HEALTH

Understanding your medicine

When treating an illness, the way in which medication is taken is just as important as actually taking it, says pharmacist Kamonsak Reungjarearnrung

Story by Arusa Pisuthipan, Main photo by Yingyong Un-anongrak

How much do you know about the medication you take? While such knowledge is crucially important to many of us, a surprisingly large number of people do not possess a thorough understanding of the drugs they use. Some are unaware of potential side effects while many do not follow directions properly and have no idea how best to store medicines.

While people are well aware that medication can treat and relieve disease, many don't know that if it is not used correctly it can also be deadly.

Here are the answers to some frequently asked questions about medications, including how to take and store them properly.

- How strictly should we follow label directions for medication prescribed by a doctor?

Label directions should be followed very strictly. According to pharmacist Kamonsak Reungjarearnrung, the most common misbehaviour among people taking medication is not following directions.

"For medicines it is said that when you take something is as important as what you take," remarked Kamonsak. "But, in my experience, missing or doubling a dose is becoming more common among sick people, especially the elderly."

The pharmacist categorised patients into two groups. Members of the first group are those who occasionally get sick and only take medication from time to time. The second group comprises patients diagnosed with chronic diseases such as diabetes, heart disease or epilepsy that require them to take medication for the rest of their lives.

It is important that members of the second group pay extra attention to the way they take their medication, Kamonsak said. This is because, aside from being potentially harmful in itself, ignoring the directions on how to take a drug is likely to lead to the condition the drug is supposed to treat getting worse.

"For example, diabetes patients have to take their medication 30 minutes before a meal so as to control their blood sugar. If they take their medication too early, their glucose level may get too low as the medication will start controlling the glucose level although the patient has yet to eat. On the contrary, if diabetes-control medication is taken too close to a meal it does not have enough time to become active," he explained.

Members of group one, though rarely sick, still must adhere to prescription instructions. This is especially true for antibiotics, the misuse of which can help a person's body become resistant to antibiotic treatment.

And if a patient forgets to take their pre-meal medication? Kamonsak said a missed does may be made up before the next meal. However, if it is almost time for the next dose, forget about the missed dose and try and maintain the schedule from then on. Never take extra medication to make up for a missed dose.

"For instance, if you forget to take a tablet before your breakfast, which you usually have at 8am, you can still take the dose until around 10am."

- Can certain types of medication be taken with milk or alcoholic drinks?

According to Kamonsak, antibiotics should not be taken with milk or dairy products because the high concentrations of calcium form chelate in the stomach, which decreases the medicine's absorption and reduces its effectiveness.

The pharmacist advised that milk should not be drunk for two hours either side of taking antibiotics.

Kamonsak recommended a more serious stance on alcohol. He said that whenever a person is being treated for an illness, they should abstain from drinking alcohol because it can hamper the effectiveness of the medication, especially antibiotics. Also, medication can react with alcohol with unexpected and potentially harmful results.

Kamonsak also recommended against medication being taken with coffee, soft drinks or fruit juice as the chemical substances in coffee, the gas in carbonated drinks and the acid in fruit juices can damage a drug's effectiveness. He advised that drugs should only be taken with water.

- What are the differences between paracetamol and aspirin? What are their maximum daily dosages?

Paracetamol and aspirin are both widely used to relieve pain and fever. Aspirin is also used as an anti-inflammatory and in platelet aggregation therapy so it may be prescribed for patients suffering from heart disease or rheumatoid arthritis or those who have had a stroke. However, it has a downside.

"Aspirin is infrequently prescribed to patients due to its unwelcome side effects, especially those relating to the gastrointestinal system," said Kamonsak. "If taken for a long period of time, say over three to five days, aspirin can cause stomach ulcers, abdominal burning or even severe gastrointestinal bleeding."

Though paracetamol is available without prescription, the overuse of these analgesic tablets can lead to some serious side effects such as liver damage.

The maximum daily paracetamol intake, according to Kamonsak, is 4,000mg, or eight standard tablets. He said there is no set daily maximum for aspirin consumption but the smallest possible dose should be taken due to the aforementioned side effects.

While aspirin should not be taken on an empty stomach, paracetamol can be taken anytime as it does not affect the stomach.

"If the pain is so chronic that you need to use painkillers for a long period of time, I suggest that you visit a specialist for a comprehensive examination to find out the actual cause of the continual pain, as it may stem from a more serious illness such as cancer," the pharmacist noted.

- Is it okay to take expired medicine if its form and colour have not changed?

Medication, especially those made from a single chemical agent such as vitamins, begins to lose its potency after the expiry date and may not be as effective or effective at all.

Some other expired medications, said Kamonsak, will turn into another chemical after they expire and can be harmful.

"For example, expired tetracycline [an antibiotic commonly used to treat bacterial infections] is poisonous and can cause life-threatening problems such as extreme liver damage."

Similarly, skin-care products should be thrown away once they expire. Such products are usually made from a combination of pharmaceutical agents that can interact with each other to become harmful when they have expired.

- What is the best way to store medication?

A long-held misconception among consumers is that medication should be kept in a refrigerator. The truth, said Kamonsak, is that medication should not be kept in the fridge unless specifically instructed by a doctor or pharmacist.

"Most medicines should be stored in a dry place away from sunlight at room temperature, which means 25C to 30C. This is why drug storage rooms in hospitals all over Thailand must be air-conditioned - so as to maintain an appropriate storage temperature," he pointed out. "Many people store their medication in the bathroom. But this popular spot is actually one of the worst places to keep them as bathroom cabinets tend to be too humid. Keeping medication in the car is also a very bad idea."

Kamonsak finished by asking the public to keep in mind that health care providers and registered pharmacists are the best source of information and advice about medications. Through them, people taking medication should always be made aware of the correct way to use it.

HEALTH TIPS

Q: My daughter is now a year and three months old. She is physically and mentally healthy, except her paediatrician has just found that she's suffering labial fusion. Could you please tell me about the causes, symptoms and treatment for labial fusion and whether it is possible for the condition to recur after it is cured?

A MOTHER OF ONE

Paediatrician Dr Anuttara Pothikamjorn replies :Labial fusion is a condition in young girls in which the two sides of the labia stick or join together. It is usually caused by an inflammation of the labial area due to the skin being exposed to irritants such as bubble bath, harsh detergent or soap or wet or dirty nappies. Inflamed skin at the labial area leads to abrasions. As the abrasions heal, the two sides of the labia attach.

Labial fusion is not an innate condition. It is commonly found in young girls aged between three months and six years and is rare in girls older than seven.

There are several degrees of labial fusion. Partial fusion is a common condition and is not something to worry about. In rare cases, the labia almost completely adhere together leading to urinary tract infection.

Treatment for labial fusion depends on the severity of the condition. In most cases, when the condition does not cause problems such as a rash or urinary tract infection, no treatment is necessary. Parents need only to continually observe the condition. Most of the time, partially fused labia will separate naturally by the time the girl has her first period.

In some cases, labial fusion may need to be treated with oestrogen cream, which is applied to the fused area twice a day for two weeks or until the labia become totally detached.

After complete separation, it is recommended that a petroleum ointment or mild antibiotic cream be applied to the labial area for at least two to three weeks to ensure that the labia do not become fused again.

Side effects of the oestrogen cream include labial hyperpigmentation and the development of breasts. However, these side effects will disappear when the oestrogen cream is no longer being used.

Recurrence of labial fusion is common even when the condition is properly treated. But, as stated, if the adhesion is not severe it will repair on its own before puberty.

To prevent labial fusion, it is recommended that children not play in a bath that has bubble bath or shampoo in it. Even mild, "baby" bubble bath or cleansing products can be too strong for children's skin. Being observant of children's genital hygiene is also vital.

'Health Tips' will run on the second Sunday of each month.
We welcome any questions about health issues, which we will forward to a specialist in the field. Fax your questions to 02-240-3668, or email arusap@bangkokpost.co.th

Bangkok Post

Last Updated : Sunday April 08, 2007