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Q: I have been using the same pharmacy for many years. Recently, it has been more of a struggle to get my prescriptions. The lines can be very long, and I feel rushed when the staff finally gets to me. Is this common? 

A: The types of changes you describe are happening across the country. Like many other businesses, pharmacies are struggling with budget cuts and staffing shortages. That’s leading to challenging working conditions for pharmacists and the technicians who support them. They’re doing more with less, and yet they’re expected to fill hundreds of prescriptions per day, administer vaccines, consult with customers, and call insurance companies to resolve billing issues. 

As a result, many pharmacy workers are experiencing burnout. They say they don’t have the time to do their jobs properly, and they worry about patient safety. Meanwhile, customers are sometimes scrambling to get their prescriptions filled or wondering if they should be concerned about the safety of their medications. 

Sometimes there’s a problem because the drug is out of stock. Your pharmacy may be unable to fill a prescription in a timely manner because they don’t have the medication on hand. It could just be that the drug is temporarily out of stock. Or it could be due to a manufacturing issue causing a shortage. 

If it’s a manufacturer issue, call your doctor’s office. Your doctor may need to change to a different medication that can work just as well. If the prescription is temporarily out of stock, ask your pharmacist to see if another store in the chain has it, make the call yourself, or ask your doctor to call in a prescription to a different pharmacy — one where it’s already confirmed that your medication is in stock and available. 

Don’t wait until the last minute to refill your prescription. Consider putting the prescription on auto-refill, which should allow the pharmacy to refill the prescription within a week of when it is due. 

Pharmacists work hard to fill prescriptions accurately, making sure you receive the right drug at the right dose. Yet mistakes sometimes occur. It’s unclear if that’s happening more frequently now.  

Always double-check medications before leaving a pharmacy. Look at your pills to become familiar with their appearance.  

If you get a batch that looks different, ask your pharmacist about it or search online to find an image of the pill you have and what it’s used for. Generic medications can come in a variety of shapes and colors, which can vary by manufacturer. 

Q: Why might a person start waking up more often to urinate during the night? 

A: Most people, once they reach middle age, will feel the need to empty their bladder at least once during the night. Doctors call it nocturia. Whether the need to urinate wakes a person up or it’s just that he or she wakes up for another reason and has the urge usually can’t be determined. 

Sometimes lifestyle is to blame. For example, it could be that you drink caffeinated beverages too late in the day. Caffeine increases your kidneys’ production of urine.  

Or maybe you’re drinking a lot of fluids close to bedtime. The kidneys never stop making urine, and many people make urine more efficiently when they’re lying flat than when they’re sitting or standing. 

Underlying conditions can cause nocturia. In women, an overactive bladder that results in a larger number of urinations is common, particularly after menopause. In men, an overactive bladder is frequently caused by an enlarged prostate (benign prostatic hyperplasia, or BPH). 

Both men and women can experience nocturia due to various medical conditions. For example, in individuals with type 2 diabetes, the kidneys remove the extra sugar that’s in the blood and produce more urine to carry that waste out of the body. Also, people with diabetes tend to drink more fluids because of increased thirst.  

In people with sleep apnea, the brain recognizes it isn’t getting enough oxygen at night. To increase oxygen circulating in the blood, the brain signals the kidneys to increase blood volume and tells the heart to pump faster. That increases urine production. 

Other reasons for nocturia include kidney disease; taking a diuretic (water pill) for heart disease or high blood pressure; or varicose veins associated with daytime retention of fluid, which shifts from the legs to the blood and kidneys at night. 

What you can do 

Treating nocturia starts with lifestyle changes. Try to stop drinking fluids several hours before bed and eliminate caffeinated beverages 10 hours before bedtime.  

Also, ask your doctor if you need to be tested for the various possible medical conditions that can cause nocturia, which may not yet have been diagnosed. 

Medications can sometimes help ease nocturia. In men with BPH, this could include drugs (alpha blockers) that improve the flow of urine, helping empty the bladder before bedtime. But you won’t go from getting up five times a night to zero times. It might just go from five to two. 

For women, bladder medications may help ease nocturia. But the drugs have possible side effects, and the risks and benefits have to be weighed carefully. 

Pill-free approaches include pelvic floor exercises, injections of botulinum toxin (Botox) or nerve stimulation. 

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, visit health.harvard.edu. 

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