors who patients should be leery of?

Pharmacists usually build up a good relationship with the area doctors, so they are able to help you find a specialist in the area.   As a pharmacist, my interaction with physicians and with their patients usually gives me a feeling of how they run their practice. Of course, some good and some bad as in everything.

Is there ever a rea­son some­one should use brand name instead of a generic ver­sion of a drug?

Gen­er­ally, no. Generic prod­ucts are fine. Formularies – the lists of drugs your health plan will cover – are made up of approved generics. Most hos­pi­tals use generics.

But there are a few sit­u­a­tions in which it might make a dif­fer­ence – thy­roid med­ica­tion, for instance.  Your body adjusts to an exact dose of thyroid medication down to the micro­gram. So vari­a­tions in prod­uct man­u­fac­tur­ing can make a difference.

It’s not even that you have to take the brand name – it’s just that, whatever you’re on, stick with it, whether it’s Syn­throid or a generic. The prob­lem would be if you move around with your prescriptions and you get different manufacturers.  Then your dosage levels could be off.

The same issue may apply to phenytoin and warfarin , and a few other drugs, too.

What about drugs from Canada or another inter­net source?

I rec­om­mend against get­ting your med­ica­tions online or “from Canada.” You don’t really know what you’re get­ting and you have no recourse.

Some of these drugs are the real thing but there are coun­ter­feits out there too. The pills can even look exactly the same. Some­times there’s no active ingre­di­ent in them at all.

The FDA is working hard to protect us from counterfeit drugs and from generics and brand drugs that do not meet regulations.  So by going outside this system there is just no guarantee what you are getting.  Here again I would have to say buyer beware.

Thanks so much, Bar­bara. I’m sure readers will find a lot of value in what you have to say.

Dr. Lavine has been an innovator in the use of movement and touch to promote health since 1981. He practices in New York City and Princeton, NJ.


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