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Could you manage this every day?

Ten medications for about nine conditions, often from more than one prescriber.

Illustrative regimen
  1. Levothyroxine 50 mcgthyroid
  2. Apixaban 5 mgstroke prevention in atrial fibrillation
  3. Metoprolol succinate 50 mgheart rate and blood pressure
  4. Lisinopril 20 mgblood pressure
  5. Furosemide 20 mgfluid
  6. Metformin 1,000 mgtype 2 diabetes
  7. Sertraline 50 mgdepression or anxiety
  8. Omeprazole 20 mgacid reflux
  9. Gabapentin 300 mgnerve pain
  10. Atorvastatin 40 mgcholesterol

One day, hour by hour

One older adult takes all ten, each as its label directs. The times are illustrative.

  1. 6:00 AMOn waking

    Levothyroxine, with water only, before anything else.

    Breakfast waits 30 to 60 minutes.

  2. 6:45 AMBefore breakfast

    Omeprazole, before she eats.

  3. 7:15 AMWith breakfast

    Apixaban, metoprolol succinate, lisinopril, furosemide, metformin, sertraline, and gabapentin: seven pills with one meal.

    By 7:30 AM she has taken 9 pills.

  4. 1:00 PMMidday

    Gabapentin, the second of three doses.

    The label allows no more than 12 hours between doses.

  5. 7:15 PMWith dinner

    Apixaban, 12 hours after the morning dose, with metformin and gabapentin.

  6. 10:00 PMBedtime

    Atorvastatin.

  7. The day, counted

    14
    pills a day
    6
    separate times to stop and remember
    9
    pills before 7:30 AM

The rules she carries

The labels and counseling for these ten medicines add instructions about food, timing, other medicines, and symptoms to watch for. As her day plays, each one goes on a note on the refrigerator door.

13rules to follow, on top of the schedule

13 rules on the refrigerator door
  1. Levothyroxine: empty stomach, water only; wait 30 to 60 minutes before eating.
  2. Levothyroxine: keep calcium and iron supplements at least 4 hours away.
  3. Omeprazole: take before eating.
  4. Metformin: take with meals.
  5. Metoprolol succinate: take with or right after a meal; do not stop suddenly.
  6. Apixaban: about 12 hours apart. A missed dose is taken as soon as remembered the same day, then the usual schedule resumes; never double up.
  7. Apixaban and sertraline: no over-the-counter NSAIDs or aspirin powders unless the prescriber approves; they add bleeding risk.
  8. Gabapentin: no more than 12 hours between doses; take it at least 2 hours after an aluminum or magnesium antacid.
  9. Gabapentin: stand up slowly; it can cause dizziness and falls.
  10. Furosemide: take it in the morning so it does not wake her at night.
  11. Lisinopril: no potassium supplements or salt substitutes unless told to use them.
  12. Atorvastatin: report unexplained muscle pain or weakness.
  13. Sertraline: do not stop suddenly.

One week

The week goes into a weekly organizer: seven days, five compartments a day. Omeprazole rides in the breakfast compartment, marked to take before eating.

98doses to sort each week, 14 a day

Weekly organizer, illustrative regimen

    The ten labels

    Select a label to show its doses in the organizer, and select it again to clear. The quantities are illustrative.

      One month

      Refills

      All ten are 30-day supplies. The label quantities are 30 for once daily, 60 for twice daily, and 90 for three times daily.

      If each prescription started on a different day, each one runs out on a different day.

      10refill dates in one month

      Pharmacies can line refills up to one date when asked.

      Illustrative dates
      1. 3 Levothyroxine, qty 30
      2. 6 Apixaban, qty 60
      3. 8 Metoprolol succinate, qty 30
      4. 11 Lisinopril, qty 30
      5. 13 Furosemide, qty 30
      6. 16 Metformin, qty 60
      7. 19 Sertraline, qty 30
      8. 22 Omeprazole, qty 30
      9. 25 Gabapentin, qty 90
      10. 28 Atorvastatin, qty 30

      Labs that bear on this regimen

      Each line joins a medicine to a lab result that bears on it.

      5labs, joined to 7 of the ten medicines

      When something changes

      Choose a situation to see which of the ten it touches.

      Between visits

      Between visits, the pharmacist follows appointments, labs, refills, supplements, and symptoms, and reports back to the physician.

      Across Torch patients, the median number of medications is 10.

      Request a consultation

      Illustrative regimen. It shows the kind of daily routine ten medications create and is not medical advice for any person.

      The regimen, times, and refill dates on this page are illustrative.