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Zoe Stefanadis, RPh

109 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

The Challenge of “Chronic Medication”

“An often-overlooked problem in managing a chronic illness—any chronic illness—is the impact on of long-term medication,” notes Pharmacist Zoe Stefanadis, founder and owner of Chapel Hill Compounding. “Everything we take in our body—food, medications, supplements—has to be metabolized,” she points out. “While medication may be essential for someone suffering from a chronic disease, long-term use can trigger other health problems—some even life-threatening. And the risk of complications has risen steeply in recent years, because so many patients are taking multiple medications. It sounds incredible, but it’s common now for people to be taking ten or more prescription drugs—something that was previously unheard of.”

Pharmacist Zoe Stefanadis, left, works with Pharmacist Stephanie Bowers to prepare a medication that can be applied transdermally.

And these risks aren’t limited to prescription medications, she points out. They can be in-creased by negative food-drug interactions and non-prescrip-tion medications and supple-ments.

“It’s worth noting, for ex-ample, that more people have been admitted to the hospital due to overdose of acetamin-ophen than controlled substan-ces,” she points out. “Individ-uals may double up on the same ingredient accidentally: they may use one product for a headache, another for arthritis, and something else when they have a cold—and they all com-bine to reach a toxic level of acetaminophen.”

She stresses that it’s not only overuse of over-the-counter medications that causes problems. “For example, taken too long, a common medication for nasal congestion can trigger ‘rebound congestion’ once it wears off. And other cold medications can raise blood pressure, or simply require higher dosages as the body becomes less responsive.”

Addressing Risks of Long-Term Medication

Prescription medications bring their own challenges, with each contributing a list of potential side effects along with the intended benefit. As medication numbers increase, so, too, does the risk of complications. “Remember,” says Ms. Stefanadis, “this all comes back to metabolism—how the body absorbs and uses the medication. This is why it is so important to understand metabolic pathways for the medications—to minimize side effects and maximize the drugs’ effectiveness.”

Custom, compounded formulations can help alleviate some of these problems, she points out. “One example of this is when non-steroidal anti-inflammatory (NSAID) medications are combined with other drugs. In these cases, transdermal formulations are a much safer alternative. By applying the NSAID locally, through the skin, we can minimize the risk of systemic problems.

“We use these formulations for people with chronic inflammation, such as rheumatoid arthritis sufferers or professional athletes. There have been cases reported where professional athletes actually had kidney failure due to high doses of oral NSAIDs,” she notes. “So transdermal is definitely a better option.

“Taking multiple medications—known as ‘polypharmacy’—can be problematic in a number of ways,” notes Ms. Stefanadis. “For example, many medications deplete vitamins and minerals, aggravating other health conditions. Statins used to treat cardiovascular disease can also deplete Coenzyme Q10—which in turn aggravates cardiovascular disease! Proton pump inhibitors prescribed for acid reflux or heartburn can hamper B12 and other nutrient absorption, negatively affecting long-term gut health.”

Side Effects, Drug Interactions

The problem of multiple drug interactions and side effects is a more complicated one, observes Ms. Stefanadis. “Often the reason people end up taking multiple medications is that they are getting additional prescriptions to treat the side effects from an initial prescribed medication. Some drugs cancel or reduce the effectiveness of others, new drugs produce new side effects.

“And—maybe most important—we’re all different,” she says. “Each one of us metabolizes food and medications differently, and that process is affected by all the things that make us unique—our genes, our age, our health history, and our lifestyle, including stress. So, our goal always, in compounding drugs, is to find the best way to deliver a medication, so that it has maximum benefit, with minimum risk, for that particular patient.”  

Patient-centered Care

Sometimes a problem comes not from taking, but from changing or stopping medications. “For example, physicians commonly prescribe SSRIs (selective serotonin reuptake inhibitors) to treat depression or anxiety for a short period,” she points out. “But abruptly stopping these medications can trigger extreme withdrawal that can include flu-like symptoms, anxiety, or even psychosis.

“In such cases, compounding pharmacies can play a critical role in helping patients safely taper off medications. For example, we can reduce dosages by as little as two percent every two weeks—something you can’t do by cutting up a pill—so the body will not even notice that the drug is no longer in the system, and there’s no withdrawal crisis. With this method, we’ve had great success helping people get off medications.”

Safe drug tapering is one compliance burden that compounding can help simplify. Working to get multiple practitioners and pharmacists and the patient aligned also helps to reduce complications. “We should have all available information so that we are serving patients to the best of our abilities,” she adds.

In part because of all the complications she sees, Ms. Stefanadis stresses the old adage about an ounce of prevention. “I try to focus on helping the body to fend off these chronic conditions through natural, supportive means,” she says, “whether that’s from a nutritional standpoint, lifestyle decisions, or supplements called adaptogens, which help the body to help itself.

“There’s a difference in the business of health care and the business of patient care,” Ms. Stefanadis explains, “and I’m in the business of patient care.”