Are Pillboxes for Multiple Medications Safe?

Like the drugs they contain, they’re not always used as directed

pill boxes
Image courtesy Sharon Basaraba

Have you ever had trouble keeping your daily medication straight? As people get older, they often start taking more than one prescription and monitoring what pills need to be taken at what time of day can be challenging. Enter the multi-compartment pillbox: a low-tech device designed to help you keep everything organized and safe.

But how well do these pillboxes actually work in practice? According to a small 2009 study by Odette Gould, a psychology professor at Mount Allison University in Sackville, N.B., they may not be as effective - or safe - as they are intended to be.

Through her study published in the Canadian Pharmacists Journal, Gould and her colleagues discovered that few people seem to use pillboxes as they are meant to be used.

About the Research

Physicians describe taking prescribed medications properly as adherence or compliance to a drug regimen. In an effort to improve adherence, doctors and pharmacists often recommend pillboxes and blister packs: sheets of pills individually packed in plastic and sealed with foil. In theory, sorting pills or groups of pills according to when they are to be taken makes taking them on schedule easier to remember.

Gould and her team surveyed 135 people between the ages of 49 and 94 years, all of whom lived independently within the community at the time of the study. Subjects took an average of 6.5 medications each, with 75 percent using a pillbox at least some of the time. Most research participants said they use pillboxes or blister packs because they're convenient, they make it easier to remember to take drugs and it helps simplify complicated drug regimens.

Though many respondents liked their pillboxes, and about half of the subjects said they never missed a dose, 39 percent of pillbox users reported missing a dose or taking it much later than expected, one to three times per week. The majority also said they put all medications together in a single daily compartment, despite having prescriptions that need to be taken separately at different times of day.

What's the Concern?

Gould's findings may not sound dangerous, but often the effectiveness, not to mention safety, of a drug depends on when it's taken. A miscalculation while stocking a 7-day pillbox stretches the effect of the mistake over an entire week's worth of medication.

There are other potential problems, too. Depending upon memory to keep multiple medications straight may be a challenge. Relying on recognizing a pill when it's out of its prescription vial may not be possible when a generic version is later prescribed, the brand of drug is changed or the color or shape of the pill is modified by the manufacturer. In some cases medications are packed in special containers to keep out moisture or light; conditions a pillbox cannot guarantee. A number of respondents said they use a plastic bag or a tissue to carry pills when they travel.

Perhaps the greatest concern highlighted in the research involved the potential for error in simply transferring pills from their prescription vials to the pillbox.

Only a few subjects said they had someone check to ensure they'd sorted them correctly according to vial labels, stating they knew their medication regimen "by heart." Within most hospital settings, filling pillboxes is seen as complex enough to require a second healthcare professional to check for accuracy.

Though 82 percent of respondents described themselves as being in good or excellent health, memory issues among even independently living older people with mild cognitive impairment could jeopardize their ability to take drugs on schedule and in the proper dosages. In fact, the researchers report instances of blister packs with medications taken out at random.

Other investigators have found similar patterns. In one 2000 review of 312 patients in Boston, 76 percent of older adults living in the community had discrepancies between which medicines were prescribed and which drugs - prescription and non-prescription - they actually took.

Using Pillboxes Safely

Though Gould and her team call for more research regarding the impact of pillboxes and blister packs on drug adherence and compliance, their study shows that the use of these devices may not be as straightforward as they are intended to be. At the very least, if you use pillboxes, make sure you're using them safely. Your pharmacist or healthcare provider should know you use pillboxes, and it would also be wise to have someone check your work to verify you've sorted your medications properly.

See Also

Sources:

Bedell SE, Jabbour S, Goldberg R, Glaser H, Gobble S, Young-Xu Y, Graboys TB, Ravid S. Discrepancies in the use of medications: their extent and predictors in an outpatient practice. Arch Intern Med. 2000;160:2129–34.

Odette N. Gould, Laura Todd and Janice Irvine-Meek. "Adherence Devices in a Community Sample: How are Pillboxes Used?" Canadian Pharmacists Journal. ISSN 1715-1635, 01/2009, Volume 142, Issue 1, pp. 28 - 35.

"FDA Drug Safety Communication: Special storage and handling requirements must be followed for Pradaxa (dabigatran etexilate mesylate) capsules."
http://www.fda.gov/Drugs/DrugSafety/ucm248746.htm

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