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By Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D.
This article was originally published in the Journal of Women's Health 2005 Jan 14(1):16-18. Copyright© Mary Ann Liebert, Inc.
Women consume a larger number of medications
and use more medications than
men.1,2 Despite this fact, women have been underrepresented
in clinical drug studies.3,4 Mounting
evidence, however, shows that women respond
differently from men to certain
medications.5 A great deal is still to be learned
about the optimal, safe, and effective dosing of
medications in women.
Numerous reasons have been given to explain
the differences between women and men in the
response to medications. Women have lower
body weight, smaller organ sizes, and a higher
proportion of fat compared with men.6,7 Differences
in metabolism (e.g., functional variations in
liver and kidneys and slower gastrointestinal metabolism)
and hormone levels affect the way medications
are processed, absorbed, and eliminated
by the body.7
A woman's response to medications may
change according to her stage in life, and hormones
have been blamed for this. For example,
hormonal levels have been implicated in the fact
that women are at increased risk of developing
potentially fatal irregular heartbeats (arrhythmias)
in response to certain drugs compared with
men.8,9 The blood levels of certain medications
may drop or be elevated immediately before the
menstrual period, making the medications less effective.
During pregnancy, blood volume expands,
which can dilute and reduce the effects of
medications.10 In addition, medications taken
within the first trimester of pregnancy are associated
with the greatest risk of causing birth defects.11
Little is known about how responses to medications
are affected by menopause, but, in general,
medication-related problems in older adults,
including women, are widely experienced.12,13
The results of aging (e.g., loss of functional capacity
of the kidneys and liver) and the subsequent
impact on drug metabolism cause increased
sensitivity to the effects of some
medications.14 The aging effects frequently are
coupled with concurrent use of multiple medications
because of the presence of multiple chronic
diseases. This leads to an increased risk of developing
an adverse drug event, that is, any
harmful, unintended, or unwanted effect of a
medication that can lead to illness or the need for
hospitalization or a visit to the emergency
The concurrent use of multiple medications
also increases the risk of developing interactions
between two or more medications (including
over-the-counter [OTC] drugs, dietary
supplements, and herbal products) or between
medications and certain foods or beverages.16,17
Other factors could also cause negative medication
use outcomes. These include self-medication
with outdated or shared medicines, failure
to comply with medication regimens because of
lack of or limited access to medications or poor
understanding of the treatment, and confusion
resulting from the use of multiple medications.18,19
Moreover, women have multiple roles
in society. As family caregivers and professionals,
women may have little time to dedicate to
themselves. Their health issues, including the use
of medications, may be jeopardized by their increasing
For these reasons, it is critical that women
across all life stages be alerted to the benefits and
risks of medications and their proper use. In particular,
- Be proactive, take responsibility for their own
health, and actively participate in decisions related
to their healthcare by asking healthcare
professionals questions about diagnosis, treatment,
and medication use.
- Be aware of the fact that medications can be
both helpful and harmful. By using medications
safely, the likelihood of positive outcomes
is significantly increased.
- Understand the need for each medication. If
more than one medication are being taken at
different times of the day, it is essential that
women take them correctly at the right dosage
- Ask their doctor or pharmacist about side effects,
particularly those requiring immediate
- Ask their doctor or pharmacist about potential
interactions with other prescription medications,
dietary supplements, herbal products,
food, and beverages.
- Ask their doctor or pharmacist about the need
to stop taking medications before surgery, as
certain medications (including herbal products)
can interfere with anesthesia or blood clotting.
- Ask their doctor or pharmacist about medications
that should not be crushed. Certain medications
if crushed may have their effectiveness reduced.
- Keep track of medications. Maintain a current
list of all prescription medications, OTC drugs,
dietary supplements, and herbal products being
- Inform their doctors and pharmacists about all
medications being taken (e.g., prescription
medications, OTC drugs, dietary supplements,
herbal products) and make their current list of
medications available to doctors during checkups,
regular office visits, hospitalizations, and
- Inform their doctor and pharmacist about any
allergies to medications.
- Inform their doctor if they are pregnant or intend
to become pregnant in the near future. Because
women generally see more than one doctor,
communication is important to help ensure
proper medication use.
- Inform their doctor and pharmacist if they feel
their medications are working differently during
different parts of their female cycle.
- Learn how to do their own research to retrieve
reliable information about the medications
they are taking and the safe and appropriate
use of medications in general. A wealth of information
is available on medication use during
a woman's life stages, including childbearing
age and older (>65 years). Women should
not rely on a single source of information.
- Read the Food and Drug Administration
(FDA)-approved drug package inserts for all
prescription and nonprescription medicines.
Be aware that herbal products are not FDA approved.
- Have a reliable medication reference book and
choose reliable internet sources for consultation
(e.g., MEDLINEplus®, FDA-approved drug packages).
- Be wise consumers. What you don't know can
hurt you. Prevention is also a medication.
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2. Correa-de-Araujo R, Miller GE, Banthin JS, Trink Y.
Gender differences in drug use and expenditures in
a privately insured population of older adults. J Wom
3. Harris D, Douglas P. Enrollment of women in cardiovascular
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Rosaly Correa-de-Araujo is the Director of Women's Health and Gender-based Research, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.