Everything you ever wanted to ask about medicines...

Your FAQs. In summer 2007 we asked malehealth readers to ask us any questions they had about the use of medicines. We passed them on to our medicine men, pharmacist Graham Phillips and Dr Ian Banks, the president of the MHF (pictured below right). These are the answers.

Can you break a tablet in half and get half the dose?

Sometimes, but not always. Tablets are often specially made to release a drug over a specified period of time, or in a specific part of the intestine, so breaking it in half can disrupt this effect. There are no hard-and-fast rules so best to check with your pharmacist.

Why take tablets with food/before food?

There are a number of reasons and it depends on the medicine being taken. For example some medication is better taken with food if it is likely to irritate the stomach — the presence of food reduces this irritant effect. Some tablets are taken on an empty stomach because substances in some food stuffs can react with the medicine and stop it working. It's all about getting the maximum benefits and the minimum side-effects

Can I booze with antibiotics?

This depends on the antibiotic. It's not a good idea to drink with any medication without checking first, but there are certain antibiotics that have a very nasty reaction with alcohol, so you should not drink at all when taking them.

Can you drink with other medicines?

The same answer applies!

Do they deliberately make medicines taste terrible?

No, but it can seem that way! In truth it's simply because it's very hard to disguise the taste. Paracetamol, for example, is particularly hard to disguise which is why Calpol has such a strong following!

How long can I keep medicines?

Medicine should only be kept for as long as the course that has been prescribed. It can be dangerous to use medicines after this date. Any unused medicine should be returned to the pharmacy for disposal. Certain medicines, such as creams and eye-drops also have an 'expiry date' after which they should not be used. If this is the case, it will be clearly stated on the label. But bear in mind that the expiry date is based on ideal storage conditions. Medicines kept at home are rarely stored carefully.

Can I use say antibiotics for human infections on my dog or cat?

No. Humans and animals react in very different ways to medicines, and need very different doses too so you may do your pet serious harm.

If I take an antibiotic for, say, a sore throat, will that also deal with any other infections I might have, such as VD?

Not necessarily. You should only ever take an antibiotic for what is was specifically prescribed, or you could end up doing more harm than good.

Can I give my medicines to my mate who has the same problem?

No. Medicines are prescribed individually according to a persons medical history. While symptoms may appear to be the same the condition might be totally different and your medicines might do more harm than good. The person might be allergic to your medicine and suffer a severe reaction and even die.

What is wrong with buying medicines off the net?

It is difficult to be 100% certain that the site you are buying medicines from is a bone fide site. There are many examples of illegal sites offering inferior or even dangerous medicines full of poisonous impurities. The RPSGB, the pharmacists' professional body is looking at a way of ensuring consumers can be confident that the site is a genuine one. Even from a genuine site it can be difficult to obtain the advice you can get from a face-to-face consultation with your pharmacist.

Can I snort medicines to make them work faster?

No. Medicines are specifically designed to be absorbed through a certain route. Absorbing medicine through the nose rather than through the gut may inactivate it, or make it dangerous. It is likely to harm the nose as well.

Why do some medicines have to be injected when it is much easier to swallow them?

There are a number of reasons. Sometimes when a drug is absorbed through the stomach wall it is changed in such a way that it is rendered useless, so it has to be directly injected into the blood. Injecting often also means a drug will act quicker — obviously of use with something like pain relief.

Can medicines affect your love life?

Some medicines do have side effects that can affect libido or the ability to maintain an erection. Any side effects will be indicated in the patient information leaflet and any concerns should be discussed with your doctor or pharmacist.

Why do they put 'this medicine can cause drowsiness' on bottles of sleeping tablets?

It may seem an obvious point but it is a legal requirement to put appropriate warnings on all medicines. While it may seem obvious to you that it is a sleeping tablet and will therefore cause drowsiness, it may not be obvious to everyone, particularly if they are taking lots of medicines and get the different drugs mixed up. Also some sleeping tablets can still be active the next day making you less alert and therefore at risk for example if driving. So, while it may seem silly, it is better to be safe than sorry!

Are anti-depressants better or worse than non-medicine based psychotherapy?

It is impossible to say — how depression is best treated will depend on the individual, and there is good evidence that both drugs and counselling therapies work. Of course the best result might be having both together

I'm on anti-depressants and have been for two years. Will I have to take them for the rest of my life? Won't I build up a tolerance to them?

Again, how long you have to take these for will depend on how your individual condition progresses. If you are concerned you should discuss it with your pharmacist or doctor. While you won't necessarily develop a tolerance to them, your condition may change in such a way that means you will have to change dose or drug at some point in the future.

If I'm feeling depressed, is it worth taking St Johns Wort?

If you are truly depressed in a medical sense you should seek the advice of a doctor and not attempt to treat yourself at all. However St John's Wort can be helpful if you are feeling "a bit down" Best to have a chat with your pharmacist first. He will send you to the GP (and not sell you anything) if that's what you really need.

What's all this business about 'not operating machinery'?

Some medicines can make you light-headed, drowsy or even confused. This is obviously not a state in which you want to be doing anything potentially dangerous, like driving or operating machinery!

Why do I have to complete the full course of antibiotics even though I'm better?

Often it can appear that the course has worked, but actually some of the infection is still present. Stopping the course too early could allow the infection to come back and make it far harder to treat thereafter.

Why do they put caffeine in some brands of paracetamol when caffeine is known to cause headaches in some people?

We have to agree. It's not particularly logical although a little caffeine will give you "a bit of a boost" Ask your pharmacist which is the most appropriate painkiller and you'll find yourself being steered away from unhelpful brands or formulations

Why do named brands of OTC pain killers cost many times the price of un-named ones when they are absolutely identical in content?

The brands have to pay for advertising and the cost of licensing before getting to the market. Sometimes the branded versions are pleasanter to take or have better formulations — but not always. The un-named or "generic" versions only have to cover their manufacturing costs. Your pharmacist will be pleased to guide you.

Why don't GPs or pharmacists routinely tell you when you can buy the same medicines OTC at lower than the price of a prescription fee?

GPs are generally unaware of the cost of each individual medicine…... and who can blame them — they've plenty else to worry about! Actually pharmacists generally do inform patients if they can buy something more cheaply "off prescription".

Why don't they give percentage (or similar) indicators of risk against the possible side effects listed on the medicines information leaflet?

A very good question. Most pharmacists agree that the information leaflets are not as helpful as they should be. It all has to do with how medicines are licensed by the authorities and there is an ongoing debate. Pharmacists ARE seeking changes.

I've got to take a drug sub-cutaneously — what does that mean? What other ways of taking drugs are there and why can't we just swallow the lot?

Sub-cutaneously means under the surface of the skin. There are many alternatives from the obvious (oral, rectal) to inhaled or on the skin's surface. It all depends on what will be most effective, fastest-acting or reducing side-effects

Why do European doctors prescribe painkillers as suppositories whereas in Britain we have to swallow them? (and often damage our guts into the bargain) Is it difficult to use suppositories or something?

Sometimes using a drug in this way can make it act quicker or have less side effects. It is not used as commonly in the UK as in Europe, perhaps because of the route!

Is it true that if you chew antibiotics rather than swallow them they make your tongue go black?

Antibiotics should never be chewed unless you are given very specific instructions to do so — for example if there is an infection in the mouth. Chewing them in other circumstances would probably make you feel or even be sick and stop the antibiotic from working properly

If you have to take, say, four tablets a day, do you need to take them exactly six hours apart and get up in the night if necessary?

It is a good idea to space tablets as evenly apart as possible. This is more important with some medications than others, and you should check with the pharmacist. In many cases a few hours leeway will not make a huge difference and you shouldn't have to get up.

What's the best treatment I can buy for a hangover - or, better still, to prevent it in the first place? (And don't say, don't drink.)

The main cause of hangovers is dehydration, so drink plenty of water. Rehydration salts can sometimes help, and a painkiller (eg paracetamol) for the headache.

I used to have a duodenal ulcer. It's gone now but does this mean I should still avoid aspirin or Nurofen?

Where possible, this is a good idea. In many cases a paracetamol-based painkiller will do the job and not upset your stomach. If you do need to take aspirin of an ibuprofen-based painkiller (like Nurofen) then make sure you do it on a full stomach. A soluble version is generally kinder on the stomach too.

Why do drugs like paracetamol or aspirin come in so many different types of tablet? Which one is best?

It's basically about choice. In most cases tablets are just fine — but some people find them hard to swallow so a capsule or soluble version is preferred. Capsules and soluble forms can also be faster-acting. So it's horses for courses really. If in doubt just ask!

How do I know a drug is safe?

No medication is 100% safe. A decision to take any medicine is a balancing act between the risks and the benefits. That is why it is always a good idea to seek advice from a doctor or pharmacist before taking anything.

If I forget to take a drug, how long have I got to put things right before I've spoiled the treatment?

That depends on the drug. Again, you should seek advice from a doctor or pharmacist. Sometimes, missing doses can be harmful but often it won't matter.

What is best for the common cold?

There is no cure for a common cold. It is often best to just rest, drink plenty of fluids and take simple painkillers (eg. paracetamol) if needed. It all depends on your individual symptoms and whether you are taking ongoing medicines for other conditions. The best advice is to ask!

Should I have a flu jab?

Not everyone will need a 'flu jab. It is advised, however, if you are over 65. It is also advised if you have a long-term condition,, such as respiratory disease, cardiovascular disease, renal disease or diabetes. Patients who are undergoing immunosuppression (i.e. treatment that affects your immune system) and those with serious liver problems should also seek vaccination. If you are in doubt, talk to your pharmacist or your GP.

These answers were first prepared for Ask About Medicines Week 2007. Use the box below to let us have your comments or questions.