Treatments have risks that must be considered. However, the failure to treat known disease states also carries extraordinary risks. It is therefore important to effectively treat diseases when possible, but also in the safest manner possible. The following is a list of rules that are designed to maximize the possibility of success while minimizing the risks of adverse outcomes. Examples of drugs that illustrate the rules are provided when appropriate.

1. Do not take medications inconsistently. Some medications, like Lithium, can trigger drug resistance with on/off patterns of use. Increasing or decreasing dosages without medical supervision can adversely affect efficacy and safety.

2. Do not use expired medications as they may lose efficacy over time. 3. Do not stop medications prematurely. Many medications, like Strattera, take 4-6 weeks to work. Patients should know when to expect an onset of action from their medications.

4. Do not stop medications abruptly. Short-acting medications, like Effexor or Paxil, can trigger headaches, dizziness or nausea with abrupt cessation. Missing dosages of short acting drugs, like Focalin, can lead to a rapid rebound in previously controlled symptoms.

5. Do keep track of whether changes in the form of medication used has affected performance. Changing from a short acting to a longer acting drug (or vice versa), using a generic, or using a drug that was re-imported from overseas can all affect performance.

6. Do not chew, crush or cut meds in half unless specifically given permission by your doctor or pharmacist to do so. Long acting drugs, such as Wellbutrin XL or Concerta, do not perform as designed when tampered with in that fashion.

7. Do not assume that you can mix alcohol, recreational drugs or even over the counter drugs with psychiatric medications. For example, alcohol plus Xanax/Valium/Klonopin can depress respirations and Motrin can increase Lithium levels.

8. Do recognize that cigarette smoking can speed up liver enzymes and reduce the effects of some medications like tricyclic antidepressants and Fluvoxamine.

9. Do recognize that diet can greatly affect performance of some medications. Geodon is absorbed better from the GI tract with food. Grapefruit juice may adversely affect some drugs, like Prozac, through a liver enzyme mechanism. Caffeine can exaggerate the anxiety/agitation side effects of atypical neuroleptics like Risperdal or Abilify.

10. Do have an informed idea from your doctor of how long you should continue on a medication. Excessive durations of treatments with some medications, especially some antidepressants, can cause apathy, fatigue and loss of efficacy. This is an issue that must be determined based on the individuals history and current medical status.

11. Do not treat the wrong diagnosis. Bipolar disorder and ADHD can be worsened by giving antidepressants alone. Thyroid insufficiency does not respond to psychiatric medications. Nothing predicts a poor medication response better than treating the wrong thing. Inducing mania with the wrong drug can be fatal.

12. Do not ignore drug interactions with other prescription drugs or nutrition supplements. Tegretol can decrease the effectiveness of oral contraceptives and ginseng can raise blood pressure in people on Adderall.

13. Do not ignore recommendations for lab and blood level monitoring. Some medications, like Depakote ER, must be dosed in a specific blood level range in order to perform as designed. Some medications require lab testing to avoid certain side effect risks. Monitoring blood glucose levels in patients on atypical neuroleptics, such as Zyprexa or Clozaril, would be an example of this.

14. Do recognize that changes in medical status can change the performance of medications. Lamictal, for example, is metabolized differently in pregnancy leading to the need for dosage adjustments (usually up). Significant weight gain or loss may change the dosage requirements of a great deal of medications. Changes in the speed of intestinal motility can change how much medication is actually absorbed from the GI tract into the bloodstream. This could affect many long acting products, such as Ritalin LA or Metadate CD. Take help from internet counseing .

15. Do not be passive. Ask about side effects, contraindications and off label usages of the medication when prescribed. Ask whether age, gender or ethnicity could affect the performance of the medication. An informed patient/consumer can partner with health care professionals to better enhance both efficacy and safety when medications are needed.