Some of these may sound familiar. Are you ...

• taking more than one prescription drug?
• getting prescriptions from more than one doctor or pharmacy?
• taking one or several over-the-counter drugs with prescriptions?
• having trouble keeping track of all your medications?
• having liver or kidney problems?
• confused, disoriented or “spacey” some of the time?

You may take prescriptions for bladder management or to keep spasms under control. Then there are the antibiotics for the urinary tract infections and possibly something for pain. There are always risks with medications, and the risks rise as you age with your SCI and as the number of medications you take increases.

Medications are taken to help your body adjust to the changes that have occurred since your spinal cord was injured. In order to give you the best possible care, your doctor must be told your complete medical and surgical history. This includes:

* What over-the-counter and prescribed medications you are taking right now
* Any allergies to medications you might have.
* Always notify your doctor if you are pregnant. Medications you take will affect your baby too.

How Do Medications Work?

Medications contain chemicals that interact with your body to:
* Replace chemicals that may be low in your body;
* Help body systems that aren't working right;
* Maintain chemical balance throughout your body.

Drugs also interact with each other. One drug can stop another from working properly or can make another drug have a greater effect than is needed.
* Your doctor always needs to know all the medications you are taking to be sure they work well together.
* Check with your doctor about drinking beer, wine, or liquor, because alcohol affects the way many drugs
* Take the medications your doctor has ordered exactly as they are prescribed. Always check with him/her if you feel you need to increase or decrease the dose.

Know Your Medications

Medications come in different forms. They vary in size, shape, or color and have distinct markings on them. They are available as tablets, capsules, ointments, or liquids.
* Know the names of your medications
* Know what they look like
* Know the dosages and times they should be taken
* Know WHY you are taking them
* Know any side effects they might cause.

You alone are responsible for all this information so you can be independent in caring for yourself. If someone else is giving it to you, personally verify each medication before you take it.

Side Effects

Most medications can cause side effects in your body. These usually are not a problem because they can be controlled by regulating the amount of drug you take and when you take it. Notify your doctor if you notice any discomfort from your medicines.

Drug Allergies

An unpredictable side effect can cause an allergic or anaphylactic reaction. Some reactions occur immediately and some are delayed several days. Know what to look for and what to do:

• The most common symptom is a skin reaction such as itching or rash.
• Call your doctor right away.
• If you have difficulty breathing or any other severe reaction to any medicine, call the ambulance immediately and be seen in the Emergency Room.

How Do You Know When To Take Your Medication?

Medication is usually scheduled for two, three, or four times each day. The schedule will be written on the prescription bottle or on the envelope containing your pills. Most medications are spaced at least 4 hours apart. Taking them more often is unwise, but feel free to consult your doctor about how best to fit medications into your personal daily schedule. Learn how long you should continue the medication. Be prepared to renew your medication long before your supply runs out.

Why Are Older People at Risk?
Because of normal changes in the body that occur with age, drugs often act differently with older people. As the body ages, the percent of water and muscle usually decreases, while the percent of fat increases. These changes can affect how long it takes for a drug to be absorbed into the body, how much is absorbed, and how long it stays. Also with age, kidney and liver function often slow down. These two organs are responsible for breaking down and removing most drugs from the body. As their function slows, undesirable drug reactions increase.
Medications tend to have a stronger effect as you age, increasing the risk of over-
medication. The risk increases as the number of medications increases. When five different drugs are taken, the risk of a bad reaction goes up to 50 percent. With eight or more drugs, the risk is about 100 percent. Bad reactions can range from medical complications to confusion and disorientation. They can cause you to be misdiagnosed with such conditions as dementia, Alzheimer’s or senility.

The use of medications, both prescription and over-the-counter, often reduces the level of endorphins­ those drugs your body produces to deal with pain and help you feel good. As a result, medications designed to help handle pain and anxiety don’t work as well, causing you to need more drugs. Other common complications for SCI survivors to note: incontinence, loss of appetite, balance problems, blurry vision and bowel accidents. In addition, lack of, or impaired sensation may make it difficult to recognize undesirable drug reactions.

How Are They at Risk?
Because older people tend to develop more long-term illnesses­arthritis, high blood pressure, heart problems, diabetes, digestive problems­it is common for them to be seeing different doctors and different pharmacists. These doctors and pharmacists are often unaware of each other or the different medications each is prescribing.However, as you age, the risk of medical problems from drugs increases with the number of drugs you take. Older adults average three prescriptions a day, 15 different prescriptions per year, and consume 70 percent of all over-the-counter drugs.

What Is Medication Misuse?
About 25 percent of older people’s hospital admissions are due to incorrect usage of prescription drugs. Older adults are far more likely than younger people to respond unpredictably to drugs, and because of this, most prescription drugs are not even tested on older adults. Medication misuse is almost always the result of either failing to closely follow directions or not clearly understanding the medication and how to use it. Misuse also occurs by being unaware of how different drugs can interact. Medications prescribed to people with SCI often deal with pain or spasticity, or bowel or bladder function, making the consequences of misuse especially troublesome or dangerous. The risks are even greater when drugs for anxiety or depression are involved.Even over-the-counter drugs such as vitamins, laxatives, cold remedies, pain relievers and antacids used in combination with prescription drugs or alcohol may lead to serious problems.

• Not taking medication prescribed for you
• Taking medication at the wrong time
• Taking the wrong amount of medication
• Stopping the medication too soon
• Mixing drugs which may react dangerously with each other
• Taking medications prescribed for someone else
• Consuming alcohol or food which may affect the medication

Don’t Be Afraid to Ask Questions
Recent studies show that older people are far less likely than younger people to ask doctors or pharmacists questions about medications. They are even less likely to ask if they’re with someone else, such as a daughter or son. Asking questions helps you to know:

• Whether to take medication with or without food or water
• How different drugs may affect you when they are taken together
• What side effects to be aware of and look out for
• The adverse effects of mixing alcohol and medications

How Do I Reduce My Risk?
Drugs, whether they are prescription or even over-the-counter, are powerful medicines whose purpose is to affect how your body works. Safe use demands that you know what you’re taking, why you’re taking it, what it’s supposed to do and what the dangers are. Using medications improperly­too much, too little, or in combination with other drugs or alcohol­puts nyou at risk. In order to cut down your risks, as well as insure maximum positive results from whatever medications you may use, here are some basic rules to follow:

Ask Questions: Know what you're taking, what it's for, and what it's supposed to do. Be sure you understand the directions: ask the doctor or pharmacist if you don't! Always take the correct amount­on schedule, and for as long as prescribed. For example: you need to finish a prescription of antibiotics, even after you’ve begun to feel better.

Talk to Your Doctor: Inform your doctor of all other drugs­prescription and over-the-counter­you’re presently taking. Always inform your doctor of past problems with specific drugs. Ask about side effects of new medicines, or foods or beverages to avoid, as well as how to store your medications. Ask your doctor how and when to report any unusual reactions.

Get Organized: If you’re taking several medications, ask about pill containers or other methods of keeping track of the various medications, doses and times. Keep a daily record of drugs you’re taking­name of the drug, doctor, dosage and times. Ask for easy-to-open containers if necessary. Discard old medicines. Don’t try to be your own doctor by using leftover pills that have worked in the past.

Be Smart, Be Safe: Take only those drugs prescribed to you­don’t use a friend’s drug, even if your friend has symptoms similar to yours. If possible, always use the same pharmacy when filling your prescriptions. On your next visit to your doctor, take all your medications with you­both prescription and over-the-counter­so you and your doctor can review what you’re taking.

Remember:
Any drug­prescription or over-the-counter­strong enough to cure problems is also strong enough to cause harm if not used properly. Prescription drugs are precisely controlled because they are capable of doing harm. If you’re taking more than one drug, which is often the case with SCI, then chances of misuse are much higher. So,
...Ask questions
...Stay informed
...Be safe

Common Drugs For Spinal Cord Injured Persons

For Spasticity

BACLOFEN (Lioresal)
Dosage: 15 to 200 mg daily by mouth

Purpose: 1. To relax skeletal muscle to decrease spasticity. 2. To relax the external sphincter to allow the passage of urine when the bladder contracts

Cautions: 1. It must not be discontinued abruptly; dosage must be decreased gradually down to zero. (If, for some reason, you suddenly cannot take it by mouth, intravenous (IV) valium will be used go wean you slowly.) 2. If discontinued abruptly, this drug can cause hallucinations, increased spasticity, abdominal cramping and tiredness. 3. Avoid drinking alcohol.

CLONIDINE (Catapres)
Dosage: .05 to 0.4 mg by mouth per day

Purpose: 1. To lower high blood pressure 2. To reduce spasticity

Cautions: 1. With prolonged use, get routine eye exams. 2. Can cause increased constipation (in which case, your bowel medication will be adjusted to help relieve this effect). 3. This drug can cause lowered blood pressure.

DANTRIUM
Dosage: 25 to l00 mg four times a day

Purpose: 1. To relax skeletal muscle to reduce spasticity due to injury to the spinal cord or brain.

Cautions: 1. This drug can cause muscle weakness or liver damage (blood level tests must be done to check the health of the liver). 2. Avoid alcohol or over-the-counter medications.

DIAZEPAM (Valium)
Dosage: 1 to 5 mg two to four times a day

Purpose: 1. To relax skeletal muscle to reduce spasticity 2. To decrease anxiety

Cautions: 1. This drug can cause addiction, tiredness, or decrease in alertness. 2. Avoid alcohol.

For Bladder

MINIPRESS
Dosage: 0.1 to 0.4 mg a day

Purpose: 1. To relax internal sphincter to allow urine to pass 2. To prevent repeated autonomic dysreflexia

Cautions: 1. This drug can cause dizziness when sitting up due to lowered blood pressure. Sitting up slowly will help reduce this feeling

PROBANTHINE
Dosage: 7.5 to 15 mg four times a day

Purpose: 1. To relax bladder wall muscle so it can store more urine without leakage

Cautions: 1. Store in tight container protected from light. 2. This drug can cause constipation or urinary retention. 3. Avoid drinking alcohol.

DITROPAN
Dosage: 5 mg three to four times a day

Purpose: 1. To relax smooth muscle in urinary tract and bladder so to reduce spasms and allow bladder to store more urine

Cautions: 1. This drug can cause constipation or urinary retention.

URECHOLINE
Dosage: 25 to 50 mg three to four times a day

Purpose: 1. To help bladder wall muscle contract to push out urine

Cautions: 1. Take with food or milk to decrease stomach upset. 2. This drug can cause dizziness when sitting up due to lowered blood pressure (sitting up slowly will help reduce this effect), sweating, or changes in bowel function.

For Bowel Program

DULCOLAX (firm, cone-shaped suppository)
Dosage: 1 suppository per rectum

Purpose: 1. To irritate the nerve endings in the bowel wall, causing COLON to contract.

Cautions: 1. Remove any stool in the rectum space where you will be putting the suppository. 2. Be sure suppository is placed against bowel wall otherwise it will not work. 3. This drug can cause mild cramping or leakage of mucous from bowel (this mucous is the normal way your body eases the passage of stool from the bowel).

GLYCERINE (soft, pencil-shaped suppository)
Dosage: 1 suppository per rectum

Purpose: 1. To irritate the nerve endings of the bowel wall, causing it to contract -- bowel secretes mucous to act as a lubricant and to ease the passage of stool

Cautions: 1. Remove any stool in the rectum space where you will be putting the suppository. 2. Be sure suppository is placed against bowel wall, otherwise it will not work

DOCUSATE SODIUM
Dosage: 1 to 4 tablets by mouth daily

Purpose: 1. To act as a surface agent helping to keep stools soft for easy natural passage

Cautions: None

MYLICON
Dosages: 40 to 80 mg by mouth 30 min. before meals Purpose: 1. To prevent buildup of gas in the digestive tract

Cautions: 1. Take tablets by chewing them.

PERICOLACE
Dosage: 1 to 2 tablets by mouth daily

Purpose: 1. To provide a stool softener with a stimulant to move the BOWEL

Cautions: None

METAMUCIL
Dosage: Sprinkle amount of powder suggested on label into 8 ounces of water, milk, or fruit juice 6 to 8 hours before planned bowel program

Purpose: 1. To create a gel-like mass that stretches the bowel causing it to squeeze and move the mass along the COLON and out of the body

Cautions: 1. Stir and drink right away. 2. After drinking mixture described above, drink one more glass of plain water.

SENEKOT
Dosages: Amount of tablets or granules as suggested on label 6 to 8 hours before bowel program

Purpose: 1. To increase movement of the whole digestive tract to move stool into the lower bowel

Cautions: None

DULCOLAX TABLETS
Dosage: 1 to 2 tablets by mouth 10 hours prior to suppository

Purpose: 1. To irritate the nerve endings in the bowel wall, causing it to squeeze hard

Cautions: 1. Be certain to time taking of Dulcolax tablet with placement of suppository as stated above. 2. This drug can cause cramping.

For Neurogenic Pain

ELAVIL Same as Norpramin NORPRAMIN
Dosage: 1O to 150 mg per day

Purpose: 1. To treat neurogenic pain 2. In high doses, to treat depression

Cautions: 1. Avoid alcohol. 2. This drug can cause drowsiness.

TEGRETOL
Dosage: l00 to 800 mg per day

Purpose: 1. To control neurogenic pain 2. To control seizures

Cautions: 1. Must have routine blood work done, because Tegretol can cause anemia in some people. 2. This drug can cause dizziness or drowsiness.

For Miscellaneous Complications

COUMADIN (Deep Vein Thrombosis & Pulmonary Embolis)
Dosage: Based on blood level tests.

Purpose: 1. To thin the blood and prevent clots

Cautions: 1. Take on an empty stomach at the same time each day. 2. Use a soft toothbrush as gums may bleed. 3. Report any sign of bleeding to your doctor. 4. This drug can cause bruising to occur easily.

CIMETIDINE (Tagamet) (Stomach Problems)
Dosage: 300 mg at bedtime

Purpose: To prevent or treat stomach ulcers by lowering the secretion of acid in the stomach Cautions: None

RANITIDINE (Zantac)
Dosage: 150 mg by mouth two times a day

Purpose & Cautions: Same as CIMETIDINE

DIDRONEL
(Excess Bone Growth, known as Heterotopic Ossification)
Dosage: 10 to 20 mg/kg a day

Purpose: 1. To prevent calcium from being added to areas of heterotopic ossification (See Complications Chapter)

Cautions: None

INVERSINE (For Sweating)
Dosage: 2.5 mg twice a day

Purpose: 1. To treat severe sweating that comes with spinal cord injury 2. To treat moderate to severe high blood pressure

Cautions: 1. This drug can cause lowered blood pressure.

ANTIBIOTICS (For Infections)
Dosage: Read the label Purpose: 1. To kill bacteria that causes infections

Cautions: 1. Take only by doctor's orders. 2. Take all that is prescribed even if the signs and symptoms are no longer present. This is to destroy all the bacteria involved. 3. Wounds and urine will be tested once in a while to make sure that the correct antibiotic has been used to treat the infection.