How can I manage my prescription and over-the-counter (OTC) medications, vitamins, and supplements safely?

Managing Your Medication List Safely

You should maintain a comprehensive, updated medication list that includes ALL prescription drugs, over-the-counter medications, vitamins, supplements, and herbal products, and bring this list (or the actual medication bottles) to every healthcare visit. 1

What Your Medication List Must Include

Your medication list should document the following for each medication 1:

• Medication name (brand and generic)
• Indication (what it treats)
• Dosage (how much you take)
• Frequency (how often)
• Route of administration (by mouth, injection, etc.)
• Start date (when you began taking it)
• End date (if applicable)
• All allergies, intolerances, and adverse drug reactions you've experienced 1

Critical Items Often Overlooked

Include these commonly forgotten items 1, 2:

• Over-the-counter pain relievers (NSAIDs, acetaminophen)
• Vitamins and mineral supplements
• Herbal remedies and dietary supplements
• Ayurvedic or traditional medicine preparations (these can contain toxic heavy metals like lead, arsenic, and mercury) 2
• Antacids and acid reducers
• Sleep aids and allergy medications
• Cough and cold preparations 3
• Medical marijuana 1

Common pitfall: Patients often don't volunteer information about herbal, alternative, or traditional medicines unless specifically asked—you must proactively include these 2.

Why This Matters for Your Safety

Medication list inaccuracies are extremely common and dangerous 1, 4, 5:

• 92% of dialysis patients had at least one medication-related problem, with 65% due to gaps in medication information transfer 1
• Medication lists in electronic health records frequently overlook over-the-counter and non-prescription drugs 5
• Drug interactions between prescription and OTC medications can cause serious harm 3, 6

Specific High-Risk Situations to Discuss

Bring your medication list when you have 1:

• New depression symptoms or cognitive changes
• Falls or balance problems
• Changes in kidney or liver function 1
• Pregnancy potential (many drugs are teratogenic) 1

How to Maintain Your List

Best practice: Use the "brown bag" method 1:

• Physically bring all medication bottles, supplement containers, and herbal products to appointments
• This allows your healthcare provider to see actual names, doses, and expiration dates
• Pharmacists are more thorough at medication reconciliation than physicians, so engage your pharmacist 1, 4

Update your list 1:

• Annually at minimum for stable conditions
• Monthly if you have unstable health conditions 1
• After every hospitalization (medication reconciliation at discharge is critical) 1
• Whenever medications are added, changed, or stopped

Special Considerations for Supplements

Vitamins and supplements are not benign 1, 6:

• Fat-soluble vitamins (A, D, E) can cause serious toxicity 6
• Folic acid and niacin have significant adverse effects 6
• Antioxidant vitamins can reduce the effectiveness of certain heart medications 1
• Many supplements contribute to medication burden, cost, and drug interactions without clear benefit 1

Discuss with your provider whether you actually need each supplement—except for recommended ones like vitamin D, many are non-contributive 1.

Critical Drug Interactions to Know

Timing matters for some medications 7:

• Take other medications at least 1 hour before or 4-6 hours after bile acid sequestrants (cholesterol medications) 7
• Some drug combinations are absolutely contraindicated (e.g., dofetilide with hydrochlorothiazide increases dangerous heart rhythm problems) 7

Food and medication interactions 1:

• Grapefruit interacts with many common medications, including most statins, increasing blood levels dangerously 1

When Kidney or Liver Disease Is Present

Your provider must adjust medication doses 1:

• Many drugs are cleared by the kidneys and require dose reduction in chronic kidney disease 1
• Monitor kidney function, electrolytes, and drug levels regularly for medications with narrow therapeutic windows 1
• Review and limit over-the-counter medicines and herbal remedies that may harm kidneys 1

Action Steps

1. Create your comprehensive list today—include everything you put in your body 1, 2
2. Add this statement to prescriptions: "As ordered if gluten-free or provide a gluten-free equivalent" (if you have celiac disease) 8
3. Avoid generic substitutions when possible, as sources can change frequently and affect safety 8
4. Ask your pharmacist to review your complete list for interactions and duplications 1, 4
5. Request annual comprehensive medication reviews from your healthcare team 1