Pill popping do's and don't's

Thursday, September 28, 2006
Australia is a nation of pill poppers. Up to 170 million prescriptions were doled out last year. But are we using our drugs safely?

We look at some of the common misconceptions about pill-taking to sort fact from dangerous fiction.

1. Is crushing pills dangerous?

A lot of people, especially the elderly and kids, find it hard to swallow tablets, so crushing them up seems the perfect solution.

Not so, says Professor Andrew McLachlan, professor of pharmacy at Sydney University.

"The medicines we have available on the pharmacy shelf in different dose forms are tested to see if they deliver that medicine and when we start to change the way they might be used then we start to come up against some problems," says Prof. McLachlan.

A simple test shows how pills are designed to be digested at different rates. Two pills are each placed in a glass of water. One tablet dissolves rapidly in a glass of water, giving us a single large dose. The other gives us a smaller, steady stream of medication. If we crush a tablet, we affect the absorption rate and that can mean trouble.

"If we were to crush up that dose form, often what will happen is the drug will be very rapidly absorbed into the blood at a higher dose than the person would expect," says Prof. McLachlan. "That can lead to an excessive effect on the person and side effects. That's a great risk."

Those risks include preventing the pills from working; burning the oesophagus or releasing too much too soon, leading to dangerously high levels of the medication in your system.

Talk to your doctor about your medicine because some pills are okay to crush or chew. The same drug might also be available in an easier-to-swallow capsule or liquid form.

There are a few tricks to make pills go down better:

- You should only ever take pills one at a time, preferably with water or juice.

- If you have trouble swallowing, try taking a deep breath before you take the pill — it can lessen the gag reflex.

- If all else fails, some people put the pill inside jelly, to make it go down easer.

2. Do alcohol and antibiotics mix?

You've probably heard that antibiotics increase the effect of alcohol and get you drunk faster. But that's false.

"If you're receiving antibiotics, you're likely to be unwell. Potentially you're also dehydrated, which means that a given dose of alcohol will make you feel more drunk. It's not necessarily to do with the antibiotic, it's how you're feeling at the time," explains Prof. McLachlan.

So if it's illness, not the antibiotics, putting you under the table, how did this story get started? Back in the '50s and '60s doctors were prescribing penicillin for sexually transmitted diseases. Alcohol can lead to friskiness, so in an effort to stop people having sex while infected — doctors told them not to mix antibiotics and drink.

Many people also believe drinking will stop antibiotics working. Wrong again.

"Drinking alcohol while you're receiving antibiotics doesn't affect the ability of that antibiotic to do its job — is to kill the infection that you've got," says Prof. McLachlan.

There are a handful of antibiotics that can react with alcohols and make you nauseous. But if you're feeling crook enough to need pills, it's probably best to lay off the booze anyway.

We hear a lot about the dangers of taking too many antibiotics so is it best to stop taking antibiotics as soon as you feel better? The answer is no. Always complete your prescribed course of antibiotics. If you don't, some of the bugs can survive and come back to make you sick again. They're also likely to develop antibiotic resistance, making them harder to kill in future.

3. Can you overdose on headache tablets?

There are three main types of painkillers: aspirin, ibuprofen and paracetamol. Prof. McLachlan says it's vital to follow the guidelines on how to take all of them.

"As long as they're used within the recommended dose, everything should be fine but making sure that we only use them in that dose range is really important," he says.

You should always take aspirin and ibuprofen with food, otherwise they can cause nausea or stomach bleeding.

Paracetamol is considered the safest painkiller when used properly but an overdose can cause liver failure and in extreme cases, death.

What is a safe daily dose of painkillers? For the average adult, the maximum for aspirin is 12 tablets; six for ibuprofen and eight for paracetamol.

But according to Dr Lynn Weeks from the national prescribing service, it's important to consider other factors too. "For some medicines it'll be important to also consider your weight," she says. "If you're a small person then take the lower end of the dose range, if you're a large bloke, then you're probably okay at the higher end of the dosage range."

Another thing to watch for is hidden overdose. For example, most cold and flu remedies contain paracetamol. If you unknowingly take painkillers as well, you're doubling the dose and going beyond safe limits.

4. Can aspirin prevent heart attack?

We know aspirin works for headache and according to vascular surgeon Professor John Harris, it is beneficial against heart attack too.

"I think there's pretty good evidence that supports small doses of aspirin having some benefit, not only in terms of heart risk but probably also in terms of reducing stroke," Prof. Harris says. "The benefit varies between men and women. The reduction in heart disease is probably greater in men and for stroke in women."

Aspirin cuts risk of heart attack by 32 percent in men and stroke by 17 percent in women.

Aspirin works because it thins the blood, which helps stop clots forming. So it might also have application in fighting the long-distance travel scourge of deep vein thrombosis. The dose is tiny — just 100mg a day — around a third of a standard tablet. But as always, speak to your doctor before starting any new medication.

5. Do pills really go out of date?

For some reason, while a lot of us will routinely throw out food past its use-by date, we're quite happy to keep taking out-of-date drugs. The thinking seems to be that drugs don't go off, but they do.

"The most common effect of taking expired drugs is that they won't work properly, so you won't get the full effect of the medicine and that will mean you're not getting the benefit you need to get for the treatment," says Dr Weekes. "A couple of kinds of antibiotics can also change their chemical structure and cause some significant serious adverse effects for you."

Side-effects from out-of-date drugs can range from a mild rash to liver problems similar to hepatitis. Don't risk it — put your expired drugs in a bag and return them to a pharmacy for proper disposal.

6. Can vitamin C prevent a cold?

Many of us stock up on vitamin C in the winter months to ward off colds, but can you take too much?

Prof. McLachlan says that's unlikely. Vitamin C is water soluble and cannot be stored in the body. Any excess is rapidly flushed out of our system through the kidneys and urine. "It's often been said that Australians, for that reason, have the most valuable urine in the world," he says.

The maximum recommended daily intake of vitamin C is 1000mg. But to maintain good health, you only need about 45 mg daily. You get that much from a single orange; red capsicum and blackcurrants are even better sources.

"There's been a lot of research to try and see whether Vitamin C can actually prevent the common cold," says Prof. McLachlan.

"Unfortunately, the results indicate that that is not true. What Vitamin C can do is shorten the duration of a cold and that's pretty clear."

A word of warning: unlike vitamin C, fat soluble vitamins like A, D and E can be stored by the body and become toxic at high levels. So while there are clear benefits to taking supplements, it doesn't pay to overdo them.

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