How to Take As Needed Medications

What does “as needed” mean?
Medications that are taken “as needed” are used only when necessary to treat a specific situation or symptom, such as pain, the common cold, allergies, constipation, anxiety, or fatigue. Some of these medications might be prescribed for you by a doctor while others can be purchased “over the counter” at your local pharmacy.

“Pro re nata” is a Latin phrase that means in the circumstances or as the circumstance arises. In medicine, pro re nata is abbreviated as p.r.n or PRN and means taken as needed or as the situation arises.

PRN medications are taken every once in a while to treat certain symptoms.

It is important to know what medications can be taken “as needed” and which ones must be taken regardless of how you feel. I take medications for low thyroid function, high cholesterol, and depression, each of which must be taken daily even if I feel great. This is non-negotiable. The list of medications I have on hand to be taken as needed is much longer and help me manage spasticity, nerve pain, anxiety, insomnia, and fatigue.

Can gabapentin or baclofen be taken “as needed”?
When I was first prescribed gabapentin and baclofen, I started them slowly, at a low dose, and titrated up to an effective dose which was taken daily on a regular schedule. Over the years, the amount of these medications I’ve needed to take has varied. At one point, I was taking 600mg of gabapentin three times daily to combat severe nerve pain. But now, I only take an occasional 300mg dose when mild nerve pain reaches the annoying or distracting stage. "As needed."

While I currently take baclofen each evening before bed, I also keep a prescription of diazepam (Valium) on hand for when the spasms get unbearable and when baclofen doesn’t sufficiently reduce the discomfort (ie, when massaging or stretching a knotted muscle causes intense crying).

Take medicines safely.
If you use PRN medications that are taken “only as needed,” it is important that you know exactly how these medications should be used. Discuss with your doctor his/her instructions regarding how frequently the medication can be used and what dosage you should use or not exceed.

Be aware that some of your PRN medications may be used instead of one of your other meds rather than in addition to. And, some medications may have similar ingredients and should not be used together. Ask your pharmacist if you ever have questions regarding medications (prescribed or OTC) to make sure that you take your medicines safely.


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Using "As Needed" Drugs with MS

(photo credit: Damian Gadal)

Talking to Your Doctor About Family Planning and MS Drugs

Some of the newer MS medications are contraindicated with pregnancy, including drugs that must be stopped for a period of time before a patient attempts to become pregnant, such as Aubagio or Gilenya. However, approximately half of all pregnancies are unintended, whether mistimed, unplanned, or unwanted, according to the CDC. So it is important to do some planning in advance to prepare yourself for the unexpected.

Talking to Your Doctor

Neurologists have much area to cover in a brief period of time during appointments. Family planning and reproduction are topics that likely do not rank in the top ten things to discuss with your MS doctor.

My neurologist may have asked once, ten years ago, whether starting a family was something I needed to discuss. Currently, my rheumatologist asks during each appointment whether my husband and I plan to have children and whether we are using consistent birth control as one of my medications is known to cause birth defects and miscarriages. It doesn’t matter that I’m almost 47 years old, my doctor still asks.

In addition to discussing symptoms and disability, please talk to your doctor about issues related to sexual activity, pregnancy, medication use, contraception, and family planning. Listed below are medications (included in the HealthCentral article), commonly used with MS patients, which have been categorized as carrying some level of risk to an unborn fetus. Research other medications on websites such as drugs.com.

If the topic of pregnancy, family planning, and MS medications is one which concerns you, please take time during your next doctor’s visit to discuss these concerns. If you do become pregnant while taking one of these medications, you can contact patient pregnancy registry programs to report drug exposure.

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Drugs to Take (And Not to Take) When Pregnant with MS

Avoiding Accidental Drug Overdose

It can be helpful to develop an organized system of handling your medications.  Some people like to use the weekly pill organizers which contain individual pockets for each day of the week into which you can place the pills you need to take at regular intervals during the week.  Some pill organizers are more specific and contain separate A.M. and P.M. pockets for each day of the week.  These organizers can be very useful.

However, I have a number of medications which are taken on an as-needed basis (such as pain medication) or a once-weekly basis (such as methotrexate).  As RA is associated with increased levels of depression and anxiety, you may have other drugs on hand such as the anti-anxiety drug alprazolam (Xanax) as I do.

Last month, I had a scary experience when I mistakenly took 10 pills of alprazolam instead of my weekly dose of 10 pills of methotrexate one late Friday night.  There were several contributing factors to the mistake.

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Medication Safety: Watch What You Put in Your Mouth

Drug Responsibility on Earth Day

We’ve talked about this before, but it is just as important to keep unused medications out of our nation’s landfills and water supply.  This year, the Drug Enforcement Agency (DEA) has scheduled another National Prescription Take-Back Day for April 27, 2013.  There are 23 locations within 10 miles of my own home in the suburbs of DC which will be available to accept unused medications on Saturday.  Find a collection site located near you.

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Celebrating Earth Day, April 22, 2013

Out with the Old, In with the New

Do you take note of the expiration dates of your medications, both prescription and over-the-counter?  I must admit that I do not always check the dates printed on the packaging.  But I’m here to tell you that it is an important thing to do.  In recent weeks, our household has encountered a couple of situations where taking expired medications have produced less than satisfactory results. 

The first situation involved an over-the-counter medication to help with chest congestion.  This drug is one of those which had previously been available by prescription only but is now available over-the-counter.  My mother looked through our “drug drawer” to see if we still had some Mucinex on hand - we did.  She began to take it, following the directions, but didn’t experience much improvement in her symptoms. 

I checked the original container and discovered that our bottle of pills was at least two years beyond the expiration date.  Oops.  Those pills were likely several years old and had lost their potency.  She stopped taking them.  Some drugs may become more potent or less stable over time and should not be taken past their expiration date.

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Out with the Old, In with the New: The Importance of Expiration Dates on Medications