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Are Pillboxes for Multiple Medications Safe?

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

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Updated April 20, 2012

Are Pillboxes for Multiple Medications Safe?

Are pillboxes used as intended?

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 which drug needs to be taken at what time of day, can become a challenge. Enter the multiple-compartment pillbox, a low-tech device designed to help you keep it all organized, and safe.

But how well do these pillboxes work, in practice? According to a small 2009 study by Odette Gould, psychology professor at Mount Allison University, they may not be as effective - or safe - as they were intended to be. In her research, published in the Canadian Pharmacists Journal, Gould and her co-authors found that few people seem to be using pillboxes as recommended.

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

Gould and her team surveyed 135 people between the ages of 49 and 94 years, all living independently within the community. Subjects took an average of 6.5 medications each, with the majority (75%) using a pillbox at least some of the time. Most said they used pillboxes or blister packs because they're convenient, they made it easier to remember to take their drugs, and it helped with complicated drug regimens.

Though many respondents liked their pillboxes, and about half of the subjects said they never missed a dose, 39% of the pillbox users reported missing a dose, or taking it much later than expected, 1-3 times per week. Also, the majority said they put all medications together in a single daily compartment, despite having prescriptions that need to be taken separately, at different times of the day.

This might not sound dangerous, but often the effectiveness - and 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 on 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 pill modified by the manufacturer. In some cases, medications are packed in a special container to keep out moisture or light, conditions a pillbox cannot guarantee. A number of respondents said they used 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 a 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.

Finally, though 82% of these 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, MA, 76% of the older adults living in the community had discrepancies between which medicines were prescribed, and which drugs (prescription and non-prescription) they actually took.

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 intended. At the very least, if you use pillboxes, make sure your pharmacist or health-care provider knows you do, and ask someone to check your work to make sure you've sorted your medications correctly.

More Advice on the Safe Use of Pillboxes and Blister Packages

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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