Introduction

Recently, a patient who was prescribed an eye medication to be used four times a day, returned a day later because her eyes flared up again. She reported that she took the medication four times and the eye felt better only in the morning, but got worse as the day progressed. The patient had in fact instilled four drops all at once instead of one drop at four equal intervals during the day! This might seem far-fetched, but there are reports of patients taking protein tablets orally instead of dissolving them in a vial to clean contact lenses. Generally, familiar eye medications are prescribed to treat, or prevent eye disease and the assumption is made that all patients understand the traditional dosing schedules. This is not always so, even when the doctor has given a verbal instruction or the dose is written on the label. Medication errors are not uncommon. These errors are due to the wrong drug, dose, timing, or route of administration. Other reasons include: not understanding the directions, forgetfulness, multiple medications with different regimens, unpleasant side effects or the medication does not seem to be working. Cost can also be a factor causing medication non-adherence; patients cannot afford to fill their prescriptions or decide to take less than the prescribed dose to make the prescription last longer.

The patient’s understanding of the reason medication is prescribed, as well as the prescribing schedule, is a starting point in helping to make sure that medications are taken correctly and safely.

Principles that prescribed medications need to follow

Figure demonstrating a good way of instilling eyedrops. P.Ramkissoon, 2018.

Dosage can be affected by the patient’s age, weight, pregnancy stage, kidney and liver health, and other health conditions.

To be effective, many medications need to reach a certain level in your bloodstream. They need to be given at specific times, to keep that amount of drug in your system. Taking a dose too soon could lead to drug levels that are too high, and missing a dose or waiting too long between doses could lower the amount of drug in your body and keep it from
working properly.

Adverse events, or unwanted negative effects, can occur with many drugs. These effects can include an allergic reaction or an interaction with another drug being taken. To help avoid these problems, be sure to tell your Eye Care Professional about any other medications you are taking or any allergic reactions you have had to drugs or foods.

Be sure to take your medications correctly to get the most out of them and to reduce your risk of side effects and other problems. Anyone giving you the drug, such as caregiver or family member, should follow your Eye Care Professional’s instructions carefully. Make sure that you understand everything about taking your medication. If you have any doubts, ask questions.

Some medications need to be taken with food; others should be taken on an empty stomach. Ask your Eye Care Professional or pharmacist if there are any foods that should be avoided while taking your medication. If you are taking medications with water, drink a full glass of water.

Take your medicine until it is finished or until your Eye Care Professional says it is okay to stop. Don’t take medicines prescribed for another person or give yours to someone else. Do not take medicine in the dark. To avoid making a mistake, turn your light on before reaching for your pills. This avoids mistakenly putting glue in the eye!

General rules for taking medicines

  • Take your medication at the same time every day.
  • Try taking your medications with a daily routine like brushing your teeth or getting ready for bed. Check if your medication should be taken on a full or empty stomach.
  • Keep a “medicine calendar” with your pill bottles and note each time you take a dose.
  • Use a pill container. Some types have sections for multiple doses at different times, such as morning, lunch, evening, and night.
  • When using a pill container, refill it at the same time each week. For example, every Sunday morning after breakfast.
  • Purchase timer caps for your pill bottles and set them to go off when your next dose is due. Some pill boxes also have timer functions.
  • When going away on holiday, be certain to take enough of your medication, plus a few days extra, in case your return is delayed.
  • If you are flying, keep your medication in your carry-on bag to avoid lost luggage. Temperatures inside the cargo hold could damage your medication.
  • If you have questions about your medication, do not be shy; ask your Eye Care Professional or pharmacist.

How to instil eye drops

  • •Wash your hands before instilling your eye drops. This reduces the chance of infection or of contaminating the eye drops.
  • Start by tilting your head back.
  • Pull your lower lid away from your eye to form a “pocket” by either (1) pulling your lower lid down with your index finger or (2) pinching the lower lid with your thumb and index finger and pulling out. Hold the bottle upside-down with the other hand, and let a drop fall into the “pocket.”
  • You may find it easier to tell that the eyedrop has gone into your eye if you keep your eyedrops in the refrigerator because the cold eyedrop will be felt.
  • If you have to put in more than one kind of eyedrop at a time, it usually does not matter which eyedrop goes in first. However, allow 3-5 minutes between putting in different eyedrops so that the first eyedrop can “soak in” and is not “washed out” by the second eyedrop.
  • Try not to allow the tip of the bottle to come into contact with your hands or your eye because this may contaminate the eyedrop and raise the risk of infection.
  • Gently squeeze the bottle so that one eyedrop falls into the small pocket created just inside your lower eyelid. If the eyedrop lands here, it is usually more comfortable than if it lands directly on your eye.
  • Slowly release your lower eyelid.
  • Allow your eyes to close gently for a few minutes. Blinking many times or squeezing your eyelids shut may force the eyedrop out of your eye so that it does not take effect.
  • You may wish to press gently against the inner corner of your eyelids, right by your nose to block off the tear drainage system, so that the medicine does not drain away from the eye. This will maximise the amount of medicine absorbed into the eye and will help minimise the amount of medicine absorbed into the bloodstream.
  • If you have difficulty installing eyedrops, ask a caregiver or family member to do it. The caregiver/family member must obey proper hygiene practices and administer medicines as prescribed.

Conclusion

Administration of medication requires a thorough understanding of when to take it, how to handle it, proper storage and disposal. It is vital taking your medications as prescribed – the right dose, at the right time, in the right way. Following the rules carefully is essential, in order to have the desired effect.

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