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Understanding Medication Adherence

The use of medications has led to dramatic advances in the treatment and prevention of many cardiovascular diseases. It’s thanks to many of these medications—combined with heart-healthy lifestyle changes—that many people are living longer and feeling better. 

But medications only work if you take them as directed. If you skip doses, elect not to take a prescribed medicine or take too much, it can be dangerous. 

In fact, medication non-adherence—not taking medication as prescribed—is a leading reason for hospitalizations, more frequent doctor visits and medical costs. It can also interrupt timely care.

Think about it this way: managing your medications is just as important to protect your heart health as getting enough exercise and eating a heart-healthy diet.  

A Public Health Issue

  • 1 in 2 medications are not taken as prescribed.
  • Up to half of patients on a statin will discontinue it within a year.
  • Non-adherence accounts for as much as 50% of treatment failures and 125,000 deaths annually.

Medications for heart disease

There are many types and combinations of medications available to treat cardiovascular disease. Medications are used to: 


If you already have heart disease, you may need multiple medications. That’s because each is used to manage different symptoms or reduce the risk of additional health problems or death. For instance, antiplatelet or aspirin therapy may prevent a stent from closing or more blood clots from forming. You may also be taking medications for other health conditions; for example, diabetes or depression

Getting the most from your medications 

In many cases, treatment for heart disease includes a balance of healthy lifestyle changes (dietexercise and sufficient sleep), medications and, for some patients, devices and/or other surgical procedures. 

To get the most from your medications:

  • Learn about each medication and why it has been recommended. For example, ask questions to be certain you understand how it works, how and when to take it, common side effects and what to do if you skip a dose or run out of medicine.

  • Remember medications work best when they are taken in the right dose, at the right time and in the right way. The benefits of doing so are:
    • Better treatment of symptoms and other outcomes
    • Fewer side effects or drug interactions
    • A lower likelihood of unnecessary treatments  and hospitalizations 

Continue to take your medication—even if you feel well or don’t have signs of the disease. 

  • Guard against interactions, which may mean your medicine will not work as well and you may experience more severe side effects.
    • Give all of your care providers—your doctors, nurses, dentist, and pharmacist—an updated list of all of the medications you take, including over-the-counter drugs and supplements
    • Consider using one pharmacy so your pharmacist can review all of your medications and flag any issues
       
  • Tell your health care provider about side effects or concerns. Sometimes side effects can subside over time; your doctor may be able to manage them by adjusting your medications if needed. Many heart disease symptoms are similar to side effects from certain medications. Your health care provider can help discern which is which. 

When problems are more likely to occur 

Medication-related problems can happen when and if you:

  • take multiple medications
  • don’t fill a new prescription or refill an existing prescription
  • take medications at the wrong time
  • skip or stop your medications without talking with your health care provider
  • take extra medication or doses
  • take medications that may interact with other drugs, alcohol, even certain beverages or foods
  • don’t report concerns or side effects from medications
  • use medications prescribed for someone else
  • have concerns about the cost of your medications—talk openly about cost; your health care team may be able to point you to assistance programs or recommend lower-cost alternatives

Snapshot of Potential Medication Mishaps

Here are some issues that can arise with cardiac medications: 

Some cholesterol-lowering medications may interact with grapefruit or grapefruit juice. 

Foods and nutrition supplements high in vitamin K can reduce the effectiveness of warfarin (brand name: Coumadin). Certain antibiotics can also make bleeding more likely.

Skipping or stopping your antiplatelet therapy (aspirin, clopidogrel (brand name: Plavix)), prasugrel (brand name: Effient), or ticagrelor (brand name: Brilinta) after having a stent placed may increase your risk of heart attack, blood clots or death. 

Skipping or taking your dofetilide (brand name: Tikosyn) or sotalol (brand name: Betapace) early can increase your risk of having abnormal heart rhythms or arrhythmias, some of which can be life-threatening. 

Missing two or more doses of rivaroxban (brand name: Xarelto) or apixaban (brand name: Eliquis) can raise your risk of stroke

Simvastatin (brand name: Zocor) should not exceed certain doses with certain cardiac medications such as: amiodarone (brand name: Pacerone), dronedarone (brand name: Multaq), diltiazem (brand names: Cardizem, Cartia XT, Tiazac, Cardizem CD/LA) 

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve) may reduce the efficacy of aspirin depending on when it is taken.

Helpful tips 

Here are some things you can do, especially if you take multiple medications, to help take your medications the right way. 

  • Get organized
    • Use a weekly pill box; some also allow you to sort your pills daily by the time of day
    • Keep a personal medication chart/schedule and mark each medication as you take it
    • Talk with your doctor about home delivery pharmacies that pre-pour medications and put them in blister packaging for you 
       
  • Work your medications into your daily routine
    • One of the best ways to remember to take your medications is to take them at set times during your normal routine. For example after breakfast or before brushing your teeth at night.
       
  • Set a reminder or reminders
    • Place reminder notes where you can see them
    • Use the CardioSmart Med Reminder app to set medication reminders and prescription refill alerts and keep a secure personal medication record
    • Add it to your calendar or set a backup alarm on your smartphone or clock
       
  • Use follow-up appointments as a chance to review your medications
    • Medication regimens often need to be or can be adjusted, so be ready to talk about how you are feeling and any issues with your medication
    • Ask about ways to lower costs if it’s a concern
       
  • Get to know your pharmacist
    • Your pharmacist is a wealth of information and can answer questions about side effects, interactions, how to take and store your medications and much more.
    • Some pharmacies or prescription drug programs offer Medication Therapy Management (MTM) programs to review and track medications for certain people.
    • Your pharmacist may be able to work with you and your health care team to find ways to reduce the number of pills you take or address any other challenges you have.
       
  • Plan ahead for travel
    • Let your doctor know if you need an extra supply of medications
    • Bring a list of all of your medications and contact information for your pharmacy and providers; you may want to keep your medications in the original prescription bottle with your name on it
       
  • Remember, it’s OK to take medication
    • Some people don’t like the idea of taking medications, but heart disease is serious. Always share any concerns with your health care team.
       
  • Enlist help
    • Ask a trusted family member or friend to help you stay on top of your medications, order refills, report problems, etc.; there may be community services if and when they are needed

Be honest with your health care providers if you are having trouble adhering to your medication regimen. Your doctor may be able to simplify your medication schedule if you take several each day.

Questions to ask

Talk openly with your health care team about your medications—if you are having trouble taking them, if cost is an issue and anything else that might be getting in the way. 

Here are some questions you might want to ask:

  • Does this medication(s) interact with others I take? Are there foods or other medications I should avoid?
  • Is there a way to make my medication regimen easier?
  • Can you walk me through what condition each medication is intended to treat?
    • What is this medication(s), why is it needed, and how does it work in the body?
    • Why was this particular medication selected?
    • What is the dosage schedule and related instruction to how to take the medication(s)?
  • How long will I be taking this medication?
  • How will we know if it’s working?
  • How should the drug be stored?
  • What do I do if I miss or delay a dose?
  • What major and common adverse effects should I be concerned about?
  • What are the brand and generic name(s) for the drug?
  • Are there medications I don’t need anymore? How do I properly dispose of unused medications?
  • How can I pay for my medications? Are there ways to reduce costs?

Other resources

To learn more about different medications that are used to treat cardiovascular disease and risk factors, visit the Find a Drug section of CardioSmart.org. For information on patient assistance programs that can help cut medication costs, visit CardioSmart's Health Care Costs Support page. 

You can find out more about cardiovascular medications and tips for taking medications safely at: 

National Heart, Lung and Blood Institute
www.nhlbi.nih.gov 

Script Your Future
www.scriptyourfuture.org 


Published: July 2015
Medical Reviewer: Craig J. Beavers, PharmD, AACC, Centennial/University of Tennessee College of Pharmacy

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