Home Health 6 tips for managing multiple medications
Photo: iStock
Photo: iStock

6 tips for managing multiple medications

Keeping track of multiple prescriptions for your MS is easier when you have a system.

by Matt Alderton

Vanessa Willison, who lives with MS, organizes her pill box every Saturday night.

Some people spend Saturday night at the theater. Others spend it at a nice restaurant with their spouse or at a pub with their friends. For others, Saturday night is for playing games, baking cookies, going dancing or singing karaoke. For 49-year-old Vanessa Willison, however, Saturday night is “Pill Night.”

“Every Saturday night, that’s what I do: I sit in my bed and watch a movie while I do my pills,” says Willison, who was diagnosed with multiple sclerosis in 2019. “It adds up to quite a few pills over the course of the day, which is hard for me to keep track of.”

Hence her Saturday night ritual, which involves counting and sorting her medications for the upcoming week and storing them inside a large pill box that’s organized by time of day and day of week. When her prescriptions are parsed out properly in her pill box, she knows exactly what to take and when.

“I have a hard time remembering,” Willison says. “With my pill box, I can glance at my meds and know exactly what I’m supposed to take.”

Willison’s medicine-cabinet amnesia isn’t unique. Among adults aged 40 and older with a chronic condition, just 24% adhere fully to their prescriptions, according to the National Community Pharmacists Association (NCPA). In the same population, nearly six in 10 people admit to having missed a dose of prescription medication in the past year, while nearly one-third report having forgotten whether they had taken their medication.

“Medication adherence is incredibly important. Because if you’re not taking a medication, it’s obviously not going to work,” says Jacci Bainbridge, a clinical pharmacy specialist at the Anschutz Outpatient Pavilion in the Neurology Clinic at the University of Colorado Denver, and professor of clinical pharmacy at the University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Science and Department of Neurology, School of Medicine.

Although there are many reasons for not taking medication — everything from the cost of the prescription to unwanted side effects — the most common is simply forgetting, NCPA says.

Fortunately, even the most forgetful people can be empowered to remember their medications. All it takes is awareness of your biggest prescription adherence obstacles, an appreciation for why it’s so important to overcome them, and a commitment to using tools and strategies that can help.

Medication mayhem
Medication adherence can be especially difficult for people with MS. One reason why is the sheer number of medications they often have to manage. For example, a 2023 study by researchers at the University of British Columbia found that over a quarter of people with MS take five or more prescription medications.

“Often, people are treating multiple symptoms of MS with multiple medications, which can lead to a high medication or pill burden. In addition to their disease-modifying therapy (DMT), they might be on medications to treat symptoms such as bladder issues, bowel dysfunction, emotional changes, fatigue, pain, spasticity and/or walking difficulties,” explains Sarah Anderson, director of clinical content and resources at the National Multiple Sclerosis Society. “And a lot of folks with MS may be managing comorbidities alongside their MS. For example, they may have high blood pressure, high cholesterol, anxiety, depression or other chronic conditions that they’re also managing with medications.”

MS symptoms and comorbidities can also impact medication adherence directly. “For example, emotional changes can lead to nonadherence. If you’re not feeling well — if your mood and emotions are off — then you can have trouble doing the things on your to-do list, including taking your medication,” Anderson says.

Likewise for MS-related cognitive impairment and fatigue: While the former can impair one’s ability to remember to take medication, the latter can deplete their energy to follow through on actually taking it.

Although a missed dose here and there might not sound like a big deal, poor medication adherence over time can have serious consequences, according to researchers, who have linked medication nonadherence not only to disease progression, but also to increased healthcare costs and reduced quality and length of life. In fact, medication nonadherence in the United States alone accounts for up to 50% of treatment failures, an estimated 125,000 preventable deaths and up to 25% of hospitalizations each year, U.S. Pharmacist reports.

Strategies for success
Adhering to medications and treatment plans is the “cornerstone” for modifying the disease course, according to Anderson, “in addition to integrating healthy behaviors into your lifestyle. Nonadherence could potentially lead to relapses or disease and disability progression,” she says.

Whether you’re taking one prescription, five, 10 or even 20, there are simple tactics you can try that might help you improve your medication adherence. Here are six of the most effective:

Photo: iStock

1. Use a pill box
Willison swears by her pill box for two reasons. First, it’s visual; when she sees it, she automatically takes a mental inventory of her medication. Second, it’s tactile; the routine act of filling it every week is a manual memory aid that helps her recall her medication schedule and stick to it.

“I put it on my nightstand where I can always see it, and that helps immensely,” Willison says. “And the constant repetition of counting my pills as I’m putting them in there helps me cognitively, too.”

Keeping your pill box on your nightstand is a great strategy, echoes Bainbridge, who keeps her own pill box on her nightstand along with a glass of water. “It’s a double system. I have the pill box to help me remember, but I also have the glass of water. If the glass is empty, I know I’ve taken my pill,” she says. “If you put your pill box near something that you routinely do at a specific time of day when you might take your medications, you’re more apt to remember. But do not store your medicine around the shower, since this may affect the stability of the product.”

If you drink a cup of coffee every morning, try putting your pill box next to your coffee machine. Or put it next to your toothbrush since you probably brush your teeth every morning and every night.

A pill box alternative is PillPack, an online pharmacy whose free service automatically sorts and portions your medications, which are dispensed in plastic packages with the day and time to take them printed on the front.

Photo: iStock

2. Write yourself a note
If you don’t want to put a pill box by your coffee machine or your bathroom sink — maybe you don’t like clutter, for example — try a sticky note, instead. “If you’re a pen-and-paper person, put a reminder on a sticky note and stick it to your bathroom mirror or your laptop — somewhere you’ll be sure to see it,” Anderson says.

3. Set an alarm
If you prefer digital solutions to analog ones, use your smartphone for reminders instead of sticky notes, Bainbridge suggests. Favorite reminder apps include Apple’s Reminders for iPhone, Pi Reminder for Android and Microsoft To Do, which is available for both iPhone and Android devices. All three apps are free to download. All you have to do is set a recurring daily reminder for the appropriate time of day and your phone will automatically alert you when it’s time to take your medication.

Photo: iStock

Alternatively, there are mobile apps designed specifically for medication management. Retail pharmacies like Walgreens and CVS, for example, have mobile apps with built-in pill reminders. Other free options include MediSafe, MyMedSchedule, MyTherapy and Dosecast, just to name a few.

If you have an Amazon Echo, you can program Alexa to give you verbal medication reminders. And for true gear heads, there are even smart pill dispensers, bottles and bottle caps that connect to your phone. Although they can be pricey, they come with handy features like automatic dose tracking and intelligent reminders that can initiate notifications via app, text message or automated phone call. One example is the iRemember portable pill container and dose tracker, which automatically tracks doses and sends reminders to your phone for a retail price of $69.99.

4. Carry extra doses
Setting alarms is all well and good. But what if your alarm goes off when you’re grocery shopping, at a hair appointment or you’re at the gym? “I always keep at least two days’ worth of pills in a tiny pill box inside of my purse — just in case,” Willison says.

Photo: iStock

5. Recruit a pill pal
Consider asking a trusted friend or family member to be your “accountability buddy,” Anderson suggests. “It can be helpful to have someone you can check in with on a daily basis to help you remember to take your medication until it becomes a habit,” she says.

In exchange for helping you with your goal — medication adherence — you can offer to help your buddy with one of their goals.

6. Revisit your treatment plan
If you’re struggling with medication adherence, talk to your doctor or pharmacist. “They can help you optimize your medications,” Anderson says. “For example, if you’re on too many medications and you’re having trouble keeping track of them, there might be a different medication you can switch to that will treat multiple MS symptoms with one pill.”

Along with doctors and pharmacists, MS Navigators can be helpful, according to Bainbridge. “They’re a good resource and can be very helpful with finding medication reminder systems,” she says.

Matt Alderton is a writer and editor in Chicago.
To learn more, contact an MS Navigator by phone at 800-344-4867.