tag:theconversation.com,2011:/fr/topics/medicines-345/articlesMedicines – The Conversation2024-03-08T13:38:33Ztag:theconversation.com,2011:article/2228582024-03-08T13:38:33Z2024-03-08T13:38:33ZAsthma meds have become shockingly unaffordable − but relief may be on the way<figure><img src="https://images.theconversation.com/files/579691/original/file-20240304-18-r33cu5.jpg?ixlib=rb-1.1.0&rect=25%2C51%2C8538%2C5469&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Its price will take your breath away.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/man-using-blue-asthma-inhaler-medication-royalty-free-image/1179346207?">Brian Jackson/Getty Images</a></span></figcaption></figure><p>The <a href="https://www.businessinsider.com/cost-asthma-medication-doubled-unjust-2023-7">price of asthma medication has soared</a> in the U.S. over the past decade and a half. </p>
<p>The jump – in some cases from around <a href="https://doi.org/10.1001/jamainternmed.2015.1665">a little over US$10</a> <a href="https://www.singlecare.com/blog/albuterol-sulfate-hfa-proventil-hfa-without-insurance/">to almost $100</a> for an inhaler – has meant that patients in need of asthma-related products <a href="https://www.businessinsider.com/cost-asthma-medication-doubled-unjust-2023-7">often struggle</a> to buy them. Others simply <a href="https://asthma.net/living/cannot-afford-inhalers">can’t afford</a> them. </p>
<p>To make matters worse, asthma <a href="https://www.fda.gov/drugs/buying-using-medicine-safely/generic-drugs">disproportionately affects</a> lower-income patients. Black, Hispanic and Indigenous communities have the <a href="https://aafa.org/asthma-allergy-research/our-research/asthma-disparities-burden-on-minorities/">highest asthma rates</a>. They also shoulder <a href="https://aafa.org/asthma-allergy-research/our-research/asthma-disparities-burden-on-minorities/">the heaviest burden</a> of asthma-related deaths and hospitalizations. Climate change will likely <a href="https://www.hsph.harvard.edu/c-change/subtopics/climate-change-and-asthma/">worsen asthma rates</a> and, consequently, these disparities.</p>
<p>I’m a health law professor at <a href="https://www1.villanova.edu/university/law/faculty-scholarship/faculty-directory/profiles/AnaSantosRutschman.html">Villanova University</a>, <a href="https://papers.ssrn.com/sol3/cf_dev/AbsByAuth.cfm?per_id=2667484">where I study</a> whether patients can get the medicines they need. And I’ve been watching this affordability crisis closely.</p>
<p>In many ways, it shows what happens when law and policy decisions aren’t aligned with public health needs. The good news, however, is that there finally seems to be some political will to rein in the price of asthma meds.</p>
<h2>Why inhaler prices are skyrocketing</h2>
<p>In 2008, the U.S. Food and Drug Administration <a href="https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/transition-cfc-propelled-albuterol-inhalers-hfa-propelled-albuterol-inhalers-questions-and-answers">banned inhalers</a> that use chlorofluorocarbons, or CFCs – which were once widely used as propellants – because they can damage the ozone layer. The FDA was following a timeline set by an environmental treaty, the <a href="https://www.unep.org/ozonaction/who-we-are/about-montreal-protocol">Montreal Protocol</a>, which the U.S. ratified in the late 1980s. </p>
<p>From 2009 onward, CFC inhalers were phased out and replaced with hydrofluoroalkane, or HFA, ones, which are more environmentally friendly. They’re also a lot pricier. For patients with insurance, the average out-of-pocket cost of an inhaler rose from $13.60 per prescription in 2004 to $25 immediately after the 2008 ban, <a href="https://doi.org/10.1001/jamainternmed.2015.1665">a 2015 study found</a>.</p>
<p>Today, the <a href="https://www.singlecare.com/blog/albuterol-sulfate-hfa-proventil-hfa-without-insurance/">average retail price</a> of an albuterol inhaler is $98. Unlike CFC inhalers, which have <a href="https://www.fda.gov/drugs/buying-using-medicine-safely/generic-drugs">generic versions</a>, HFA inhalers are <a href="https://www.scientificamerican.com/article/unlikely-victims-of-banning-cfcs/">covered by patents</a>. While <a href="http://doi.org/10.1089/jamp.2016.1297">the drug itself</a> hasn’t changed, the switch to a different device allowed companies to increase their prices.</p>
<p>In 2020, the FDA finally approved the <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-generic-commonly-used-albuterol-inhaler-treat-and-prevent-bronchospasm">first generic version</a> of an albuterol inhaler. But generic competition still isn’t robust enough to lower prices meaningfully.</p>
<p>Patients with good insurance <a href="https://allergyasthmanetwork.org/advocacy-updates/united-healthcare-albuterol-epinephrine-cost/">may pay very little</a> or even nothing. But uninsured patients face steep market prices, and as of 2023, there were <a href="https://aspe.hhs.gov/sites/default/files/documents/e06a66dfc6f62afc8bb809038dfaebe4/Uninsured-Record-Low-Q12023.pdf">over 25 million</a> uninsured Americans. <a href="https://www.cdc.gov/asthma/asthma_stats/insurance_coverage.htm">Even insured patients may have trouble</a> affording their asthma meds, the CDC has found. </p>
<p>The same asthma medication for which U.S. patients pay top dollar is available elsewhere at much cheaper prices. Consider the following case for inhalers. The pharmaceutical company Teva sells <a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ccd3aaec-4892-40d0-ad60-3e570178fbe1">QVAR RediHaler</a>, a corticosteroid inhaler, <a href="https://doi.org/10.1016/S2213-2600(24)00012-2">for $286</a> in the U.S.</p>
<p>In Germany, Teva sells that same inhaler for $9.</p>
<h2>Seeking meds from Mexico and Canada</h2>
<p>Some U.S. patients have traveled abroad to obtain cheaper asthma medication. After the 2008 ban on CFCs, it became common for patients to <a href="https://doi.org/10.1177/8755122515595052">visit border towns in Mexico</a> to purchase albuterol inhalers. They were sold for <a href="https://doi.org/10.1177/8755122515595052">as little as $3 to $5</a>. </p>
<p>A study of inhalers available to U.S. patients in Nogales, Mexico – about an hour south of Tucson, Arizona – found that Mexican products were <a href="http://doi.org/10.1177/8755122515595052">generally comparable to U.S. inhalers</a>. But researchers found some differences in performance, suggesting that American patients who use them could be getting a slightly different dose than their usual.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Asthma medication is seen on the shelves of a Mexican pharmacy." src="https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580250/original/file-20240306-24-xrc96u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Asthma meds are considerably more affordable south of the border.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-interior-of-farmacia-san-pablo-news-photo/1041982048">Jeffrey Greenberg/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p>There have also been reports of Americans turning to Canadian pharmacies to purchase asthma inhalers at much cheaper prices. In one case, a U.S. pharmacy would have charged $857 for a three-month supply. A patient obtained it for <a href="https://www.seattletimes.com/life/wellness/canadian-pharmacy-provided-inhaler-at-a-fraction-of-us-cost/">$134 from a pharmacy in Canada</a>.</p>
<h2>One potential fix: Importing cheaper meds</h2>
<p>U.S. law has long <a href="https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/frequently-asked-questions-about-drugs">prohibited</a> personal importation of pharmaceutical drugs. However, a recent development could <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-allow-florida-import-cheaper-drugs-canada-2024-01-05">pave the way for states</a> to import cheaper asthma drugs.</p>
<p>In January 2024, the <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/us-fda-allow-florida-import-cheaper-drugs-canada-2024-01-05/">FDA authorized</a> the importation of certain prescription drugs from Canada for the first time. <a href="https://www.kff.org/policy-watch/what-to-know-about-the-fdas-recent-decision-to-allow-florida-to-import-prescription-drugs-from-canada/">For now</a>, this authorization is limited to Florida, and it covers only drugs for HIV/AIDS, prostate cancer and certain mental health conditions.</p>
<p>Should it prove successful, the program could serve as a blueprint for other states.</p>
<h2>Another possible solution: Price-capping</h2>
<p>Policymakers could also try borrowing a page from the insulin playbook. Insulin prices <a href="https://doi.org/10.1001/jamanetworkopen.2023.18074">climbed for almost two decades</a> before Congress acted, capping the cost of insulin for Medicare patients. The 2022 <a href="https://www.congress.gov/bill/117th-congress/house-bill/5376/text">Inflation Reduction Act</a> established an out-of-pocket ceiling of $35 per month for prescription-covered insulin products. </p>
<p>If this cap had been in effect two years earlier, it would have saved 1.5 million Medicare patients about $500 annually, <a href="https://www.hhs.gov/about/news/2023/08/16/first-anniversary-inflation-reduction-act-millions-medicare-enrollees-savings-health-care-costs.html">a recent study estimated</a>. It also would have saved Medicare <a href="https://www.hhs.gov/about/news/2023/08/16/first-anniversary-inflation-reduction-act-millions-medicare-enrollees-savings-health-care-costs.html">$761 million</a>.</p>
<p>A similar approach could be taken for asthma meds.</p>
<p>Congress could create an asthma-specific rule similar to the insulin case. Or it could place provisions for asthma-med prices into a larger piece of legislation.</p>
<p>While this approach depends on the political environment, there are signs the government is becoming more willing to act. In January 2024, the U.S. Department of Health and Human Services <a href="https://www.hhs.gov/about/news/2024/01/29/readout-hhs-officials-meeting-private-sector-patient-advocacy-leaders-improve-national-access-important-asthma-medications.html">hosted a meeting</a> to discuss the problem with manufacturers and other stakeholders.</p>
<p>It’s a start. And – together with other measures – it brings some hope that asthma meds might soon become more affordable to those in need.</p><img src="https://counter.theconversation.com/content/222858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ana Santos Rutschman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An inhaler that costs nearly $300 in the US goes for just $9 in Germany. What gives?Ana Santos Rutschman, Professor of Law, Villanova School of LawLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2193942024-02-18T19:51:14Z2024-02-18T19:51:14ZTaking expensive medicines or ones unavailable in Australia? Importing may be the answer<figure><img src="https://images.theconversation.com/files/572982/original/file-20240202-17-nh9fym.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/redhead-nutritionist-working-home-on-laptop-2264305089">shurkin_son/Shutterstock</a></span></figcaption></figure><p>The cost-of-living crisis may be driving some Australians to look for cheaper medicines, especially if those medicines are not subsidised or people don’t have a Medicare card. Options can include buying their medicines from overseas, in a process called
“<a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/personal-importation-scheme">personal importation</a>”.</p>
<p>Others also use this option to import medicine that is not available in Australia.</p>
<p>Here’s what’s involved and what you need to know about the health and legal risks.</p>
<hr>
<p>
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<strong>
Read more:
<a href="https://theconversation.com/medicare-turns-40-since-1984-our-health-needs-have-changed-but-the-system-hasnt-3-reforms-to-update-it-217264">Medicare turns 40: since 1984 our health needs have changed but the system hasn't. 3 reforms to update it</a>
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</em>
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<h2>Cost-of-living crisis bites</h2>
<p>Many Australians, particularly those with long-term illnesses, are finding it increasingly hard to afford health care.</p>
<p>The <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release#barriers-to-health-service-use">Australian Bureau of Statistics</a> reports the proportion of people who delayed or did not see a GP due to cost doubled in 2022-23 (7%) compared with 2021-22 (3.5%). </p>
<p>A <a href="https://australianhealthcareindex.com.au/wp-content/uploads/2022/11/Australian-Healthcare-Index-Report-Nov-22.pdf">survey</a> published in 2022 of over 11,000 people found more than one in five went without a prescription medicine due to the cost. </p>
<p>For those with a Medicare card it’s usually best (and cheapest) to get medicines locally, especially if you also have a concession card. However, for some high-cost medicines, personal importation may be cheaper. That’s when an individual arranges for medicine to be sent to them directly from an overseas supplier.</p>
<p>A 2023 study found <a href="https://www.publish.csiro.au/AH/AH23143?jid=AHv47n6&xhtml=5AA1F839-38C8-45E8-A458-79DCDB7597FB">1.8%</a> of Australians aged 45 or older had imported prescription medicines in the past 12 months. That indicates potentially hundreds of thousands of Australians are importing prescription medicines each year. </p>
<p>Almost half of the survey respondents indicated they would consider importing medicines to save money.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">Last year, half a million Australians couldn't afford to fill a script. Here's how to rein in rising health costs</a>
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<h2>What’s involved?</h2>
<p>Australia’s drug regulator, the Therapeutic Goods Administration (TGA), allows individuals to import up to three months’ supply of medicines for their own personal use (or use by a close family member) under the <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/personal-importation-scheme">personal importation scheme</a>.</p>
<p>This often involves ordering a medicine through an overseas website. </p>
<p>If the medicine would require a prescription in Australia, you must also have a legally valid prescription to import it. </p>
<p>Selling or supplying these medicines to others outside your immediate family is strictly prohibited.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Female doctor looking at computer screen, female patient looking on" src="https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572985/original/file-20240202-15-68qdfj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If the medicine would require a prescription in Australia, you must also have a legally valid prescription to import it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/consultant-discussing-test-results-patient-284516642">Monkey Business Images/Shutterstock</a></span>
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<p>
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Read more:
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<h2>How could this help?</h2>
<p>For some high-cost medicines, personal importation may be cheaper than having the medicine dispensed in Australia. This is most likely for medicines not subsidised by the <a href="https://www.pbs.gov.au/info/about-the-pbs">Pharmaceutical Benefits Scheme</a> (the PBS). People who do not hold a Medicare card may also find it cheaper to import certain medicines as they do not have access to PBS-subsidised medicines.</p>
<p>For example, for people with a specific type of leukaemia, treatment with sorafenib is not covered by the PBS. For these patients it could be up to about ten times more expensive to have their treatment dispensed in Australia as it is to import. That’s because there is a cheaper generic version available overseas.</p>
<p>Personal importation may also allow you to access medicines that are available overseas but are not marketed in Australia.</p>
<hr>
<p>
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Read more:
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</em>
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<h2>What are the risks?</h2>
<p>All medicines carry risks, and medicine sold online can pose additional dangers. The TGA does not regulate medicines sold overseas, so the safety and quality of such medicines can be uncertain; they may not be produced to <a href="https://www.tga.gov.au/what-tga-regulates">Australian standards</a>. </p>
<p>While similar regulatory agencies exist in other countries, when ordering medicines from overseas websites it can be difficult to determine if the product you are buying has been assessed to ensure it is safe and will do what it says it will do.</p>
<p>The medicines purchased could be counterfeit or “fake”. Products bought through unverified or overseas websites may have undisclosed ingredients, contain a dose that differs from that on the label, or lack the active ingredient entirely. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"842375297823571969"}"></div></p>
<p><a href="https://www.tga.gov.au/importing-therapeutic-goods">Not all medicines</a> can be legally imported through the personal importation scheme. Certain medicines are never allowed to be imported into Australia, and others can only be imported by a medical professional on behalf of a patient. </p>
<p>So if you attempt to import a restricted medicine, the Australian Border Force <a href="https://www.abf.gov.au/entering-and-leaving-australia/can-you-bring-it-in/categories/medicines-and-substances">may seize it</a>. Not only would you lose your medicine, but you could also receive a fine or face <a href="https://www.tga.gov.au/news/blog/can-i-import-medicine-personal-use#:%7E:text=If%20you%20try%20to%20import,a%20fine%20or%20jail%20time.">jail time</a>.</p>
<p>As with any purchase from an overseas business, there is also a risk you may lose your money and you might not be protected by Australian consumer laws. </p>
<p>If you do choose to import medicines by buying them from an overseas website, you should also consider what could happen if delivery is delayed and you don’t get your medicine in time.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-fake-drugs-end-up-in-our-public-health-system-and-how-to-spot-them-73594">How fake drugs end up in our public health system (and how to spot them)</a>
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<h2>Where can I get more advice?</h2>
<p>If you are thinking about importing medicines you should first discuss this with a health professional, such as your GP or pharmacist. </p>
<p>They can help you determine if personal importation is permitted for the medicine you need. You can also discuss if this is the best option for you. </p>
<p>If you are having difficulty covering the cost of your medicines your doctor or pharmacist can also explore other potential alternatives to ensure you are receiving the most cost-effective treatment available in Australia.</p>
<h2>Where do I go online?</h2>
<p>If you then decide to import, here are some reputable sites to help navigate the global online medicines market: </p>
<ul>
<li><p><a href="https://everyone.org/">everyone.org</a> helps people everywhere in the world access the latest medicines not available in their own countries</p></li>
<li><p><a href="https://buysaferx.pharmacy/">Alliance for Safe Online Pharmacies</a> is a not-for-profit organisation that collates information on how to find safe online pharmacies based in different regions of the world</p></li>
<li><p><a href="https://www.pharmacychecker.com/accredited-online-pharmacies/">PharmacyChecker</a> has also collated a list of trusted online pharmacies that ship medicines internationally.</p></li>
</ul>
<p>Australian government websites about importing medicines include those from <a href="https://www.tga.gov.au/news/blog/can-i-import-medicine-personal-use">the TGA</a> and on what to consider when buying medicines online from <a href="https://www.healthdirect.gov.au/buying-medicines-online#overseas">overseas</a>.</p><img src="https://counter.theconversation.com/content/219394/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta Lee Johnson is employed as the Senior Pharmacist for Research within SA Pharmacy and is a Board Director for the Society of Hospital Pharmacists of Australia. In the last five years, she has received research funding or consultancy funds (for development and delivery of educational materials) from SA Health, the Medical Research Future Fund, the Hospital Research Foundation – Parkinson's, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Society of Hospital Pharmacists of Australia, the Australian College of Pharmacy, Mundipharma Pty Ltd, Aspen Pharmacare Australia Pty Ltd, Reckitt Benckiser (Australia) Pty Ltd and Viatris Pty Ltd.</span></em></p><p class="fine-print"><em><span>Kirsten Staff does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>But this comes with legal and health risks. Here’s what you need to know before importing medicine for yourself or your immediate family.Jacinta L. Johnson, Senior Lecturer in Pharmacy Practice, University of South AustraliaKirsten Staff, Senior Lecturer in Pharmacy, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2148952023-11-30T17:23:43Z2023-11-30T17:23:43ZBuvidal: is it really a ‘game changer’ in the treatment of problematic opioid use?<p>To overcome problematic opioid use, traditional forms of opioid substitution therapy, such as <a href="https://www.nhs.uk/medicines/methadone/">methadone</a> and <a href="https://www.nhs.uk/medicines/buprenorphine-for-pain/">oral buprenorphine</a>, have become valuable tools. <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002209.pub2/full?highlightAbstract=opioid">Research</a> shows that patients receiving substitution therapy are more likely to stay in treatment and stop using heroin than patients receiving treatments that do not involve substitutes – such as counselling or group therapy.</p>
<p>But not all those on substitute medication are able to stop using illicit opioids. Some continue to use them in addition to the substitute. One <a href="https://www.sciencedirect.com/science/article/abs/pii/S0376871621001460">barrier</a> to success is the need to attend a clinic or pharmacy every day, or every few days, to obtain the substitute. </p>
<p>In early 2019, a new form of substitute treatment, long-acting injectable buprenorphine, was approved for use in the UK. Unlike methadone and oral buprenorphine, <a href="https://www.nice.org.uk/advice/es19/evidence/evidence-review-pdf-6666819661#:%7E:text=Buprenorphine%20prolonged%2Drelease%20injection%20is,buprenorphine%20prolonged%2Drelease%20injection%20subcutaneously.">long-acting injectable buprenorphine</a> is administered via an injection either weekly or monthly. The treatment – also known by its brand names Buvidal or Sublocade – has been heralded as a “<a href="https://nation.cymru/news/welsh-university-carries-out-game-changer-drug-treatment-research/">game changer</a>” by both doctors and patients. </p>
<h2>Opioids</h2>
<p>In 2021, nearly 5,000 drug-related deaths were <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations">registered</a> in England and Wales. About half of those involved an opioid. </p>
<p>Opioids are a class of drugs that include substances derived from the opium poppy. They include <a href="https://www.nhs.uk/medicines/morphine/">morphine</a> and <a href="https://www.emcdda.europa.eu/publications/drug-profiles/heroin_en">heroin</a>, as well as synthetic alternatives that mimic the effects of naturally occurring opioids such as <a href="https://www.nhs.uk/medicines/tramadol/">tramadol</a> and <a href="https://bnf.nice.org.uk/drugs/fentanyl/">fentanyl</a>.</p>
<p>Opioids work in the brain to produce a variety of effects, including pain relief. They also produce feelings of euphoria, joy and pleasure. Opioids have a depressant effect on the body, so if someone overdoses, they can stop breathing and may die. Overdose is a particular risk for those who use illegally obtained opioids of unknown strength, such as heroin.</p>
<p>Often people are unable to stop using opioids despite the risk of death and the serious negative health and social consequences. Such drugs are hard to give up, partly because stopping causes painful physical and psychological withdrawal symptoms.</p>
<h2>Opioid substitution therapy</h2>
<p>An effective form of treatment for problematic opioid use is opioid substitution therapy, where illegally obtained opioids are substituted for prescribed alternatives. </p>
<p>Providing a legal substitute of known purity is useful in many ways. Most notably, it removes the need to buy and use illicit opioids. This reduces the risk of <a href="https://www.bmj.com/content/357/bmj.j1550">overdose</a> and the need to commit crimes like <a href="https://academic.oup.com/bjc/article-abstract/49/4/513/2747197">theft and shoplifting</a> to get money to pay for drugs.</p>
<p>But while daily attendance and supervised consumption may help to minimise the risk of misuse, it also has its drawbacks. For example, it can bring patients into regular contact with their former drug-using networks and can require time-consuming journeys that interfere with employment, education and other responsibilities.</p>
<p>Long-acting injectable buprenorphine does not have these drawbacks. It is not unlike <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369037/">long-acting</a> forms of contraception, in that the medicine releases slowly over time, thereby avoiding the peaks and troughs associated with oral formulations.</p>
<p>When the pandemic broke and the UK went into lockdown, <a href="https://www.emcdda.europa.eu/publications/topic-overviews/covid-19-and-people-who-use-drugs_en">concerns</a> were raised by experts that daily attendance at clinics or pharmacies for opioid substitution medication might increase the risk of COVID transmission. </p>
<p>Keen to stop the spread of the virus while also providing safe and continuous treatment to patients, the Welsh government <a href="https://committees.parliament.uk/writtenevidence/107535/pdf/">agreed</a> to fund the roll-out of long-acting injectable buprenorphine to drug services across Wales. </p>
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<figcaption><span class="caption">Two doctors discuss Buvidal from the perspective of lived experience.</span></figcaption>
</figure>
<p>That decision was supported by <a href="https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-023-01348-5">emerging evidence</a> of the effectiveness of the medication from a drug service in south Wales that had been piloting the medicine before the pandemic. </p>
<h2>Results</h2>
<p>While the primary aim at that time was to stop the spread of COVID, it quickly became clear that the medication was benefiting patients in many other ways. </p>
<p>Patients taking part in a <a href="https://kaleidoscope68.org/app/uploads/2022/05/Kaleidoscope-Peer-led-Buvidal-Review..pdf">survey</a> about the new medication reported reductions in cravings, lower levels of anxiety, reductions in offending and abstinence from illicit opioids. They described rebuilding their lives, getting jobs, reconnecting with family members and heralded long-acting injectable buprenorphine as a “game changer”, “life changing” and even a “miracle”. </p>
<p>Positive results have also been reported in <a href="https://www.jsatjournal.com/article/S0740-5472(22)00058-7/fulltext">systematic reviews</a> that summarise the findings of the currently small, and not very robust, body of evidence on the effectiveness of the medication.</p>
<p>However, alongside the reports of success, less positive <a href="https://kaleidoscope68.org/app/uploads/2022/05/Kaleidoscope-Peer-led-Buvidal-Review..pdf">stories</a> have emerged suggesting that the treatment may not be a silver bullet. Some patients have found the transition onto the medication challenging because it required them to be in full withdrawal before their first dose. </p>
<p>Others have been overwhelmed with emotions because the medication made them feel so clear-headed that their past traumas – suppressed by years of illicit opioid use – had begun to resurface. There have also been <a href="https://kaleidoscope68.org/app/uploads/2022/05/Kaleidoscope-Peer-led-Buvidal-Review..pdf">reports</a> of an increase in crack cocaine use among some patients and concerns about the reduced amount of contact (from daily to monthly) with drug services.</p>
<p>Even though there is a “<a href="https://pubmed.ncbi.nlm.nih.gov/16764215/">ceiling effect</a>” that reduces the risk of overdose, this medication still carries a risk of respiratory depression. This risk is <a href="https://pubmed.ncbi.nlm.nih.gov/15957155/">greater</a> among those using alcohol, benzodiazepines or other opioids such as heroin.</p>
<p>Long-acting injectable buprenophine is still in its infancy worldwide, so the evidence for its effectiveness is slim. To determine if it really is a “game changer”, experts will need to look at its impact across a wider range of outcomes, over longer periods and with larger samples than have been considered to date.</p><img src="https://counter.theconversation.com/content/214895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katy Holloway receives funding from Welsh Government and is a member of Welsh Government's National Implementation Board for Drug Poisoning Prevention. </span></em></p><p class="fine-print"><em><span>Fabrizio Schifano receives funding from Welsh Government. Currently a World Health Organization (WHO) member of the Expert Committee on Drug Dependence (ECDD; 2023). Previously, Schifano was a member of the ACMD UK and an expert advisor of the European Medicines Agency (EMA) for Psychiatry. </span></em></p>Long-acting injectable buprenorphine is also known by the brand names Buvidal or Sublocade.Katy Holloway, Professor of Criminology, University of South WalesFabrizio Schifano, Chair in Clinical Pharmacology and Therapeutics, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2130712023-09-20T05:57:51Z2023-09-20T05:57:51ZHow do hay fever treatments actually work? And what’s best for my symptoms?<figure><img src="https://images.theconversation.com/files/549215/original/file-20230920-21-6mbsm0.jpg?ixlib=rb-1.1.0&rect=9%2C224%2C6221%2C3895&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/ill-upset-african-woman-blowing-running-1444224848">Shutterstock</a></span></figcaption></figure><p>Spring has sprung and many people are welcoming longer days and more time outdoors. But for <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis">almost one in five Australians</a>, spring also brings the misery of watery, itchy red eyes, a runny, congested nose, and sneezing. </p>
<p>Hay fever (also known as allergic rhinitis) is caused when an allergen enters the nose or eyes. Allergens are harmless airborne substances the body has incorrectly identified as harmful. This triggers an immune response, which leads to the release of inflammatory chemicals (mediators) – one of which is histamine.</p>
<p>Allergens that trigger hay fever differ from person to person. Common seasonal allergens include tree, grass and weed pollens (year-round allergens include dust mites, mould and pet dander). It’s now <a href="https://www.sciencedirect.com/science/article/pii/S132602002302191X">pollen season</a> in many parts of Australia, with pollen counts at their highest and hay fever cases surging. </p>
<p>So what medicines can prevent or reduce hay fever symptoms, and how do they work?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-i-have-covid-or-hay-fever-heres-how-to-tell-188030">Do I have COVID or hay fever? Here’s how to tell</a>
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</em>
</p>
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<h2>Antihistamines</h2>
<p>Knowing the release of histamine is a cause of hay fever symptoms, it’s unsurprising that <em>anti</em>-histamines are one of the most frequently recommended medicines to treat hay fever. </p>
<p>Antihistamines block histamine from binding to histamine receptors in the body and having an effect, reducing symptoms.</p>
<p>In Australia, we broadly have two types. The older sedating (introduced in the <a href="https://www.tga.gov.au/news/safety-alerts/first-generation-antihistamines-winter-warning">1940s</a>) and newer, less-sedating (introduced in the 1980s) antihistamines. </p>
<p>Less-sedating antihistamines used to treat allergic rhinitis include bilastine (Allertine), cetirizine (Zyrtec), loratadine (Claratyne) and fexofenadine (Telfast). Bilastine, which came onto the Australian market only last year, is only available from a pharmacy, on recommendation from a pharmacist. The others have been around longer and are available at supermarkets and in larger quantities from pharmacies. Cetirizine is the <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/35-cetirizine-hydrochloride#:%7E:text=Risks%20of%20cetirizine%20hydrochloride%20use,significant%20at%20the%20proposed%20doses.">most likely</a> (of the less-sedating antihistamines) to cause sedation.</p>
<p>The older sedating antihistamines (such as promethazine) cross the blood-brain barrier, causing drowsiness and even brain fog the next day. They have lots of side effects and potential drug interactions, and as such have little place in the management of hay fever. </p>
<p>The newer less-sedating antihistamines are <a href="https://australianprescriber.tg.org.au/articles/antihistamines-and-allergy.html#:%7E:text=Less%20sedating%20antihistamines%20are%20equally,an%20ongoing%20good%20safety%20profile">equally effective</a> as the older sedating ones.</p>
<figure class="align-center ">
<img alt="Woman with red eyes touches her face" src="https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549218/original/file-20230920-29-y20eo4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hay fever can cause watery, itchy red eyes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-on-young-woman-inflamed-eyes-2271555335">Shutterstock</a></span>
</figcaption>
</figure>
<p>Antihistamines are usually taken orally (as a tablet or solution) but there are also topical preparations such as nasal sprays (azelastine) and eye drops. Antihistamine nasal sprays have <a href="https://www.sciencedirect.com/science/article/abs/pii/S108112061000743X">equal to or better efficacy</a> than oral antihistamines.</p>
<p>The individual response to antihistamines varies widely. For this reason, you may need to trial several different types of antihistamines to see which one works best for you.</p>
<p>Increasing the dose of an antihistamine, or combining an oral and topical antihistamine, does not provide any additional benefit. Paying extra for a brand name doesn’t offer any more or less effect than the generic (both have the same active ingredient and are <a href="https://www.tga.gov.au/news/news/generic-prescription-medicines-fact-sheet">bioequivalent</a>, which means they have the same outcomes for patients).</p>
<h2>Steroid nasal sprays</h2>
<p>If your symptoms don’t improve from antihistamines alone, a nasal spray containing a corticosteroid is often recommended. </p>
<p>Corticosteroids prevent the release of several key chemicals that cause inflammation. How they work is complex: in part, corticosteroids “turn off” the production of late phase inflammatory mediators (cytokines and chemokines). This reduces the future release of more inflammatory mediators, which reduces inflammation.</p>
<p>Corticosteroids and antihistamines have different mechanisms of action. Research shows corticosteroid nasal sprays are <a href="https://journals.sagepub.com/doi/full/10.2500/ajra.2016.30.4397">more effective</a> than antihistamines in controlling an itchy, runny, congested nose. But when instilled into the nose, corticosteroids <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1016/j.otohns.2007.10.027">also reduce</a> the eye symptoms of hay fever. </p>
<p>There are also nasal sprays that contain both an antihistamine and corticosteroid. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sneezing-with-hay-fever-native-plants-arent-usually-the-culprit-190336">Sneezing with hay fever? Native plants aren't usually the culprit</a>
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</em>
</p>
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<p>While there are a range of corticosteroid nasal sprays containing different active ingredients, a large study published this year shows they are all <a href="https://www.frontiersin.org/articles/10.3389/fphar.2023.1184552/full">about as effective as each other</a>, and work best when they have been taken for several days. </p>
<h2>Sodium cromoglycate</h2>
<p>Another medicine used to treat hay fever symptoms is sodium cromoglycate, which is available as an eye drop and over-the-counter in pharmacies. </p>
<p>This medicine is known as a mast cell stabiliser. As the name suggests, it stabilises or prevents mast cells from breaking down. When mast cells break down, they release histamine and other chemicals that cause inflammation. </p>
<p>This eye drop is both a preventative and treatment medicine, usually used before allergies strike. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375451/">Evidence shows</a> it is effective at reducing the symptoms of allergic conjunctivitis (eye inflammation from allergies). </p>
<figure class="align-center ">
<img alt="Man blows nose at pharmacy check out" src="https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549220/original/file-20230920-15-ow0w0v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you’re not sure where to start, your pharmacist or prescriber can talk you through your options.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pharmacist-suggesting-medical-drug-buyer-102268021">Shutterstock</a></span>
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<h2>Decongestants</h2>
<p>Decongestants constrict blood vessels. They can be taken orally, administered as a nasal spray, or instilled into the eyes. When administered into the eyes it will reduce redness, and when administered into the nose, it will stop it from running. </p>
<p>However, decongestants should be used for a short duration only and are not for long term use. In fact, if a nasal spray decongestant is used for more than five days, you can experience something called “rebound congestion”: a severe stuffy nose. </p>
<h2>Saline</h2>
<p>Saline (saltwater) nasal sprays or irrigation products are also available to flush out the allergens and provide hay fever relief. While there are not many studies in the area, there is evidence that saline irrigation <a href="https://www.cochrane.org/CD012597/ENT_nasal-saline-allergic-rhinitis#:%7E:text=Saline%20irrigation%20may%20reduce%20patient,any%20outcomes%20beyond%20three%20months">may reduce hay fever symptoms</a>. Saline is safe and is not associated with adverse effects.</p>
<p>If you’re suffering from hay fever symptoms and unsure what to try, talk to your prescriber or pharmacist, who can guide you through the options and identify the best one for your symptoms, medical conditions and medicines.</p>
<p>Allergen immunotherapy (or allergen shots) is another option hay fever sufferers <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-immunotherapy-faqs">may discuss</a> with their doctors. However it’s not a quick fix, with therapy taking three to five years.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-considering-allergen-immunotherapy-for-my-hay-fever-what-do-i-need-to-know-190408">I’m considering allergen immunotherapy for my hay fever. What do I need to know?</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/213071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Bushell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Struggling with watery, itchy red eyes and a runny, congested nose? Here are your options for hay fever treatment.Mary Bushell, Clinical Assistant Professor in Pharmacy, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2086302023-09-05T15:17:02Z2023-09-05T15:17:02ZWegovy was inspired by Gila monster venom – here are some other drugs with surprising origins<figure><img src="https://images.theconversation.com/files/544065/original/file-20230822-5769-ebr25z.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3489%2C2331&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The inspiration for Wegovy and Ozempic</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lizard-gila-monster-heloderma-suspectum-696050818">Vaclav Sebek/Shutterstock</a></span></figcaption></figure><p>Many of the drugs we use today started their journey from bench to bedside in a computer. But this is certainly not the case for all drugs. Indeed, many have <a href="https://www.sciencedirect.com/science/article/abs/pii/B9780123864543012410">exotic origins</a>, including the blockbuster drugs <a href="https://www.mdpi.com/2077-0383/12/3/772">Wegovy and Ozempic</a>, which were inspired by the venom of the Gila monster.</p>
<p>Scientists found that a hormone in the Gila monster’s venom called exendin-4 could be used to treat type 2 diabetes. Exendin-4 is similar to a hormone found in humans called GLP-1, which is released after eating and is important for <a href="https://www.sciencedirect.com/science/article/abs/pii/B9780128001011000028">controlling blood sugar levels</a> in humans. </p>
<p>Research into <a href="https://link.springer.com/article/10.1007/s00125-023-05929-0">extendin-4</a> yielded <a href="https://link.springer.com/article/10.1007/s11095-022-03302-1">semaglutide</a>, a derivative of the molecule but one that will stay in the body for far longer, producing the desired pharmacological effect. And that’s how Wegovy and Ozempic, which <a href="https://www.newscientist.com/article/2371780-everything-you-need-to-know-about-the-drugs-ozempic-and-wegovy/#:%7E:text=Ozempic%20and%20Wegovy%20are%20brand,people%20with%20type%202%20diabetes.">both contain semaglutide</a>, came into being. </p>
<p>The Gila monster is not the only reptile to inspire groundbreaking drugs. Indeed, the venom of the Brazilian pit viper inspired a class of drugs known as ACE inhibitors. </p>
<p>In the late 1960s, researchers were studying this snake’s venom and its effects on blood pressure. They isolated a peptide from the venom, which could inhibit an enzyme called angiotensin-converting enzyme (ACE) and lead to a decrease in blood pressure. This resulted in the development of a synthetic version of the peptide being created called captopril. </p>
<p>Although captopril is rarely prescribed today, it led to the next generation of ACE inhibitors, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK557708/">enalapril</a>, which are widely prescribed to treat high blood pressure and heart failure.</p>
<p>Venoms from both land and sea creatures provide a rich source of medicinal compounds. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214764/">Cone snails</a> are known for producing a variety of venom peptides that they use to immobilise their prey. A synthetic version of one of the peptides found in their venom is used in the painkilling drug
<a href="https://go.drugbank.com/drugs/DB06283">ziconotide</a>.</p>
<p>Another sea creature, the Caribbean sea squirt, has provided us with the anti-cancer drug <a href="https://www.cancerresearchuk.org/about-cancer/treatment/drugs/trabectedin">trabectedin</a>. <a href="https://link.springer.com/article/10.1007/s12325-016-0344-3">Studies</a> conducted with trabectedin showed positive results in treating advanced soft-tissue cancers, such as liposarcoma and leiomyosarcoma. In 2015, the US Food and Drug Administration granted accelerated approval for trabectedin for treating <a href="https://classic.clinicaltrials.gov/ct2/show/results/NCT03074318">these cancers</a> in patients with advanced soft tissue cancer who failed to respond to chemotherapy.</p>
<h2>Anticoagulants</h2>
<p>Medical leeches have also provided humanity with life-saving drugs. When these creatures latch on to a person to suck their blood, they inject compounds such as hirudin and calin to stop their victim’s blood from clotting. </p>
<p>The anticoagulant drugs <a href="https://pubmed.ncbi.nlm.nih.gov/9777138/">bivalirudin and desirudin</a> are derived from hirudin. These drugs are given to people at a high risk of getting blood clots – such as those with atrial fibrillation, a type of heart arrhythmia. If a blood clot jams up an artery, it can cause a stroke or heart attack.</p>
<figure class="align-center ">
<img alt="A medical leech sucking blood from a human" src="https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545314/original/file-20230829-19-wn1ky4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Leech saliva contains useful anticoagulant compounds.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-leeches-on-human-body-drink-1851433564">Vital9s/Shutterstock</a></span>
</figcaption>
</figure>
<p>The story of another anticoagulant called <a href="https://www.acs.org/education/whatischemistry/landmarks/warfarin.html#:%7E:text=Warfarin%20sodium%20was%20approved%20for,blood%20thinner%20in%20the%20world.">warfarin</a> dates back to the 1920s when cattle in the US and Canada began dying from a mysterious bleeding disorder. It turned out that the cause was the mouldy sweet clover hay the cattle were eating. The harmful compound in the mould that caused the bleeding, called dicoumarol, was eventually developed into warfarin. </p>
<p>Warfarin was initially sold as rat poison as it was so effective at causing internal bleeding in rodents. However, researchers soon realised its potential therapeutic use in humans as an <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/warfarin">anticoagulant</a>. The drug really took off in 1955 after US president <a href="https://www.nature.com/articles/nrcardio.2017.172">Dwight Eisenhower was successfully treated</a> with it following a heart attack.</p>
<h2>Explosive finding</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/10779131/#:%7E:text=1.,work%20with%20Theophile%2DJules%20Pelouze.">Nitroglycerin</a> was first discovered in the 19th century, and is derived from glycerol where its explosive properties were initially noted. However, its medicinal properties were soon recognised. </p>
<p>Middle-aged men who worked with explosives – such as those building the rail networks – would <a href="https://www.medscape.com/viewarticle/987903#vp_2">sometimes note</a> that their chest pain subsided after handling sticks of dynamite. Medical researchers got wind of this story and developed nitroglycerin into a drug to relieve angina symptoms by dilating the blood vessels and improving blood flow to the heart.</p>
<p>The drug is still used today and is known for the annoying side-effect of triggering explosives scanners at airports. </p>
<p>Finally, there is chemotherapy. We have the deadly chemical warfare agent mustard gas to thank for this. During the first world war, scientists noticed that mustard gas <a href="https://medicine.yale.edu/ycci/clinicaltrials/learnmore/tradition/chemotherapy/">destroyed lymphatic tissue</a>, they wondered if it might destroy cancer cells in lymph nodes. But it wasn’t until the 1940s that nitrogen mustard (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325736/">a derivative of mustard gas</a>) was first used to treat a patient with blood cancer. Several drugs derived from mustard agents were subsequently developed. </p>
<p>While modern drugs will continue to be mostly designed on computers – and, increasingly, <a href="https://www.technologyreview.com/2023/02/15/1067904/ai-automation-drug-development/">artificial intelligence</a> – drug researchers will continue to look for inspiration for new meds in weird and wonderful places.</p><img src="https://counter.theconversation.com/content/208630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Craig Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From rat poison to explosives, many of the drugs we use have interesting origin stories.Craig Russell, Lecturer, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114122023-08-31T21:39:50Z2023-08-31T21:39:50ZHere’s what new 60-day prescriptions mean for you and your hip pocket<figure><img src="https://images.theconversation.com/files/545417/original/file-20230829-19-mvx2g4.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/customer-paying-bill-by-cell-phone-623126426">Shutterstock</a></span></figcaption></figure><p>From today, there are significant <a href="https://www.health.gov.au/our-work/60-day-prescriptions">changes</a> to how some common medicines are prescribed and dispensed in Australia. This means you could walk away from the pharmacy with 60-days’ worth of your usual medicine from a single prescription.</p>
<p>Until now, most long-term medicines were only available for 30 days at a time. So the price of these medicines for some patients may effectively halve. </p>
<p>You would also need fewer trips to the GP for a prescription and fewer visits to the pharmacy to have your medicine dispensed.</p>
<p>But not all medicines are yet eligible for 60-day scripts and not everyone is prescribed 60-days’ worth of medicine at a time. Here’s what the changes mean for you.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">Last year, half a million Australians couldn't afford to fill a script. Here's how to rein in rising health costs</a>
</strong>
</em>
</p>
<hr>
<h2>Can I get a 60-day script today?</h2>
<p>If you have a current prescription, you need to use this prescription first before you get a new one. To be eligible for a prescription that provides medicine for 60 days your medication needs to be on the <a href="https://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2022-12/Increased-Dispensing-Quantities-List-of-Medicines.pdf">approved list</a>.</p>
<p>Your doctor also needs to assess if you are stable on it. This is to avoid wastage. We know new treatments can result in frequent changes to medication regimens, which would result in wasted medicines if they don’t end up being used.</p>
<p>Your doctor may also give you “repeat” prescriptions for 60-days’ worth of medicines at a time. Under the new rules, this could mean up to <a href="https://www.health.gov.au/resources/publications/60-day-prescriptions-information-kit-for-prescribers?language=ha">12 months’ supply</a> of medicine (the initial script plus five “repeats”). You would have to pay for each of these repeat scripts when your medicine is dispensed every 60 days.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-time-of-day-should-i-take-my-medicine-125809">What time of day should I take my medicine?</a>
</strong>
</em>
</p>
<hr>
<h2>Is my medicine on the list?</h2>
<p>The roll-out of 60-day scripts will be in three stages. The first stage, which begins today, <a href="https://www.health.gov.au/our-work/60-day-dispensing/pbs-medicines-current-item-codes">includes</a> medicines for cardiovascular disease (such as heart disease and stroke), heart failure, high cholesterol, gout, osteoporosis, and the gut conditions Crohn’s disease and ulcerative colitis.</p>
<p>This includes some of the most common medicines prescribed in Australia, such as atorvastatin for lowering cholesterol, and perindopril for lowering blood pressure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person adding medications to pill organizer" src="https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545419/original/file-20230829-21-3sh11g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not all your medicines may be affected by the changes.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/1TL8AoEDj_c">Laurynas Mereckas/Unsplash</a></span>
</figcaption>
</figure>
<p>The following stages, set to be rolled out over the coming 12 months, include medicines for diabetes, epilepsy, glaucoma, asthma and Parkinson’s disease. </p>
<p>When fully implemented, these changes will affect more than 300 prescription medicines available on the Pharmaceutical Benefits Scheme (PBS).</p>
<p>These medicines have been chosen because they are appropriate treatments for people living with stable, chronic health conditions, they meet clinical safety criteria, and are considered cost-effective.</p>
<p>Medicines not available for 60-day dispensing are those only for short-term use and medicines known to be at risk of overuse. These <a href="https://www.nps.org.au/australian-prescriber/articles/pharmaceutical-drug-misuse-in-australia#information-sources-for-prescribers">include</a> pain medicines and some medicines for mental health conditions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-pharmacists-are-angry-at-script-changes-and-why-the-government-is-making-them-anyway-204028">Here's why pharmacists are angry at script changes – and why the government is making them anyway</a>
</strong>
</em>
</p>
<hr>
<h2>Will I save money?</h2>
<p>The government has brought in these changes mainly to try to make medicines more affordable. We know people do not seek medical care or fill prescriptions <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release">due to cost</a>. </p>
<p>The <a href="https://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee">maximum price you pay</a> at the pharmacy for a PBS script (known as the co-payment) is not changing. <a href="https://www.pbs.gov.au/info/about-the-pbs">It’s still</a> A$7.30 for concession card holders and $30 for non-concession card holders. But by having 60-day dispensing, you’ll only be charged this every two months instead of every month.</p>
<p>But not everyone will save money from a 60-day prescription because in some cases your pharmacy may already be discounting your medicine. If the price for 60-days’ supply would not take the price over $30, you may not be getting two scripts for the price of one. </p>
<p>For example, a commonly discounted medicine is atorvastatin. In Australia, a non-concession patient generally pays between $8 and $22 for 30-days’ supply. But it’s likely that a 60-day supply would cost between $15 and $30.</p>
<p>The amount you or your family need to pay to reach the <a href="https://www.pbs.gov.au/info/general/faq#WhatisthePBSSafetyNet">PBS safety net</a> is also not changing. This is the threshold you need to reach before medicines become free (for concession card holders) or discounted (non-concession card holders) for the rest of the calendar year. In some instances, 60-day dispensing may result in you or your family reaching the safety net threshold later, or not at all.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman looking into purse, holding coin" src="https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545421/original/file-20230829-15-pcnddr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The changes are meant to make medicines more affordable.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-old-person-senior-hold-wallet-1844510152">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-the-pbs-safety-net-and-is-it-really-the-best-way-to-cut-the-cost-of-medicines-180315">What is the PBS safety net and is it really the best way to cut the cost of medicines?</a>
</strong>
</em>
</p>
<hr>
<h2>How should I store my medicine?</h2>
<p>If you don’t store your medicines correctly at home they can become degraded and not work so well. With a 60-day supply, correct storage is even more important. </p>
<p>As a general rule of thumb, never store your medicines in hot rooms or your car (even in winter) and don’t store them in direct sunlight. If your medicine needs to be stored in the fridge, your pharmacist will let you know.</p>
<p>One example is <a href="https://media.healthdirect.org.au/medicines/GuildLink_Information/58775/CMI/ujcxalae10320.pdf">latanoprost</a>, which are drops for the eye condition glaucoma. You can keep the bottle you are using in the cupboard but you need to store the unopened, second bottle in the fridge.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">Health Check: what should you do with your unused medicine?</a>
</strong>
</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>Remember, 60-day dispensing is only available for new prescriptions. When you next see your doctor, if your condition is stable and your medicine is suitable, you will be provided a 60-day script. Your pharmacist will then dispense a 60-day supply.</p>
<hr>
<p><em>If you have any questions about the new rules, ask your local pharmacist. Information is also available from the <a href="https://www.health.gov.au/our-work/60-day-prescriptions">Commonwealth health department</a> and the <a href="https://www.60dayscripts.com.au/">Consumers Health Forum</a>.</em></p><img src="https://counter.theconversation.com/content/211412/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Bartlett is a member of the Pharmaceutical Society of Australia, a previous director of Blooms the Chemist management services and remains a shareholder.</span></em></p><p class="fine-print"><em><span>Associate Professor Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p>The price you pay at the pharmacy for your long-term medicines may effectively halve. But not all medicines or patients qualify.Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyNial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050592023-07-28T12:52:44Z2023-07-28T12:52:44ZBreastfeeding: mothers taking prescription medicines faced with a lack of information – new review<figure><img src="https://images.theconversation.com/files/534299/original/file-20230627-15-svfyno.jpg?ixlib=rb-1.1.0&rect=85%2C0%2C9504%2C6260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most medicines are safe for most breastfed babies, while serious harm to infants is rare.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-son-sitting-on-sofa-breastfeeding-2251534251">Krakenimages.com/Shutterstock</a></span></figcaption></figure><p>Breastfeeding is a cornerstone of early childhood nutrition and development. However, taking prescription medicines can reduce breastfeeding rates because parents who take such medications often face a lack of information about their potential impact on babies or how medicines affect lactation. </p>
<p>To better understand the effects of medicines on breastfeeding, we conducted a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284128">systematic review</a> of the available information. We scoured electronic databases for research on the impact of prescription medicines on breastfeeding. These studies examined how medicines affected milk composition, milk production and the health of breastfed infants. </p>
<p>We found a limited number of high-quality studies, with only ten established databases reporting on breastfeeding, medicines and infant outcomes together. And, unfortunately, none of these studies covered educational outcomes, making it difficult to assess potential long-term risks, harms and benefits.</p>
<p>Our research shows that more data collection is needed. And our work and <a href="https://doi.org/10.1371/journal.pone.0225133">other research</a> highlights there is a need for additional support to help breastfeeding mothers overcome physical barriers, including delayed milk production and <a href="https://pubmed.ncbi.nlm.nih.gov/28027444/">anxiety</a> about the use of prescription medicine.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-old-contraception-methods-that-show-why-the-pill-was-a-medical-breakthrough-207572">Five old contraception methods that show why the pill was a medical breakthrough
</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
<hr>
<h2>Safety</h2>
<p>Most medicines are safe for most breastfed babies, while serious harm to infants is rare. In most cases, the benefits of breastfeeding outweigh the risks of harms associated with medicine use. Still, this can be a complex issue and it’s essential to weigh the benefits and risks carefully.</p>
<p>There are some medicines that require extra checks on infants and their ability to breastfeed. For example, infants whose mothers use antibiotics such as amoxicillin and erythromycin (which are known to be safe to use during breastfeeding), should be checked for oral thrush and diarrhoea, as prompt treatment is important. </p>
<p>The <a href="https://bnf.nice.org.uk">British National Formulary</a> (BNF) offers advice on the prescribing and administration of medicines. Infants of mothers taking certain medicines, such as those for epilepsy, mental health conditions, sedatives, or opioids, should be monitored for signs of sedation, sleepiness, poor feeding, weight loss and irritability. </p>
<p>Health professionals should also assess how effectively the baby is feeding by observing suckling and attachment to the breast. This is important because these types of medicines can interfere with an infant’s ability to feed and receive adequate nutrition.</p>
<p>The BNF expresses reservations regarding prescribing some sedative medicines that pass into breastmilk, where there is a risk of infant sedation, as with benzodiazepines (such as diazepam), and some anti-seizure medicines such as phenobarbital or primidone. </p>
<p>It recommends avoiding certain medicines during breastfeeding altogether, including some antipsychotics, such as olanzapine and clozapine, and the antidepressants escitalopram and fluoxetine. But other antidepressants, such as citalopram, may be used with caution. Most antipsychotic injections should be avoided during breastfeeding too, as should fingolimod which is used to treat multiple sclerosis. </p>
<p>Breastfeeding while using many medicines for serious illness, such as cancer, should be discussed with medical professionals. There may be little or no information from human studies, and there may be too little information to guarantee safety. Examples include many monoclonal antibodies used to treat cancer, and the immunosuppressant, mycophenolate mofetil, which is used to prevent the rejection of kidney, heart or liver transplants.</p>
<h2>Advice</h2>
<p>Mothers taking medicines should not blame themselves for being hesitant towards breastfeeding. Medical advice should be sought before birth. And families should not feel compelled to choose between breastfeeding and continuing with prescription medicines.</p>
<p>It’s essential for doctors, pharmacists and other health professionals to consult reliable information sources, including <a href="https://wicworks.fns.usda.gov/resources/lactmed">LactMed</a> and <a href="https://www.e-lactancia.org/">E-lactancia</a>, or contact the <a href="https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/">Drugs in Breastmilk helpline</a>.</p>
<p>To help families who need prescription medicines, it is crucial for public health teams controlling the collection of routine healthcare data to treat data collection on medicine use during and after pregnancy and during labour as a priority. This would allow research into the benefits and harms of medicine use before and during breastfeeding. </p>
<p>Such information would help parents make informed decisions regarding their medical treatment, breastfeeding and monitoring infants. It would also help minimise parental anxiety and potentially harmful false dilemmas.</p><img src="https://counter.theconversation.com/content/205059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sue Jordan receives funding from the ConcePTION project. The ConcePTION project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 821520. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. Funding was awarded to SJ, SLL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. </span></em></p><p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Not enough data is being collected about the impact taking prescription medication has on breastfeeding.Sophia Komninou, Lecturer in Public Health Nutrition, Swansea UniversitySue Jordan, Professor of Medicines Management and Health Services Research, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055132023-05-17T13:34:07Z2023-05-17T13:34:07ZUsing pharmacists to ease pressure on GPs will only work with proper funding and more staff<figure><img src="https://images.theconversation.com/files/526748/original/file-20230517-5572-g47292.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C4931%2C3297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You may soon be able to visit your pharmacist to get certain medicines without seeing a GP first.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacy-product-customer-pharmacist-help-man-2269716989">Yuri A/PeopleImages.com/ Shutterstock</a></span></figcaption></figure><p>The NHS is under tremendous pressure and patients are increasingly struggling to <a href="https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis">access appointments and urgent care</a>. In a bid to improve primary care for patients, the UK government recently outlined a <a href="https://www.england.nhs.uk/long-read/delivery-plan-for-recovering-access-to-primary-care-2/">number of changes</a> it plans to implement in England. </p>
<p>One of these proposed initiatives is allowing pharmacists to supply a number of prescription-only medicines for common conditions – including sinusitis, shingles and uncomplicated urinary tract infections – without patients needing a prescription from their GP. </p>
<p>It’s hoped that this scheme, called <a href="https://www.chemistanddruggist.co.uk/CD136989/Pharmacy-First-set-for-national-launch-by-end-of-2023-following-consultation">Pharmacy First</a>, will help save 10 million GP appointments yearly (alongside the other proposed changes) once scaled up across the country.</p>
<p>Not only are pharmacists very well-equipped in terms of knowledge and skills to provide these services, we also know from equivalent trial schemes that such programmes work well for patients. But Pharmacy First will only work if adequate funding is provided to pharmacies to ensure they can provide these additional services.</p>
<p>Pharmacists are more than capable of providing patients with good-quality care, which is why it makes sense to expand the role they have in providing patients with this care. </p>
<p>To become a pharmacist, you need to complete a four-year degree. Many of the skills learnt during study are similar to what GPs would learn – such as understanding how to make a physical assessment of a patient, in addition to the science of medicines. </p>
<p>Pharmacists must also complete a one-year work placement with a national exam at the end – after which they register with the regulator, the General Pharmaceutical Council. This means pharmacists are regulated in a similar way to doctors to ensure they practise in a safe way. </p>
<p>After graduating, pharmacists are required to complete professional development courses in order to develop specialist expertise and maintain their competence. This means pharmacists are very well-qualified to provide care to patients which complements that already provided by GPs. </p>
<figure class="align-center ">
<img alt="A young female pharmacist holding a clipboard and pen speaks with an older female customer." src="https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=594&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=594&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526749/original/file-20230517-19-4mx9pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=594&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pharmacists are well-qualified to supply patients with certain prescription-only medicines.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacy-medical-insurance-customer-black-woman-2269474071">Yuri A/PeopleImages.com/Shutterstock</a></span>
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<p>Furthermore, some pharmacists (mainly in hospitals and general practice) have already been able to <a href="https://www.researchgate.net/publication/5826392_Pharmacist_prescribing_in_the_UK-a_literature_review_of_current_practice_and_research">prescribe medicines to patients</a> without medical practitioner sign-off since 2006. This <a href="https://www.bmj.com/content/380/bmj-2022-071883">prescribing programme</a> has successfully shown that pharmacists are able to prescribe medicine in hospitals, care homes and GP surgeries without any compromise to patient safety. </p>
<p>In order to be able to prescribe medicines, pharmacists need to complete an accredited programme which is regulated by the General Pharmaceutical Council. This course ensures that pharmacists have the relevant diagnostic and prescribing skills to be independent prescribers, and to ensure safe prescribing for patients. </p>
<p>Prescribing skills are now being taught within the MPharm degree in the UK. This means all pharmacists joining the workforce from 2026 onwards will already be qualified to prescribe and supply prescription-only medicines. </p>
<h2>Making it work</h2>
<p>In Scotland and Wales, <a href="https://www.cps.scot/featured/nhs-pharmacy-first-scotland">similar national initiatives</a> to Pharmacy First have been in place since 2006. Based on the research we have so far from these programmes, allowing pharmacists to supply prescription-only medications has been a benefit to patients.</p>
<p>Studies have found that these initiatives are associated with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886314/">improved access to care</a> and have <a href="https://ihub.scot/media/7311/cps-mas-report-fv-jan-2019.pdf">alleviated pressures</a> in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886314/">other parts of the NHS</a>. </p>
<p>Expanding the powers of pharmacists throughout the country to supply prescription-only medicines may also be extremely beneficial to <a href="https://bmjopen.bmj.com/content/4/8/e005764">people living in deprived areas</a>, for whom pharmacies are often their only source of health advice and medicines. As such, the Pharmacy First scheme may ensure more people are able to access the healthcare they need.</p>
<p>But a major concern with the government’s plan regards the funding that will be provided. Since 2015, funding for community pharmacies has been cut by 30% in real terms, leading to the closure of <a href="https://thecca.org.uk/wp-content/uploads/2023/02/Primary-care-closures-in-England-1.pdf">720 highstreet pharmacies</a> in England. In addition, pharmacies currently rely on NHS England for <a href="https://psnc.org.uk/wp-content/uploads/2022/10/Pharmacy-Funding-and-Capacity-briefing.pdf">more than 90% of their funding</a>. </p>
<p>While community pharmacists have been calling for the Pharmacy First scheme for several years, the government’s plans will only work if there’s an immediate injection of funding. This will halt closures and alleviate the already existing pressure on community pharmacies – ensuring these additional services can readily be provided. While the government has <a href="https://www.england.nhs.uk/2023/05/patients-to-benefit-from-faster-more-convenient-care-under-major-new-gp-access-recovery-plan/">promised £645 million</a> for the Pharmacy First scheme, this will not be enough to close the funding gap that already exists while ensuring new services can be provided.</p>
<p>Pharmacists are already experiencing numerous work-related pressures. Prescription numbers <a href="https://www.ibisworld.com/uk/bed/nhs-prescriptions-volume/44123">continue to rise</a> dramatically. Paired with the fact that patients are already being encouraged to use pharmacies for <a href="https://committees.parliament.uk/writtenevidence/13438/html/">advice and treatment</a> without appointment, many pharmacists are struggling to keep up with their workload.</p>
<p>In addition, staffing levels are difficult to maintain, as pharmacists and pharmacy technicians are <a href="https://www.pulsetoday.co.uk/news/pulse-pcn/pcn-pharmacist-recruitment-has-unintended-consequences-warns-government-report">being recruited</a> to <a href="https://www.bma.org.uk/advice-and-support/gp-practices/employment-advice/employing-clinical-pharmacists-in-gp-practices">work in general practice</a>. If more isn’t done by the government to recruit pharmacists or encourage students to enrol in pharmacy courses, it may hinder the success of the Pharmacy First scheme once it’s introduced – and in the longer term, the role of community pharmacy in providing vital patient care.</p>
<p>While it’s far from certain if these plans will actually save 10 million appointments for GPs a year, it’s clear that pharmacists could be of even greater benefit to patients. But this ambitious scheme will only work if measures are taken to increase pharmacy funding and staff numbers.</p><img src="https://counter.theconversation.com/content/205513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Portlock does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The proposed plans will likely benefit patients – but only if more is done to ensure pharmacists can provide these additional services.Jane Portlock, Professor of Pharmacy Postgraduate Education, Interim Director of CIPPET, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2053962023-05-15T04:06:09Z2023-05-15T04:06:09ZMy child has a cough, so what’s wrong with using cough syrup?<figure><img src="https://images.theconversation.com/files/526078/original/file-20230515-124801-1buxmk.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C5955%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-girl-sick-lies-bed-coughs-1878376429">Shutterstock</a></span></figcaption></figure><p>As winter approaches, many parents will be bracing for the cold and flu season. Young children typically get at least <a href="https://raisingchildren.net.au/toddlers/health-daily-care/health-concerns/colds">six colds a year</a>. </p>
<p>In previous generations, parents might have reached for the cough syrup to relieve a dry or chesty cough. </p>
<p>But we now know cough syrups <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001831.pub5/full">aren’t very effective</a> at treating children’s coughs.</p>
<p>And amid <a href="https://pubmed.ncbi.nlm.nih.gov/19101060/">mounting evidence of harms</a> from poisoning and deaths, many countries including Australia have restricted cough medicines so they can’t be given to children aged under six. </p>
<h2>What’s in cough medicine?</h2>
<p>Active ingredients in cough syrups vary depending on their claimed benefit. They can contain cough suppressants (dampening the body’s cough reflex), expectorants and mucolytics (both of which help clear phlegm). </p>
<p>Other medicines marketed for cold and flu often contain decongestants (to relieve a blocked nose) and sedating antihistamines to relieve sneezing, stop a runny nose and to aid sleep. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-i-have-a-cough-and-what-can-i-do-about-it-119172">Health Check: why do I have a cough and what can I do about it?</a>
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<p>The riskiest medications are those with a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2010.01780.x">sedative action</a>, such as sedating antihistamines or opioid-based cough suppressants. While sedation may be a desired effect for parents with a sleepless child, young children are particularly at risk of serious harm or death. Sedatives can also cause agitation and hyperactivity. </p>
<p>While cough syrups that don’t contain sedatives are likely safer, there are very few studies of safety and efficacy of these products in children. Adverse events including <a href="https://pubmed.ncbi.nlm.nih.gov/10195488/">agitation and psychosis</a>
have been reported, especially with overuse. </p>
<p>Overuse may result from parents misreading the label, intentionally using more in the hope it will work better, inadvertent extra doses and the use of inaccurate measuring devices such as household spoons. </p>
<h2>How are cough syrups restricted?</h2>
<p>Young children under two years old are <a href="https://pubmed.ncbi.nlm.nih.gov/19101060/">most at risk of a fatal overdose</a> from cough syrups. But Australia’s drug regulator <a href="https://web.archive.org/web/20140717013231/http://tga.gov.au/industry/otc-notices-cough-cold-review-outcomes.htm#.U8cntK3P0Q8">recommends against</a> using cough syrups for anyone under six years of age. As such, there are no dosing instructions for children under six years on the labels of these products.</p>
<p>Cough syrups are still available for older children and adults. Pharmacists are likely to ask the age of the person who will take it and provide guidance on dosing and appropriate use. </p>
<figure class="align-center ">
<img alt="Person pours cough syrup onto a spoon" src="https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526082/original/file-20230515-201419-kifs2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dosing errors can be made when using a household spoon.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthcare-people-medicine-concept-woman-pouring-657897406">Shutterstock</a></span>
</figcaption>
</figure>
<p>Our research, published today in the <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.51865">Medical Journal of Australia</a>, shows restricting the use of cough and cold medicines in children results in a significant and sustained decrease in poisonings. </p>
<p>Our study looked at dosing errors, adverse events at correct doses, and accidental “exploratory ingestions”, such as when a toddler helps themselves to the medicine cabinet. </p>
<p>The government mandated labelling changes in 2012 and 2020 for these products. In 2012, labels for medicated cough and cold products could no longer list dosing instructions for children under six, and had to carry additional warnings. In 2020, warnings were put on sedating antihistamines saying they were not to be used in children under two years for <em>any</em> reason (including allergy and hayfever). </p>
<p>This resulted in a halving of the rate of poisons centre calls, and a halving in the rate of hospitalisations. Despite this, hundreds of calls are still made to Australian poisons centres per year regarding these products in young children.</p>
<h2>When is it OK to use cough syrups?</h2>
<p>Harms have mostly been documented in younger children. This is likely due to their smaller size, meaning it takes less medicine to cause harm, and also their susceptibility to sedative effects due to their developing brains. </p>
<p>Cough syrups can be used for in children aged six to 11 years, however <a href="https://web.archive.org/web/20140717013231/http://tga.gov.au/industry/otc-notices-cough-cold-review-outcomes.htm#.U8cntK3P0Q8">caution is still needed</a>. These products should only be given in consultation with a doctor, pharmacist or nurse practitioner.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-cough-medicines-work-62425">Health Check: do cough medicines work?</a>
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<p>Some herbal products are available and marketed for children, such as <em>Hedera helix</em> (ivy leaf extract). Unfortunately, there is no convincing evidence these medications <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275562/">meaningfully improve cough symptoms</a>. But the risk of poisoning is low. </p>
<p>Simple syrups containing no medication can also be effective: <a href="https://link.springer.com/article/10.1007/s00408-019-00305-5">up to 85% of the effectiveness</a> of cough medicines has been put down to the “placebo effect”. This could be due to syrups coating the throat and dampening that irritating tickling sensation.</p>
<h2>So what can I do for my kid?</h2>
<p>The best thing you can do for your child is give them rest and reassurance. </p>
<p>Antibiotics will only be needed if a doctor diagnoses them with <a href="https://www.healthdirect.gov.au/pneumonia#:%7E:text=Bacterial%20pneumonia%20may%20be%20caused,Haemophilus%20influenzae%20and%20Moraxella%20catarrhalis.">acute bacterial pneumonia</a> or with a chronic cough due to a bacterial infection, such as protracted bacterial bronchitis, whooping cough or a <a href="https://healthinfo.healthengine.com.au/lung-abscess">lung abscess</a>.</p>
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<img alt="Girl with a fever looks at her Dad, whose arm is touching her head" src="https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526085/original/file-20230515-154092-smbbsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Treat fevers with over-the-counter medicines such as paracetamol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-sleeping-sickness-on-bed-796939429">Shutterstock</a></span>
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<p>Paracetamol or ibuprofen can be used if they have fever, aches and pains along with their cough. Check the correct dosage on the packaging for your child’s weight and age.</p>
<p>If your child is older than 12 months and has a wet cough (producing phlegm in their throat), consider giving them honey. There is growing evidence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264806/">honey can reduce the production of mucus</a> and therefore, the amount of coughing.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/still-coughing-after-covid-heres-why-it-happens-and-what-to-do-about-it-179471">Still coughing after COVID? Here's why it happens and what to do about it</a>
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<img src="https://counter.theconversation.com/content/205396/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rose Cairns receives funding from the National Health and Medical Research Council (NHMRC, Investigator Grant). She is also the recipient of an untied educational grant from Reckitt to fund a PhD stipend into over-the-counter analgesic research. She has previously recieved honoraria/speaker fees from Reckitt, HealthEd and The Pharmacy Guild of Australia for giving educational presentations on poisoning.</span></em></p><p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vairea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents.</span></em></p>Children aged under six years shouldn’t have cough syrup. It’s not only ineffective, it can be harmful.Rose Cairns, Lecturer in Pharmacy, University of SydneyNial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2034242023-04-12T03:38:13Z2023-04-12T03:38:13ZNew asthma medicine restrictions will hurt the poorest children the most<figure><img src="https://images.theconversation.com/files/520383/original/file-20230412-20-y1di31.jpg?ixlib=rb-1.1.0&rect=177%2C0%2C5465%2C3257&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pediatrician-stethoscope-listening-lungs-child-bronchitis-1877921899">Shutterstock</a></span></figcaption></figure><p>Last week, without warning, the federal government significantly restricted the subsidy for an important and safe asthma medicine for children. <a href="https://www.pbs.gov.au/news/2023/04/files/Revised-PBS-restrictions-for-fluticasone-propionate-50-micrograms-per-dose-inhalers.pdf">A short document</a> explained to prescribers what had changed, but gave no reasons. </p>
<p>The medicine, fluticasone propionate 50mcg, is a <a href="https://www.nationalasthma.org.au/living-with-asthma/how-to-videos/how-to-use-a-standard-mdi-and-spacer">metered-dose inhaler</a>, more commonly known by the brand names Flixotide Junior or Axotide Junior. It’s one of the the lowest dose medicines of its type available, and until April 1 the government had subsidised <a href="http://medicarestatistics.humanservices.gov.au/statistics/do.jsp?_PROGRAM=/statistics/pbs_item_standard_report&itemlst=%2708516F%27&ITEMCNT=1&LIST=8516F&VAR=SERVICES&RPT_FMT=1&start_dt=202107&end_dt=202206">nearly 80,000</a> of these puffers each year. </p>
<p>However, the new change will make it harder to afford, especially for vulnerable families, who already suffer the greatest burden of asthma.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-asthma-what-we-know-dont-know-and-suspect-96409">What causes asthma? What we know, don't know and suspect</a>
</strong>
</em>
</p>
<hr>
<h2>The importance of asthma prevention</h2>
<p>When a child has asthma, <a href="https://www.nationalasthma.org.au/understanding-asthma/what-is-asthma">inflammation and sensitivity</a> causes airway narrowing, which makes it hard to breathe. </p>
<p>About <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/asthma-prevalence-children">one in ten Australian children</a> has long-term asthma. It can cause frightening breathlessness, poor school participation, and sometimes hospitalisation. Rarely, and tragically, children die from asthma. </p>
<p>Children with persistent or severe asthma symptoms need medicines to reduce airway inflammation. “Inhaled steroids” are the safest and most effective treatments. In fact, the World Health Organisation has included them on its <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.03">List of Essential Medicines for Children</a>.</p>
<p>These medicines <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa051378">reduce the risk</a> of severe flares of symptoms, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909590/">especially</a> in children with a history of such flares. The aim is to use the lowest effective dose, yet it is the subsidy of low dose fluticasone which the new policy affects.</p>
<figure class="align-center ">
<img alt="Mother gives child asthma medicine" src="https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520386/original/file-20230412-20-m6601g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Inhaled steroids can prevent an asthma flare up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-5-years-old-child-taking-64883092">Shutterstock</a></span>
</figcaption>
</figure>
<h2>How medicine subsidy decisions work</h2>
<p>To be sold in Australia, all prescription medicines must be registered by the <a href="https://www.tga.gov.au/">Therapeutic Goods Administration</a>, which assesses the safety and efficacy of the medicine.</p>
<p>The <a href="https://www.pbs.gov.au/pbs/home">Pharmaceutical Benefits Scheme</a> (PBS) is a list of medicines our government helps to pay for. This scheme caps the cost of dispensed medicines at about A$30 for most people, and about A$7 for people with concession cards.</p>
<p>To get a drug on the list, the manufacturer needs to convince the <a href="https://www.pbs.gov.au/info/industry/listing/participants/pbac">Pharmaceutical Benefits Advisory Committee</a> (PBAC) the medicine is cost-effective.</p>
<p>Having this sort of process – a single major payer, and well-qualified decision-makers – is a good thing. It’s a reason Australia has much more affordable medicines <a href="https://www.oecd-ilibrary.org/sites/2493ee95-en/index.html?itemId=/content/component/2493ee95-en">than the United States</a>. This usually benefits both patients and health authorities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/passive-smoking-synthetic-bedding-and-gas-heating-in-homes-show-the-strongest-links-to-asthma-176677">Passive smoking, synthetic bedding and gas heating in homes show the strongest links to asthma</a>
</strong>
</em>
</p>
<hr>
<h2>The new rules</h2>
<p>Previously, any doctor could prescribe low dose fluticasone for a child with asthma under the PBS. But as of April 1, this is no longer true.</p>
<p>The new <a href="https://www.pbs.gov.au/info/news/2023/04/revised-pbs-restrictions-for-fluticasone-propionate">PBS rules</a> are complicated.</p>
<p>First, no one over the age of six will get any government subsidy to help with the cost of this medicine.</p>
<p>Second, the PBS will only subsidise it for children under the age of six if a paediatrician or lung specialist has started the medicine, and if the prescriber has first contacted the PBS for approval.</p>
<p>The PBS has not spelled out why this change was made, either on their website or when <a href="https://www.ausdoc.com.au/news/pbs-abruptly-restricts-gp-prescribing-of-kids-asthma-inhaler/">pressed by journalists</a>. </p>
<p>Generally, if the Pharmaceutical Benefits Advisory Committee and a manufacturer can’t agree on a medicine’s price, the medicine will stay off the PBS, and will remain unsubsidised. Alternatively, the Pharmaceutical Benefits Advisory Committee may place restrictions on the population for whom the medicine is subsidised.</p>
<p>In this case, given no safety or effectiveness concerns have been raised, and the change coincided with a scheduled <a href="https://www.pbs.gov.au/info/industry/pricing/price-disclosure-spd/current-price-disclosure-cycle-2023-april">price-reduction date</a>, the new restrictions may be simply about money – the Pharmaceutical Benefits Advisory Committee and the manufacturer not agreeing on a price.</p>
<h2>What does it mean for families?</h2>
<p>In children over the age of six, several alternative medicines can be prescribed. </p>
<p>But in children under five, there are no good alternatives, with no other age-appropriate low-dose steroid inhalers approved by the TGA. </p>
<figure class="align-center ">
<img alt="Child uses enhaler" src="https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520385/original/file-20230412-18-4znf9z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In children aged over six, there are several alternative medicines, but that’s not the case for younger children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/boy-using-nasal-spray-bottle-allergy-549780931">Shutterstock</a></span>
</figcaption>
</figure>
<p>In the under-five age group, GPs now have three options if they think their patient needs inhaled steroids: </p>
<ol>
<li><p>prescribe fluticasone 50mcg on a private script</p></li>
<li><p>refer to a child or lung specialist</p></li>
<li><p>prescribe other medicines “off label” (in a way not approved by the TGA), which will often involve higher-dose steroids. </p></li>
</ol>
<p>All of these are problematic.</p>
<p>The use of private scripts will mean families need to pay whatever their local pharmacy charges them. At many pharmacies we expect the price to be around <a href="https://www.chemistwarehouse.com.au/buy/118662/axotide-junior-50mcg-inhaler-120-doses---fluticasone-propionate">$11</a> to <a href="https://www.pbs.gov.au/medicine/item/8516F">$28</a> per inhaler, but there are no guarantees all pharmacies will provide the medication at this cost. </p>
<p>The use of private scripts will certainly hurt families who rely on <a href="https://www.health.gov.au/save-more-on-pbs/concessional-patients">concessions</a> or <a href="https://www.servicesaustralia.gov.au/pbs-safety-net-thresholds?context=22016">safety nets</a>, including <a href="https://www.pbs.gov.au/info/publication/factsheets/closing-the-gap-pbs-co-payment-measure">Aboriginal and Torres Strait Islander children</a> and those from low socioeconomic backgrounds who are <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/asthma-prevalence-children">disproportionately affected</a> by asthma.</p>
<p>Requiring referral to a specialist also has many detrimental consequences. There are already bulging waitlists for these services, leading to delays in care. In many parts of Australia there are no bulk-billing specialists, which makes it hard for vulnerable families to access these services. </p>
<p>GPs will feel obliged to refer cases they previously would have been able to manage, which may erode the community’s trust in GPs. </p>
<p>The decision adversely impacts the interests of so many Australian kids, especially those from our most vulnerable populations who already suffer disproportionately from asthma. The Pharmaceutical Benefits Advisory Committee and the manufacturer should work together to reconsider it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-price-of-pbs-medicines-is-coming-down-but-are-we-helping-the-right-people-190137">The price of PBS medicines is coming down. But are we helping the right people?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/203424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brett Montgomery has no relationship with the manufacturer of the medicines discussed in this article (GSK). Brett is a member of the guidelines committee for the Australian Asthma Handbook, which is an unpaid role. The Australian Asthma Handbook is a project of the National Asthma Council Australia. The National Asthma Council Australia has received funding from GSK for some activities, but is not a sponsor of the Handbook. Brett writes here in an individual capacity rather than on behalf of any organisation.</span></em></p><p class="fine-print"><em><span>Louisa Owens is affiliated with the National Asthma Council of Australia and Asthma Australia. Louisa has no relationship with the manufacturer of the medicines discussed in this article (GSK). Loiusa is a member of the guidelines committee for the Australian Asthma Handbook, which is an unpaid role. The Australian Asthma Handbook is a project of the National Asthma Council Australia. The National Asthma Council Australia has received funding from GSK for some activities, but is not a sponsor of the Handbook. Louisa is also a member of the Professional Advisory Council for Asthma Australia. Louisa writes here in an individual capacity rather than on behalf of any organisation</span></em></p><p class="fine-print"><em><span>Shivanthan Shanthikumar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children with persistent or severe asthma symptoms need medicines to reduce airway inflammation. But a change last week means these medicines are harder to access.Brett Montgomery, Senior Lecturer in General Practice, The University of Western AustraliaLouisa Owens, Senior Conjoint Lecturer, UNSW SydneyShivanthan Shanthikumar, Clinician Scientist Fellow; Paediatric Respiratory Specialist, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990852023-02-10T01:50:05Z2023-02-10T01:50:05ZIs my medicine making me feel hotter this summer? 5 reasons why<figure><img src="https://images.theconversation.com/files/508796/original/file-20230208-24-lf74uh.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overheated-woman-sitting-on-couch-waving-1707953323">Shutterstock</a></span></figcaption></figure><p>If you’re really feeling the heat this summer, it might be down to more than the temperature outside.</p>
<p>Some types of medicines can increase your core body temperature or make you feel hotter than you really are. Some can affect your body’s ability to cool down.</p>
<p>Here’s what you need to know about heat intolerance and medicines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-cope-with-extreme-heat-days-without-racking-up-the-aircon-bills-128857">How to cope with extreme heat days without racking up the aircon bills</a>
</strong>
</em>
</p>
<hr>
<h2>What is heat intolerance?</h2>
<p>Some people simply dislike the feeling of feeling hot, while others feel hot at temperatures most people find comfortable. Both are examples of
<a href="https://www.medicalnewstoday.com/articles/325232#symptoms">heat intolerance</a>.</p>
<p>Typical symptoms during warm weather include excessive sweating (or not sweating enough), exhaustion and fatigue, nausea, vomiting or dizziness, and changes in mood.</p>
<p>A number of factors can cause heat intolerance.</p>
<p>This includes the disorder <a href="https://my.clevelandclinic.org/health/diseases/6004-dysautonomia">dysautonomia</a>, which affects people’s autonomic nervous system – the part of the body that regulates the automatic functions of the body, including our response to heat. </p>
<p>Conditions such as diabetes, alcohol misuse, <a href="https://theconversation.com/what-causes-parkinsons-disease-what-we-know-dont-know-and-suspect-57579">Parkinson’s disease</a>, the autoimmune disease <a href="https://theconversation.com/explainer-what-is-guillain-barre-syndrome-and-is-it-caused-by-the-zika-virus-53884">Guillain-Barré syndrome</a> and <a href="https://theconversation.com/explainer-what-are-mitochondria-and-how-did-we-come-to-have-them-83106">mitochondrial disease</a> can cause dysautonomia. People in old age, those with some neurological conditions, or people less physically fit may also have it.</p>
<p>But importantly, medications can also contribute to heat intolerance.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-reasons-to-check-on-your-elderly-neighbour-during-a-heatwave-196218">5 reasons to check on your elderly neighbour during a heatwave</a>
</strong>
</em>
</p>
<hr>
<h2>1. Your body temperature rises</h2>
<p>Some medicines directly increase your body temperature, which then increases the risk of heat intolerance. </p>
<p>These include <a href="https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/bph.15465">stimulant medications</a> to treat ADHD (attention deficit hyperactivity disorder), such as methylphenidate, dexamfetamine and lisdexamfetamine.</p>
<p><a href="https://www.healthdirect.gov.au/antipsychotic-medications">Antipsychotic medications</a> (such as clozapine, olanzapine and quetiapine) used to treat mental health conditions, such as schizophrenia and bipolar disorder, are other examples. </p>
<p>These ADHD and antipsychotic medicines raise your temperature by acting on the hypothalamus, the region of the brain essential for cooling.</p>
<p>The drug levothyroxine, used to treat an under-active thyroid, also increases your body temperature, this time by <a href="https://www.ncbi.nlm.nih.gov/books/NBK500006/">increasing your metabolism</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Medical illustration of hypothalamus region of brain" src="https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508840/original/file-20230208-28-ki6965.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some medicines raise your body temperature directly by acting on the hypothalamus region of the brain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-hypothalamus-1292650669">SciePro/Shutterstock</a></span>
</figcaption>
</figure>
<h2>2. Your blood flow is affected</h2>
<p>Other medicines constrict (tighten) blood vessels, decreasing blood flow to the skin, and so prevent heat from escaping this way. This means your body can’t regulate its temperature as well in the heat. </p>
<p>Examples include <a href="https://www.healthdirect.gov.au/beta-blockers">beta-blockers</a> (such as metoprolol, atenolol and propranolol). These medications are used to treat conditions such as high blood pressure, angina (a type of chest pain), tachycardia (fast heart rate), heart failure, and to prevent migraines. </p>
<p><a href="https://www.nhs.uk/conditions/decongestants/">Decongestants</a> for blocked noses (for example, pseudoephedrine and phenylephrine), triptans for migraines (such as sumatriptan and zolmitriptan) and the ADHD medications mentioned earlier can also act to decrease blood flow to the skin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-nose-spray-good-sex-clears-a-stuffy-nose-just-as-effectively-and-is-a-lot-more-fun-167901">Forget nose spray, good sex clears a stuffy nose just as effectively — and is a lot more fun</a>
</strong>
</em>
</p>
<hr>
<h2>3. You can get dehydrated</h2>
<p>Other medicines can cause dehydration, which then makes you more susceptible to heat intolerance. The best examples are <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretics/art-20048129">diuretics</a> such as furosemide, hydrochlorothiazide, acetazolamide and aldosterone.</p>
<p>These are used to control high blood pressure and heart failure by forcing your kidneys to remove more fluid from your body. </p>
<p>Laxatives, such as senna extract and bisacodyl, also remove water from your body and so have a similar effect.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-do-i-tell-if-im-dehydrated-107437">Health Check: how do I tell if I'm dehydrated?</a>
</strong>
</em>
</p>
<hr>
<h2>4. You can sweat less</h2>
<p>Other medicines have a drying effect. This can be needed for medicines to do their job (for instance, to dry up a runny nose). For others, it is an unwanted side effect. </p>
<p>This drying reduces the amount you sweat, making it harder to lose heat and regulate your core temperature. A number of medicines have these effects, including:</p>
<ul>
<li>some antihistamines (such as promethazine, doxylamine and diphenhydramine)</li>
<li>certain antidepressants (such as amitriptyline, clomipramine and dothiepin)</li>
<li>medicines used to treat <a href="https://www.healthdirect.gov.au/urinary-incontinence#:%7E:text=Urinary%20incontinence%2C%20or%20poor%20bladder%20control%2C%20is%20very%20common%20in,to%20cure%20or%20improve%20it.">urinary incontinence</a> (for example, oxybutynin and solifenacin) </li>
<li>nausea medicine (prochlorperazine)</li>
<li>medicines for stomach cramps and spasms (for instance, hyoscine) </li>
<li>the antipsychoptics chlorpromazine, olanzapine, quetiapine and clozapine.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-do-men-really-sweat-more-than-women-73903">Health Check: do men really sweat more than women?</a>
</strong>
</em>
</p>
<hr>
<h2>5. You don’t feel thirsty</h2>
<p>Finally, some medicines, such as the antipsychotics haloperidol and droperidol, can aggravate heat intolerance by reducing your ability to feel thirsty. </p>
<p>If you don’t feel thirsty, you drink less and are therefore at risk of dehydration and feeling hot.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman staring at glass of water on counter" src="https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508849/original/file-20230208-31-oak7ni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People taking some medications just don’t feel thirsty.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/upset-young-woman-looking-through-glass-754782025">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-can-extreme-heat-lead-to-death-91480">Health Check: how can extreme heat lead to death?</a>
</strong>
</em>
</p>
<hr>
<h2>What can you do about it?</h2>
<p>If you are feeling hot this summer and think your medicine may be contributing, it’s very important you keep taking your medicine.</p>
<p>Speak to your pharmacist or doctor about your symptoms. They will offer advice and discuss alternatives.</p><img src="https://counter.theconversation.com/content/199085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vairea Skincare LLC and a Standards Australia panel member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Jessica Pace does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you think your medicine may be contributing to overheating, it’s very important you keep taking your medicine. Discuss your symptoms with your pharmacist or doctor.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyJessica Pace, Associate Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1966462022-12-21T19:11:54Z2022-12-21T19:11:54ZDrinking alcohol this Christmas and New Year? These medicines really don’t mix<figure><img src="https://images.theconversation.com/files/502253/original/file-20221220-22-w0zd44.jpg?ixlib=rb-1.1.0&rect=8%2C17%2C5742%2C3811&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/champagne-glasses-hands-people-party-1377409880">Shutterstock</a></span></figcaption></figure><p>A glass or two of champagne with Christmas lunch. A cool crisp beer at the beach. Some cheeky cocktails with friends to see in the New Year. There seem to be so many occasions to unwind with an alcoholic drink this summer.</p>
<p>But if you’re taking certain medications while drinking alcohol, this can affect your body in a number of ways. Drinking alcohol with some medicines means they may not work so well. With others, you risk a life-threatening overdose.</p>
<p>Here’s what you need to know if you’re taking medication over summer and plan to drink.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-different-drinks-make-you-different-drunk-88247">Do different drinks make you different drunk?</a>
</strong>
</em>
</p>
<hr>
<h2>Why is this a big deal?</h2>
<p>After you take a medicine, it travels to the stomach. From there, your body shuttles it to the liver where the drug is metabolised and broken down before it goes into your blood stream. Every medicine you take is provided at a dose that takes into account the amount of metabolism that occurs in the liver.</p>
<p>When you drink alcohol, this is also broken down in the liver, and it can affect how much of the drug is metabolised. </p>
<p>Some medicines are metabolised <em>more</em>, which can mean not enough reaches your blood stream to be effective. </p>
<p>Some medicines are metabolised <em>less</em>. This means you get a much higher dose than intended, which could lead to an overdose. The effects of alcohol (such as sleepiness) can act in addition to similar effects of a medicine.</p>
<p>Whether or not you will have an interaction, and what interaction you have, depends on many factors. These include the medicine you are taking, the dose, how much alcohol you drink, your age, genes, sex and overall health. </p>
<p>Women, older people and people with liver issues are more likely to have a drug interaction with alcohol.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-are-50-75-more-likely-to-have-adverse-drug-reactions-a-new-mouse-study-finally-helps-explain-why-195358">Women are 50–75% more likely to have adverse drug reactions. A new mouse study finally helps explain why</a>
</strong>
</em>
</p>
<hr>
<h2>Which medicines don’t mix well with alcohol?</h2>
<p>Many medicines interact with alcohol regardless of whether they are prescribed by your doctor or bought over the counter, such as <a href="https://www.drugs.com/article/herbal-supplements-alcohol.html">herbal medicines</a>.</p>
<p><strong>1. Medicines + alcohol = drowsiness, coma, death</strong></p>
<p>Drinking alcohol and taking a medicine that depresses the <a href="https://adf.org.au/drug-facts/depressants/">central nervous system</a> to reduce arousal and stimulation can have additive effects. Together, these can make you extra drowsy, slow your breathing and heart rate and, in extreme cases, lead to coma and death. These effects are more likely if you use more than one of this type of medicine. </p>
<p>Medicines to look out for include those for depression, anxiety, schizophrenia, pain (except <a href="https://www.nps.org.au/australian-prescriber/articles/alcohol-and-paracetamol">paracetamol</a>), sleep disturbances (such as insomnia), allergies, and colds and flu. It’s best not to drink alcohol with these medicines, or to keep your alcohol intake to a minimum. </p>
<p><strong>2. Medicines + alcohol = more effects</strong></p>
<p>Mixing alcohol with some medicines increases the effect of those medicines. </p>
<p>One example is with the sleeping tablet zolpidem, which is <a href="https://www.tga.gov.au/news/product-recalls/zolpidem-stilnox">not to be taken with alcohol</a>. Rare, but serious, side effects are strange behaviour while asleep, such as sleep-eating, sleep-driving or sleep-walking, which are more likely with alcohol.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-cant-sleep-what-drugs-can-i-safely-take-102343">I can't sleep. What drugs can I (safely) take?</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Medicines + craft beer or home brew = high blood pressure</strong></p>
<p>Some types of medicines only interact with some types of alcohol.</p>
<p>Examples include some medicines for depression, such as phenelzine, tranylcypromine and moclobemide, the antibiotic linezolid, the Parkinson’s drug selegiline, and the cancer drug procarbazine.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two young women drinking alcohol sitting on bench outside bar" src="https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502281/original/file-20221221-19-slbol7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinking craft beer this summer? This can interact with some drugs to raise your blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/two-smiling-women-sitting-on-wooden-bench-1267696/">ELEVATE/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>These so-called <a href="https://www.mydr.com.au/medicine/monoamine-oxidase-inhibitors-maois-for-depression/">monoamine oxidase inhibitors</a> <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0020/145802/oncol_maoi.pdf">only interact with</a> some types of boutique and artisan beers, beers with visible sediment, Belgian, Korean, European and African beers, and home-made beers and wine.</p>
<p>These types of alcohol contain high levels of tyramine, a naturally occurring substance usually broken down by your body that doesn’t ordinarily cause any harm. </p>
<p>However, monoamine oxidase inhibitors prevent your body from breaking down tyramine. This increases levels in your body and can cause your blood pressure to rise to dangerous levels. </p>
<p><strong>4. Medicines + alcohol = effects even after you stop drinking</strong></p>
<p>Other medicines interact because they affect the way your body breaks down alcohol. </p>
<p>If you drink alcohol while using such medicines you may you feel nauseous, vomit, become flushed in the face and neck, feel breathless or dizzy, your heart may beat faster than usual, or your blood pressure may drop. </p>
<p>This can occur even after you stop treatment, then drink alcohol. For example, if you are taking metronidazole you should avoid alcohol both while using the medicine and for at least 24 hours after you stop taking it. </p>
<p>An example of where alcohol changes the amount of the medicine or related substances in the body is acitretin. This medication is used to treat skin conditions such as severe psoriasis and to prevent skin cancer in people who have had an organ transplant.</p>
<p>When you take acitretin, it changes into another substance – <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2017-CMI-02034-1&d=20221221172310101">etretinate</a> – before it is removed from your body. Alcohol increases the amount of etretinate in your body. </p>
<p>This is especially important as etretinate can cause birth defects. To prevent this, if you are a woman of child-bearing age you should avoid alcohol while using the medicine and for two months after you stop taking it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-dont-know-what-causes-most-birth-defects-78592">Why we don't know what causes most birth defects</a>
</strong>
</em>
</p>
<hr>
<h2>Myths about alcohol and medicines</h2>
<p><strong>Alcohol and birth control</strong></p>
<p>One of the most common myths about medicines and alcohol is that you can’t drink while using <a href="https://youly.com.au/blog/sexual-reproductive-health/does-alcohol-make-the-pill-less-effective/">the contraceptive pill</a>.</p>
<p>It is generally safe to use alcohol with the pill as it <a href="https://www.healthline.com/health/womens-health/birth-control-and-alcohol#:%7E:text=There's%20a%20bit%20of%20good,a%20less%20effective%20birth%20control.">doesn’t directly affect</a> how well birth control works. </p>
<p>But the pill is most effective when taken at the same time each day. If you’re drinking heavily, you’re more likely to forget to do this the next day. </p>
<p>Alcohol can also make some people nauseous and vomit. If you vomit within three hours of taking the pill, it will not work. This increases your risk of pregnancy. </p>
<p>Contraceptive pills can also affect your response to alcohol as the hormones they contain can change the way your body <a href="https://americanaddictioncenters.org/alcoholism-treatment/birth-control">removes alcohol</a>. This means you can get drunk faster, and stay drunk for longer, than you normally would.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman holding pack of contraceptive pills" src="https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=268&fit=crop&dpr=1 600w, https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=268&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=268&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=336&fit=crop&dpr=1 754w, https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=336&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/502282/original/file-20221221-16-n1zjeb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=336&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Yes you can drink while on the pill. But if you vomit within a few hours of taking it, the pill won’t work.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-hands-opening-birth-control-pills-2139091435">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/always-forgetting-to-take-your-medicines-here-are-4-things-that-could-help-193717">Always forgetting to take your medicines? Here are 4 things that could help</a>
</strong>
</em>
</p>
<hr>
<p><strong>Alcohol and antibiotics</strong></p>
<p>Then there’s the myth about not mixing alcohol with any <a href="https://theconversation.com/mondays-medical-myth-you-cant-mix-antibiotics-with-alcohol-4407">antibiotics</a>. This only applies to <a href="https://www.healthdirect.gov.au/medicines/medicinal-product/aht,21161/metronidazole">metronidazole</a> and <a href="https://www.healthdirect.gov.au/medicines/brand/amt,1011571000168100/linezolid-apo">linezolid</a>. </p>
<p>Otherwise, it is generally safe to use alcohol with antibiotics, as alcohol does not affect how well they work.</p>
<p>But if you can, it is best to avoid alcohol while taking antibiotics. Antibiotics and alcohol have similar side effects, such as an upset stomach, dizziness and drowsiness. Using the two together means you are more likely to have these side effects. Alcohol can also reduce your energy and increase how long it takes for you to recover.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-you-cant-mix-antibiotics-with-alcohol-4407">Monday's medical myth: you can't mix antibiotics with alcohol</a>
</strong>
</em>
</p>
<hr>
<h2>Where can I go for advice?</h2>
<p>If you plan on drinking alcohol these holidays and are concerned about any interaction with your medicines, don’t just stop taking your medicines.</p>
<p>Your pharmacist can advise you on whether it is safe for you to drink based on the medicines you are taking, and if not, provide advice on alternatives.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-let-your-pet-accidentally-get-drunk-this-silly-season-sorry-tiddles-87671">Don't let your pet accidentally get drunk this silly season (sorry Tiddles)</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/196646/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vairea Skincare LLC and a Standards Australia panel member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Jessica Pace does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Drinking alcohol with some medicine means they may not work so well. With others, you risk a life-threatening overdose.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyJessica Pace, Associate Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937172022-12-05T03:18:34Z2022-12-05T03:18:34ZAlways forgetting to take your medicines? Here are 4 things that could help<figure><img src="https://images.theconversation.com/files/496080/original/file-20221118-14-4r4lvk.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C5068%2C3434&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">ksenia yakovleva/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Taking regular medicines is common, and it’s not unusual for people to miss an occasional dose or take it outside the regular time window. Forgetting to do something is normal, but in the case of medicines, forgetting to take them at the prescribed time can have <a href="https://pubmed.ncbi.nlm.nih.gov/29278439/">negative health effects</a>.</p>
<p>By one <a href="https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1&isAllowed=y%20available%20from%20https://apps.who.int/iris/handle/10665/42682">estimate</a>, about half the population of people taking regular medicines don’t take them as prescribed. Is this a breakdown in communication? A lack of understanding of their importance? Forgetfulness? </p>
<p>Largely, reasons for not taking medicines as prescribed can be organised into two types: intentional and unintentional.</p>
<p>Unintentional is when a patient intends to follow the prescribed regimen but doesn’t due to factors outside their control, including forgetfulness, difficulties understanding dosing instructions, or cost.</p>
<p>But for some, a patient consciously decides not to follow the prescribed regimen. This could be due to side effects, or not believing in the necessity of the medicine.</p>
<p>Medication-taking is complex because each person is unique and the challenges to each person’s medication-taking can vary quite significantly. The most effective strategy is one that also considers why a person isn’t taking their medicine. What are some of the support strategies available, and are they actually helpful?</p>
<h2>Pill boxes</h2>
<p>The most <a href="https://pubmed.ncbi.nlm.nih.gov/30561486/">commonly used</a> methods to support medication adherance are organisational strategies such as days-of-the-week pill containers.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hands taking pills out of a container." src="https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496081/original/file-20221118-20-4r4lvk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pill containers labelled Monday to Friday can be filled at home.</span>
<span class="attribution"><span class="source">towfiqu barbhuiya/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>These are functional if a patient has to take many different medications. </p>
<p>But they’re not always suitable – if the user does not fill the container correctly or doesn’t remember to collect the prefilled pack (called a Webster-pak, blister pack or dosette box) from the pharmacy, this simple intervention quickly becomes ineffective.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A medication box with many compartments" src="https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496082/original/file-20221118-22-8vm3kd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pharmacy can also make up dosette boxes, with medications for different times of day.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Some medicines can’t be packed because their stability is compromised with repacking, and patients with reduced eyesight or dexterity can <a href="https://www.nps.org.au/australian-prescriber/articles/encouraging-adherence-to-long-term-medication">struggle to use</a> these containers. </p>
<p>So while they are an effective prompt, simple reminder cues such as days-of-the-week pill containers may not be ideal for everyone. </p>
<h2>Alarms</h2>
<p>Pre-set alarms are another commonly used reminder method. </p>
<p>However, this strategy is not infallible, and the <a href="https://pubmed.ncbi.nlm.nih.gov/36175739/">literature shows</a> many patients miss medication doses when out of routine because they turn their alarm off subconsciously when occupied with another task. </p>
<p>Reminder alarms only seem to be effective when they are interactive or personalised.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sketch of an automated tablet machine - a round device with padlock" src="https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=721&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=721&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=721&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=905&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=905&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496083/original/file-20221118-15-wkrws0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=905&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Automated pill dispensers are handy for those with memory issues, but they’re not cheap.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>For example, in a handy combination of both methods above, you can now buy automated pill dispensers with alarms that go off at predetermined times and only stop when the medication is removed.</p>
<p>These can be especially handy for those with memory issues such as dementia. However, they are not cheap, costing a few hundred dollars each, and so will not be accessible for everyone.</p>
<h2>Mobile apps</h2>
<p>The latest Apple iOS update allows you to track your medications and schedule reminders. </p>
<p>Medication reminder apps were first developed to support older adults and people with chronic diseases required to manage multiple medicines. </p>
<p>But they’ve now been embraced as a suitable support for anyone wishing to independently manage their own medicines, including those on short-term medicines such as antibiotics. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Phone with pill reminders on screen" src="https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496085/original/file-20221118-11-wkrws0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smart phone apps can help with medication reminders.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>They provide simple, practical health-specific information as well as supporting medication-taking through automation. </p>
<p>According to <a href="https://www1.racgp.org.au/newsgp/clinical/medication-reminder-apps-not-a-bitter-pill-to-help">The Royal Australian College of General Practitioners</a>, a lot of patients like receiving reminder prompts through an app, and it helps them remember to take their medication.</p>
<p>Although the platforms differ slightly, the general premise is a patient independently inputs their medication-taking and prescription refill schedule, and the app then generates automatic reminders for the patient. </p>
<p>The only downside is like any notification, they can be easily dismissed or overlooked.</p>
<h2>Habit stacking</h2>
<p>When our day changes, for example if we go out for brunch and we usually take our medicines with breakfast, or an unexpected visitor arrives at the usual 11am pre-lunch tablet time, often we forget our medications. This is where “habit stacking” may be beneficial. </p>
<p>Although habit stacking is a relatively new approach to fostering medication taking, habit formation has been repeatedly shown to <a href="https://pubmed.ncbi.nlm.nih.gov/30229557/">effectively support wellbeing</a>. Linking medication-taking to a behaviour that does not change from day to day, such as cleaning your teeth, or removing shoes when entering the house, can help you to remember medications. </p>
<p>Some more habit stacking examples to support medication taking may include:</p>
<p>• hygiene routine – shower, shave, swallow</p>
<p>• after dinner unwind – cuppa and meds</p>
<p>• morning mantra as you leave the house – keys, phone, wallet, meds.</p>
<h2>What else can we do?</h2>
<p>We are all unique, so to make sure we actually take our medicines we need to find what works for us, and consider why we weren’t actually taking them in the first place. </p>
<p>Reminders, gadgets, habit stacking, or a combination may help. We need strategies that can adapt to the unexpected.</p><img src="https://counter.theconversation.com/content/193717/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amelia Cossart does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>About half the population of people taking regular medicines don’t take them as prescribed. Here are some tips to help you remember.Amelia Cossart, Postdoctoral Research Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1886012022-08-18T01:20:30Z2022-08-18T01:20:30ZLying down, sitting, leaning over? What science says about the best way to take your medicine<figure><img src="https://images.theconversation.com/files/479516/original/file-20220817-18222-qj3sxa.jpg?ixlib=rb-1.1.0&rect=1%2C2%2C997%2C772&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-senior-man-taking-medicines-horizontal-62995330">Shutterstock</a></span></figcaption></figure><p>When pharmacists dispense tablets or capsules they commonly advise when and how often to take them, and if this needs to be with or without food. </p>
<p>You generally don’t hear them tell you to lean to one side when swallowing. But preliminary research from Johns Hopkins University in the United States <a href="https://aip.scitation.org/doi/full/10.1063/5.0096877">suggests</a> this might improve how fast your medicine is absorbed and gets to work.</p>
<p>The results are based on a computer simulation, rather than in actual patients, and may not equate to the real world. So it’s too early to suggest you strike a yoga pose when taking your medicine. </p>
<p>But your posture can be important when taking pills or capsules, for comfort or safety.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-time-of-day-should-i-take-my-medicine-125809">What time of day should I take my medicine?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens when you swallow your medicine?</h2>
<p>Once you swallow a tablet or capsule, it moves down the throat to the stomach. There, a tablet swells and disintegrates, or a capsule breaks open. The drug can then dissolve and your body can absorb it.</p>
<p>Most drugs do not start being absorbed until they reach the small intestine. However, some drugs, such as aspirin, are likely to be absorbed in the stomach because of its acidic environment.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"726886205082595328"}"></div></p>
<p>A number of other factors can also affect where and how a drug is absorbed. </p>
<p>These include how fast the tablet disintegrates to release the drug, how fast the swallowed contents move from the stomach to the small intestine, the amount of food and drink consumed before taking the medicine, and how easily the drug is absorbed across the gut lining.</p>
<h2>How about this latest study?</h2>
<p>The US researchers <a href="https://publishing.aip.org/publications/latest-content/body-posture-affects-how-oral-drugs-absorbed-by-stomach/">used computer simulations</a> to investigate how posture affects how drugs <a href="https://aip.scitation.org/doi/full/10.1063/5.0096877">are absorbed</a>. </p>
<p>The researchers used software they developed to simulate several ways of taking a pill: staying upright, leaning to the left or right, or leaning backwards.</p>
<p>They showed leaning 45 degrees to the right favoured a faster movement of stomach contents into the duodenum (the first part of the small intestine). This would allow the pill to be absorbed more quickly and start to take effect.</p>
<p>The results could be important for medicines that you’d want to act quickly, such as pain medicines, or ones used to treat a heart attack. </p>
<p>There is already some <a href="https://pubmed.ncbi.nlm.nih.gov/18936930/">earlier evidence</a> from real patients suggesting posture may influence how medicines are absorbed. This includes the option of leaning to the right. But the authors acknowledge many factors influence absorption, not just posture.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-is-it-ok-to-chew-or-crush-your-medicine-39630">Health Check: is it OK to chew or crush your medicine?</a>
</strong>
</em>
</p>
<hr>
<h2>When is it best to sit or stand?</h2>
<p>Sometimes your pharmacist may advise you to swallow your medicine sitting, standing, or lying down for reasons other than speeding up absorption. </p>
<p>For example, certain drugs are more likely to cause side effects such as <a href="https://www.healthdirect.gov.au/gord-reflux">heartburn</a>, where stomach acid leaks from the stomach and moves up into the oesophagus (food pipe).</p>
<p>These include non-steroidal anti-inflammatory drugs, such as <a href="https://www.healthdirect.gov.au/ibuprofen">ibuprofen</a> (Nurofen), <a href="https://www.healthdirect.gov.au/medicines/medicinal-product/aht,20761/diclofenac">diclofenac</a> (Voltaren), and iron supplements. </p>
<p>So if this is a problem for you, it may help to take these medicines sitting or standing, and not lying down straight away afterwards. That’s because your stomach acid is less likely to leak back up into your oesophagus. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elderly woman sitting down at table with pill and cup" src="https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479518/original/file-20220817-1490-bjhdxn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some medicines can irritate the throat or cause heartburn. So it’s best to take these upright.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-woman-taking-pills-her-country-218558989">Shutterstock</a></span>
</figcaption>
</figure>
<p>Some medicines can irritate the throat if they become stuck. This is because they damage the protective mucosal barrier that lines your oesophagus and stomach, causing irritation and inflammation. </p>
<p>For these medicines it is important to take these sitting up or standing, and remaining upright for 30 minutes afterwards.</p>
<p>These include the antibiotic <a href="https://www.healthdirect.gov.au/doxycycline">doxycycline</a>, and drugs known as bisphosphonates (for osteoporosis), such as <a href="https://www.healthline.com/health/drugs/risedronate-oral-tablet">risedronate</a> (Actonel) and <a href="https://www.healthdirect.gov.au/medicines/brand/amt,39580011000036106/alendronate-sandoz">alendronate</a> (Fosamax).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-older-people-get-osteoporosis-and-have-falls-68145">Why older people get osteoporosis and have falls</a>
</strong>
</em>
</p>
<hr>
<h2>How about lying down?</h2>
<p><a href="https://www.healthdirect.gov.au/medicines/brand/amt,3285011000036105/nitrolingual">Glyceryl trinitrate</a> (Nitrolingual) is an under-the-tongue spray. It’s prescribed to people with <a href="https://www.heartfoundation.org.au/bundles/your-heart/angina">angina</a>, a type of chest pain caused by an underlying heart problem. </p>
<p>Pharmacists advise patients to sit or lie down before using this spray as it can cause a sudden drop in blood pressure, making you feel very dizzy. </p>
<p>Other heart medicines, such as diuretics, are also known to cause dizziness. Although you don’t usually need to take these medications lying down, if you do become dizzy it is best to sit or lie down, and ensure you stand up slowly afterwards.</p>
<p>There are also <a href="https://www.medsafe.govt.nz/profs/puarticles/march2017/medicineinducedvertigo.htm">medications</a> that can cause drowsiness or make you feel “woozy”. These can include strong pain killers (such as opiates), sleeping tablets, some epilepsy medications, or drugs for certain mental health conditions, such as anxiety or schizophrenia. </p>
<p>These don’t need to be swallowed while lying down, but lying down can help if you become dizzy or drowsy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman lying on side in bed holding glass of water and a pill" src="https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479519/original/file-20220817-18377-wztyfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some medicines can make you dizzy. So you can lie down after taking them.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-woman-taking-medicine-home-closeup-776225686">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What if I’m not sure?</h2>
<p>Next time your pharmacist dispenses your medicine, unless they provide specific guidance about sitting, standing or lying down, you are generally safe to take it whichever way is most comfortable.</p>
<p>So how about this latest evidence suggesting leaning to the right might help? At this stage, you likely won’t hear your doctor or pharmacist recommend you should lean over to take your medicines until further research is done. </p>
<p>But next time you need to take a medicine for pain, as long as it is not uncomfortable, feel free to try this to see if your pain is relieved faster.</p><img src="https://counter.theconversation.com/content/188601/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elise Schubert is a registered pharmacist and a PhD Candidate receiving scholarship from the University of Sydney and Canngea Pty Ltd.</span></em></p><p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and member of the Australian Institute of Company Directors. Nial is the science director of Canngea Pty Ltd, chief scientific officer of Vairea Skincare LLC, and a Standards Australia panel member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Associate Professor Tina Hinton has previously received funding from the Schizophrenia Research Institute (formerly Neuroscience Institute of Schizophrenia and Allied Disorders). She is currently a Board member of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists. </span></em></p>Sometimes, it’s best to take your medicine sitting up. Other times, lying down is safer. Here’s what we know so far.Elise Schubert, Pharmacist and PhD Candidate, University of SydneyNial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyTina Hinton, Associate Professor of Pharmacology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1860422022-08-17T02:38:06Z2022-08-17T02:38:06Z5 drugs that changed the world (and what went wrong)<figure><img src="https://images.theconversation.com/files/477820/original/file-20220805-19484-orrk38.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/classic-drugstore-museum-interior-glass-bottles-1164873649">Shutterstock</a></span></figcaption></figure><p>It’s hard to measure the impact of any one drug on world history. But here are five drugs we can safely say made a huge difference to our lives, often in ways we didn’t expect.</p>
<p>They have brought some incredible benefits. But they’ve usually also come with a legacy of complications we need to look at critically. </p>
<p>It’s a good reminder that today’s wonder drug may be tomorrow’s problem drug. </p>
<h2>1. Anaesthesia</h2>
<p>In the late 1700s, English chemist Joseph Priestley <a href="https://www.ch.ic.ac.uk/rzepa/mim/environmental/html/n2o.htm">made a gas</a> he called “phlogisticated nitrous air” (nitrous oxide). English chemist Humphry Davy thought it could be used as pain relief in surgery, but instead it became a <a href="https://journals.physiology.org/doi/full/10.1152/ajplung.00206.2014">recreational drug</a>. </p>
<p>It wasn’t until 1834 that we reached another milestone. That’s when French chemist Jean-Baptiste Dumas named a new gas <a href="https://www.worldofmolecules.com/solvents/chloroform-molecule.html">chloroform</a>. Scottish doctor James Young Simpson used it in 1847 <a href="http://dx.doi.org/10.1136/fn.86.3.F207">to assist a birth</a>.</p>
<p>Soon anaesthesia was more widely used during surgery, bringing <a href="https://theconversation.com/a-short-history-of-anaesthesia-from-unspeakable-agony-to-unlocking-consciousness-74748">better recovery rates</a>. Before anaesthesia, surgical patients would often die of shock from the pain.</p>
<p>But any drug that can make people unconscious can also cause harm. Modern anaesthetics are still dangerous because of the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/general-anaesthetics">risks</a> of suppressing the nervous system.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chloroform bottle on display" src="https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Before anaesthesia, surgical patients would die of shock from the pain.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/25182210@N07/5828813781">dynamosquito/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-anaesthesia-from-unspeakable-agony-to-unlocking-consciousness-74748">A short history of anaesthesia: from unspeakable agony to unlocking consciousness</a>
</strong>
</em>
</p>
<hr>
<h2>2. Penicillin</h2>
<p>What happened in 1928 to Scottish physician Alexander Fleming is one of the classic stories of accidental drug discovery. </p>
<p>Fleming went on holiday, leaving some cultures of the bacterium streptococcus on his laboratory bench. When he came back, he saw some airborne penicillium (a fungal contaminant) had <a href="https://academic.oup.com/jimb/article/36/6/775/5993612">stopped the streptococcus</a> from growing.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Penicillin growing on Petri dish" src="https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Antibiotics saved millions of lives but we’re now suffering from their popularity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/86257416@N02/14720615367">Antony Scimone by MMU Engage/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Australian pathologist Howard Florey and his team stabilised penicillin and <a href="https://www.nobelprize.org/prizes/medicine/1945/florey/biographical/">carried out the first human experiments</a>. With American financing, penicillin was mass-produced and changed the course of World War II. It was used to treat <a href="https://news.wisc.edu/d-day-invasion-was-bolstered-by-uw-madison-penicillin-project/">thousands of service personnel</a>.</p>
<p>Penicillin and its descendants are enormously successful front-line drugs for conditions that once killed millions of people. However, their widespread use has led to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/antibiotic-resistant-bacteria">drug-resistant strains of bacteria</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-of-the-scariest-antibiotic-resistant-bacteria-in-the-past-five-years-100654">Five of the scariest antibiotic-resistant bacteria in the past five years</a>
</strong>
</em>
</p>
<hr>
<h2>3. Nitroglycerin</h2>
<p>Nitroglycerin was invented in 1847 and displaced gunpowder as the most powerful explosive in the world. It was also the first modern drug to treat <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/heart-conditions-angina">angina</a>, the chest pain associated with heart disease. </p>
<p>Factory workers exposed to the explosive began to experience <a href="https://doi.org/10.1046/j.1440-1681.2000.03240.x">headaches and flushing in the face</a>. This was because nitroglycerin is a vasodilator – it dilates (opens) the blood vessels. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tweet about Dr Murrell's experimentation with nitroglycerin" src="https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=678&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=678&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=678&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=852&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=852&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=852&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">London physician William Murrell experimented with nitroglycerin on himself and tried it on his angina patients.</span>
<span class="attribution"><a class="source" href="https://twitter.com/search?q=William%20Murrell%20nitroglycerin&src=typed_query&f=top">Twitter</a></span>
</figcaption>
</figure>
<p>London physician William Murrell <a href="https://www.acs.org/content/acs/en/molecule-of-the-week/archive/n/nitroglycerin.html">experimented</a> with nitroglycerin on himself and tried it on his angina patients. They got almost immediate relief.</p>
<p>Nitroglycerin made it possible for millions of people with angina to live relatively normal lives. It also paved the way for medications such as blood pressure-lowering drugs, beta-blockers and statins. These medicines have <a href="https://www.health.harvard.edu/heart-health/blood-pressure-drugs-may-extend-life-even-for-frail-older-people">extended lives and increased the average lifespan</a> in Western countries.</p>
<p>But because people’s lives are now extended, there are now higher rates of deaths from <a href="https://news.cancerresearchuk.org/2015/02/04/why-are-cancer-rates-increasing/">cancer and other non-communicable diseases</a>. So nitroglycerin turned out to be a world-changing drug in unexpected ways. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-2-cancers-58063">How Australians Die: cause #2 – cancers</a>
</strong>
</em>
</p>
<hr>
<h2>4. The pill</h2>
<p>In 1951, US birth control advocate Margaret Sanger asked researcher Gregory Pincus <a href="https://www.nma.gov.au/defining-moments/resources/the-pill">to develop an effective hormonal contraceptive</a>, funded by heiress Katharine McCormick. </p>
<p>Pincus found that progesterone helped to stop ovulation, and used this to develop a trial pill. Clinical trials were conducted on vulnerable women, notably in Puerto Rico, where there were <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-puerto-rico-pill-trials/">concerns</a> about informed consent and side effects.</p>
<p>The new drug was released by GD Searle & Co as Enovid in 1960, with US Food and Drug Administration approval. This was granted because the risk of pregnancy was seen as <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-us-food-and-drug-administration-approves-pill/">greater than</a> the risk of side effects, such as blood clots and strokes.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1523846612958814210"}"></div></p>
<p>It took ten years to prove a link between oral contraceptive use and serious side effects. After a 1970 US government inquiry, the pill’s hormone levels <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-senate-holds-hearings-pill-1970/">were lowered dramatically</a>. Another outcome was the <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-senate-holds-hearings-pill-1970/">patient information sheet</a> you will now find inside all prescription drug packets.</p>
<p>The pill caused <a href="https://www.nma.gov.au/defining-moments/resources/the-pill">major global demographic changes</a> with smaller families and increased incomes as women re-entered the workforce. However, it’s still raising questions about how the medical profession has <a href="https://www.journals.uchicago.edu/doi/abs/10.1086/715419">experimented on women’s bodies</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-expect-when-coming-off-the-pill-and-5-things-to-do-before-you-do-183367">What to expect when coming off the pill, and 5 things to do before you do</a>
</strong>
</em>
</p>
<hr>
<h2>5. Diazepam</h2>
<p>The first benzodiazepine, a type of nervous system depressant, was created in 1955 and marketed by drug company Hoffmann-La Roche as <a href="https://pubmed.ncbi.nlm.nih.gov/24007886/">Librium</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Valium bottles and dropper" src="https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=706&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=706&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=706&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=887&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=887&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=887&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Valium was onced used to help people engage with psychotherapy.</span>
<span class="attribution"><a class="source" href="https://collection.sciencemuseumgroup.org.uk/objects/co193001/bottled-valium-carton-plastic-pipette-instructions-sedative-controlled-drug-diazepam">Roche/Science Museum/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>This and related drugs were not sold as “cures” for anxiety. Instead, they were supposed to <a href="https://theconversation.com/how-to-reduce-dependency-on-drugs-like-valium-with-alternative-therapies-72571">help people engage in psychotherapy</a>, which was seen as the real solution.</p>
<p>Polish-American chemist Leo Sternbach and his research group chemically <a href="https://www.washingtonpost.com/archive/politics/1980/01/20/adventurous-chemist-and-his-pill/16cd98f6-00a6-4f5c-8e86-08451ed3451b/">altered Librium in 1959</a>, producing a much more powerful drug. This was diazepam, marketed from 1963 as Valium.</p>
<p>Cheap, easily available drugs like these had a huge impact. From 1969 until 1982, Valium was the <a href="https://drugabuse.com/benzodiazepines/valium/history-and-statistics/">top-selling pharmaceutical</a> in the United States. These drugs created a culture of managing stress and anxiety with medication.</p>
<p>Valium paved the way for modern antidepressants. It was more difficult (but not impossible) to <a href="https://pubmed.ncbi.nlm.nih.gov/29123931/">overdose on these newer drugs</a>, and they had fewer side effects. The first SSRI, or selective serotonin reuptake inhibitor, was fluoxetine, <a href="https://www.pbs.org/wgbh/aso/databank/entries/dh87pr.html">marketed from 1987 as Prozac</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-chemical-imbalance-theory-of-depression-is-dead-but-that-doesnt-mean-antidepressants-dont-work-187769">The chemical imbalance theory of depression is dead, but that doesn't mean antidepressants don't work</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/186042/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippa Martyr does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Each of these five drugs have brought some incredible benefits. But they’ve usually also come with a legacy of complications.Philippa Martyr, Lecturer, Pharmacology, Women's Health, School of Biomedical Sciences, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1803152022-03-31T03:34:52Z2022-03-31T03:34:52ZWhat is the PBS safety net and is it really the best way to cut the cost of medicines?<figure><img src="https://images.theconversation.com/files/455154/original/file-20220330-13-1xo1vg7.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C627&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-holding-medicine-box-capsule-pack-704036482">Shutterstock</a></span></figcaption></figure><p>Earlier access to free or cheaper medicines is on the cards, after a <a href="https://www.health.gov.au/resources/publications/budget-2022-23-pharmaceutical-benefits-scheme-safety-net">federal budget announcement</a> made earlier this week.</p>
<p>Improved access to subsided prescription drugs through the <a href="https://www.pbs.gov.au/pbs/home">Pharmaceutical Benefits Scheme</a> or PBS will benefit Australians who need multiple medicines throughout the year. This is particularly so for people with chronic conditions or who have multiple members in the family who need scripts.</p>
<p>From July 1, access to free or cheaper medicines will kick in sooner, under the so-called <a href="https://www.servicesaustralia.gov.au/pbs-safety-net-thresholds?context=22016">PBS safety net</a>, as the threshold for access has been lowered.</p>
<p>However, this isn’t the only way to reduce the costs of medicines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-budget-2022-spends-a-little-on-favoured-interest-groups-but-misses-a-chance-for-real-reform-179835">Health budget 2022 spends a little on favoured interest groups but misses a chance for real reform</a>
</strong>
</em>
</p>
<hr>
<h2>What’s changed?</h2>
<p>If you only fill a script now and again, concession card holders pay A$6.80 and general patients pay up to $42.50 for a PBS-subsidised medicine.</p>
<p>However, if you need multiple scripts throughout the year, once you reach a certain threshold, the PBS safety net can kick in. Then, medicines are free for concession card holders and cost $6.80 for general patients.</p>
<p>The PBS safety net is <a href="https://www.servicesaustralia.gov.au/pbs-safety-net-thresholds?context=22016">calculated by calendar year</a> and is reset on January 1 each year.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1474168994223386631"}"></div></p>
<p>As of July 1, the <a href="https://www.health.gov.au/resources/publications/budget-2022-23-pharmaceutical-benefits-scheme-safety-net">PBS safety net threshold will be reduced</a> to $244.80 (down from $326.40) for concession card holders and $1,457.10 (down from $1,542.10) for general patients.</p>
<p>You can reach the PBS safety net sooner each year if you <a href="https://www.servicesaustralia.gov.au/how-to-reach-threshold-sooner-family?context=22016">combine your family’s PBS accounts</a>. In other words, if you or your partner or children require multiple medicines, your family may have quicker access to free or cheaper medicines for the rest of the year.</p>
<p>The PBS safety net is not to be confused with the <a href="https://www.servicesaustralia.gov.au/what-are-medicare-safety-nets-thresholds?context=22001">Medicare safety net</a>. This relates to doctors’ fees charged for out-of-hospital services.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523">Explainer: what is Medicare and how does it work?</a>
</strong>
</em>
</p>
<hr>
<h2>Who will benefit?</h2>
<p>An average patient pays about <a href="https://www.aihw.gov.au/reports/australias-health/medicines-in-the-health-system">$121 out-of-pocket costs</a> per year on medicines, way below the PBS safety net thresholds. </p>
<p>So the PBS safety net only affects those who continuously use many prescription drugs. <a href="https://www.health.gov.au/resources/publications/budget-2022-23-pharmaceutical-benefits-scheme-safety-net">Under changes announced in the budget</a>, concession card holders who fill more than 36 prescriptions a year (three per month) or general patients who fill about 34 scripts a year will benefit from the reduced thresholds.</p>
<p>A large proportion of these are <a href="https://www.aihw.gov.au/reports/australias-health/medicines-in-the-health-system">older than 65, with chronic conditions</a>, who require medicines continually.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elderly woman's hand resting on walking frame" src="https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455389/original/file-20220331-39548-1tyyit3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Elderly people on multiple medications are among those expected to benefit from the latest changes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/aging-time-1111826444">Shutterstock</a></span>
</figcaption>
</figure>
<p>For elderly patients, some medications are essential to control their symptoms and prevent them from being admitted to hospital. These medications include those to treat heart or mental health conditions.</p>
<p>So the money spent on improving access to these essential medicines could be offset by <a href="https://www.nejm.org/doi/full/10.1056/nejmsa0807998">lower hospital costs</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">Last year, half a million Australians couldn't afford to fill a script. Here's how to rein in rising health costs</a>
</strong>
</em>
</p>
<hr>
<h2>Other ways to cut costs</h2>
<p>Australia uses a range of mechanisms to manage the costs of prescription drugs, in addition to the PBS safety net. In general, these relate to how the government assesses drugs and sets prices.</p>
<p>After a new drug enters the market, the <a href="https://www.pbs.gov.au/pbs/industry/listing/participants/pbac">Pharmaceutical Benefits Advisory Committee</a> reviews its clinical effectiveness, safety and cost-effectiveness (or “value for money”) compared with other treatments before recommending it for listing on the PBS.</p>
<p>For clinically-equivalent drugs with different brands, the PBS only subsidises up to the price of the <a href="https://www.pbs.gov.au/browse/brand-premium">lowest priced brand</a>. If a patient needs the more expensive medicine, they pay a brand premium.</p>
<p>However, this brand premium <a href="https://www.nps.org.au/consumers/keeping-your-medicines-costs-down#what-is-the-pbs-safety-net?">cannot count towards</a> the PBS safety net threshold. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-pronounce-the-name-of-your-medicine-heres-why-15416">Can't pronounce the name of your medicine? Here's why</a>
</strong>
</em>
</p>
<hr>
<h2>How about cheaper generic drugs?</h2>
<p>Assessing drugs for “value for money” and only subsidising clinically equivalent drugs to the price of the lowest priced brand are among measures allowing Australians access to cheaper <em>brand-name</em> drugs than countries without price controls.</p>
<p>However, Australians pay a higher price for <em>generic</em> prescription drugs – drugs no longer under patent protection – than many other countries. </p>
<p>Generic drugs are often not subsidised because they are cheaper than the PBS general co-payment of $42.50. So patients pay the full cost.</p>
<p>In fact, <a href="https://www.aihw.gov.au/reports/australias-health/medicines-in-the-health-system">about 30%</a> of all PBS-listed medicines cost less than $42.50, many of them generic drugs. </p>
<p>The cost of these PBS-listed, cheaper, non-subsidised generics counts towards your PBS safety net threshold.</p>
<p>To control prices for generic drugs, the government requires manufacturers to disclose how much they charge pharmacies. The government then reduces the amount it pays to pharmacies for each generic drug. </p>
<p>This <a href="https://www.pbs.gov.au/info/industry/pricing/price-disclosure-spd">price disclosure policy</a> has been effective to lower the prices of generic drugs. But this price disclosure policy does not guarantee Australians get the best prices for generic drugs some other countries enjoy.</p>
<p>Instead, the government could set a price for each generic drug, by using the best price obtained by other comparable countries. This <a href="https://grattan.edu.au/wp-content/uploads/2017/03/886-Cutting-a-better-drug-deal.pdf">international benchmarking</a> pricing strategy is used by other countries such as Canada, New Zealand, Japan and many member states of the European Union.</p>
<p>If the Australia government can get cheaper generic drugs as these countries, it would mean substantial savings for many Australians.</p><img src="https://counter.theconversation.com/content/180315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yuting Zhang receives funding from Australian Research Council, Department of Veterans' Affairs, and National Health and Medical Research Council.</span></em></p>Changes in the latest federal budget will mostly affect people who need multiple medicines throughout the year, perhaps for chronic disease. But there are other ways to reduce drug costs.Yuting Zhang, Professor of Health Economics, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1783002022-03-03T07:29:34Z2022-03-03T07:29:34ZGetting urgent medicines in a flood zone can be a life or death challenge<p>I’m writing this from the flooded far north coast of New South Wales, where all around me people are contending with the awful and unexpected consequences of a catastrophic flood. </p>
<p>I have worked in rural health for a long time and this has been the worst I have experienced it. It is well <a href="https://link.springer.com/article/10.1007/s11069-020-03887-z">established</a> that those living in flood-prone areas often already have more financial and health issues than others.</p>
<p>Among those consequences is the need to manage medicines safely, and sometimes urgently find and acquire medicines you need to stay alive and healthy or keep pain at manageable levels.</p>
<p>The far north coast has a high population of older people, many of whom need daily medicines such as insulin to survive.</p>
<p>While I was picking up medicines for a family member this morning, another older person turned up at the pharmacy with a script. She was running out of her medicine today but the pharmacy did not have the required medicines left. She continued her hunt for medicines at the last pharmacy in the area we have access to.</p>
<p>These are just some of the challenges people face when it comes to medicines in a disaster zone.</p>
<h2>From ordinary errand to a life or death challenge</h2>
<p>A week ago, if you needed to top up your medicine supplies, you could pop down to the local chemist. The script would be filled, and supplies plentiful. It would be an easy trip.</p>
<p>Today during floods, an errand like that means confronting challenges such as:</p>
<ul>
<li><p>many chemists being underwater or badly flooded</p></li>
<li><p>the chemists that are open are contending with a surge of demand as people flock there to buy medicines</p></li>
<li><p>power is down in many places, meaning online systems for managing scripts are impossible to access and fridges used to store medicines such as insulin at home are not working</p></li>
<li><p>phone and internet is down or patchy in many places</p></li>
<li><p>petrol is very hard to get and running out, so many people cannot drive to the chemist</p></li>
<li><p>many people have lost their cars too or have water damaged cars</p></li>
<li><p>some people cannot leave home due to landslides or floodwaters</p></li>
<li><p>roads are being cut off and supply lines disrupted because the highway is blocked off</p></li>
<li><p>getting a new script is not as easy as heading to the doctor’s office; some GPs are also flooded in, their practices inundated or not-operational and many are unable to get to work and/or stuck without power, phone or internet.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498798439643361280"}"></div></p>
<p>These challenges are not unique to our area nor are they unique to floods. People who have survived <a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">bushfires</a> and other disasters have faced similar issues.</p>
<p>But with disasters predicted to become more frequent and more intense as the climate changes, it does raise the question what systems we can put in place to deal with these challenges in future without putting people at risk.</p>
<h2>What can be done?</h2>
<p>Firstly, if you are in an emergency, depending on your circumstances, please call 000 or contact the SES on 132 500.</p>
<p>When preparing your evacuation plan, ensure you have a list of all your medicines, care plans, scripts, Medicare and other health-care cards details and other important medical information ready. </p>
<p>If an evacuation warning is out for your area, ensure all your information and medicines are packed. Store medicines that need to remain cold in an esky with ice bricks, so you are ready when you need to evacuate. The esky is important; power may not be available for a while when you leave home.</p>
<p>Several apps are available to help in preparing for a disaster and <a href="https://www.healthdirect.gov.au/blog/how-to-take-medicines-safely-in-a-natural-disaster">taking your medicines safely</a>, such as the Red Cross’ <a href="https://www.redcross.org.au/prepare">RediPlan</a> emergency survival plan or the <a href="https://www.nps.org.au/consumers/medicinewise-app?c=getting-started-5cfff60c#what-is-the-medicinewise-app?">MedicineWise app</a>.</p>
<p>If you know a flood is heading your way, it’s also handy to have extra cash at hand. During this flood disaster, electronic payment systems were not working in many places in the Northern Rivers. Having some cash can further reduce already very stressful circumstances.</p>
<p>If you’re flood-affected, in need of medicines and can get yourself to a pharmacy, it may be OK even if you have lost your scripts in the floods. The pharmacist may be able to call <a href="https://www.australianpharmacist.com.au/mick-fanning-takes-pharmacist-to-work-during-floods/?fbclid=IwAR01BothXjaztpxWs2Y2zt--fnH_3BYbhMZS6C7MwF_YJrRRbtLY6mHtvVQ">the GP on their mobile</a>. </p>
<p>If you have internet access, use social media to see if others can help with transport or delivery of medicines. Many people feel powerless during disasters and will be keen to help. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498537920180862980"}"></div></p>
<p>And there may be some <a href="https://www.health.nsw.gov.au/pharmaceutical/pharmacists/Pages/faq-supply-of-medicines.aspx#owing">strictly limited circumstances</a> under which a pharmacist can provide a small emergency supply of certain medicines <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0024/1029156/dm-accessing-meds-in-a-disaster.pdf">without a script</a>. </p>
<p><a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0024/1029156/dm-accessing-meds-in-a-disaster.pdf">According</a> to Queensland Health:</p>
<blockquote>
<p>In an emergency situation where you are not able to reach a community pharmacy, your GP’s prescription can be filled by a Queensland Health public hospital pharmacy. However, please be aware that hospitals may not stock the full range of medicines prescribed by your GP, as the needs of hospital and community patients are different.</p>
</blockquote>
<p>You can use <a href="https://www.myhealthrecord.gov.au/">My Health Record</a> to get certain key details on your medicines and health details, if you’ve got internet access.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498450313879199745"}"></div></p>
<p>After the floods, it is important to look at <a href="https://www.mayoclinic.org/healthy-lifestyle/consumer-health/expert-answers/after-a-flood/faq-20058421#:%7E:text=Any%20medications%20%E2%80%94%20pills%2C%20liquids%2C,contaminated%20water%20should%20be%20discarded">replacing medicines</a> that have been in contact with flood water or other contaminated water. This includes pills, liquids, injections, inhalers or creams. Contact your doctor or pharmacist as soon as possible and organise replacement medications.</p>
<p>You can also contact the NPS Medicines Line 1300 MEDICINE (1300
633 424) or the healthdirect helpline (1800 022 222 or <a href="https://www.healthdirect.gov.au/nurse-on-call#:%7E:text=Call%20NURSE%2DON%2DCALL%20on,apply%20from%20anywhere%20in%20Victoria.">Nurse on Call</a> in Victoria) if you are unsure or have <a href="https://www.healthdirect.gov.au/blog/how-to-take-medicines-safely-in-a-natural-disaster">questions about your medicines</a>.</p>
<p>More broadly, access to medicines during a natural disaster is complex, and we need to continue strong partnerships and collaboration between organisations to ensure access during disasters.</p>
<p>Having a good spread of chemists around different parts of a town or rural areas helps boost the chances that even if some are hit by disasters, others are able to operate and provide people with medicines (which is what we have seen in the 2022 floods in some areas).</p>
<p>Privately owned and hospital-run helicopters have been used to get medicines to residents in flood-affected areas of Brisbane; ensuring disaster-prone regions have the infrastructure and machines needed for this kind of help is important.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498836780203741189"}"></div></p>
<p>COVID forced us to think creatively about delivering medical supplies to people who need them but are <a href="https://www.ppaonline.com.au/programs/covid-19-programs/covid-19-home-medicine-service">unable to visit a pharmacy</a>. This shows what’s possible when needs must be met. </p>
<p>Thinking carefully about people’s health during and after disaster is crucial to building disaster resilience. Ensuring uninterrupted supplies, extra support for vulnerable people and access to medicines is a core part of that goal.</p><img src="https://counter.theconversation.com/content/178300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sabrina Pit has received funding in the past from NHMRC.</span></em></p>Thinking carefully about people’s health during and after disaster is crucial to building disaster resilience. Ensuring access to medicines is a core part of that goal.Sabrina Pit, Honorary Senior Research Fellow at the University of Sydney, Honorary Adjunct Research Fellow, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1762352022-02-20T19:15:27Z2022-02-20T19:15:27ZTaking COVID pills at home sounds great. But we need to use them wisely or risk drug resistance and new variants<figure><img src="https://images.theconversation.com/files/445858/original/file-20220211-27-1n6de7i.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-middleaged-woman-casual-clothes-home-1815255227">Shutterstock</a></span></figcaption></figure><p>GPs can now prescribe <a href="https://www.tga.gov.au/media-release/tga-provisionally-approves-two-oral-covid-19-treatments-molnupiravir-lagevrio-and-nirmatrelvir-ritonavir-paxlovid">antiviral pills</a> for <a href="https://www1.racgp.org.au/newsgp/clinical/what-gps-need-to-know-about-the-new-covid-antivira">some</a> of their vulnerable COVID-19 patients to take at home. More patients are expected to have access in <a href="https://www.theguardian.com/australia-news/2022/feb/10/covid-19-pills-vulnerable-and-unvaccinated-australians-to-be-prioritised-for-new-oral-treatments">coming weeks and months</a>.</p>
<p>These drugs are given to people at greater risk of severe disease at the start of their infection, to stop them getting so sick they need to go to hospital. So they are an important next step in our fight against the pandemic. But we should look at these antivirals as another option to manage COVID-19, not a silver bullet.</p>
<p>These pills aren’t suitable for everyone, especially pregnant women, and need to be taken very soon after diagnosis. Not everyone benefits. Then there’s the theoretical risk they could help lead to more viral variants.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-approves-two-new-medicines-in-the-fight-against-covid-how-can-you-get-them-and-are-they-effective-against-omicron-175321">Australia approves two new medicines in the fight against COVID. How can you get them and are they effective against Omicron?</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, what are antiviral drugs?</h2>
<p>Viruses cannot reproduce unless they invade a host cell, hijack its machinery and use it to replicate and spread to the next cell. </p>
<p>Antiviral drugs sabotage part of this process. They either prevent the virus from entering the cell, prevent it from replicating or stop it being released.</p>
<p>Unlike earlier COVID-19 antiviral drugs, such as remdesivir, these new antiviral pills will be taken at home. This makes them easier to use, potentially preventing people with COVID-19 deteriorating and needing to go to hospital.</p>
<p>These pills have also been designed specifically to target SARS-CoV-2, the virus that causes COVID-19, <a href="https://www.nature.com/articles/s41422-022-00618-w">including the Omicron variant</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">Why are there so many drugs to kill bacteria, but so few to tackle viruses?</a>
</strong>
</em>
</p>
<hr>
<h2>Merck’s pill</h2>
<p>One of the newly approved antivirals is molnupiravir (brand name Lagevrio). This causes <a href="https://www.science.org/doi/abs/10.1126/scitranslmed.abb5883">fatal mutations</a> in the virus as it tries to replicate.</p>
<p><a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116044">In a recently published study</a>, researchers treated 1,433 people within five days of symptoms and a COVID-19 diagnosis. Half took molnupiravir, the other half placebo, for five days.</p>
<p>All had at least one risk factor for severe COVID-19, such as diabetes, obesity, or serious heart, lung or kidney disease. None had been vaccinated.</p>
<p>In the molnupiravir group, 7.3% were admitted to hospital or died from any cause in the following month compared with 14.1% who took the placebo. That’s a 48% risk reduction when you compare the two. You would need to treat 15 people with the drug to prevent one hospitalisation or death. There were no serious side effects.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1445891929384755212"}"></div></p>
<p>But we need to exercise caution. Molnupiravir damages the viral genes, causing mutations so the virus cannot replicate. So it also has the potential to damage human genes, especially in susceptible cells that are dividing, such as foetal cells. At least, that’s what <a href="https://academic.oup.com/jid/article/224/3/415/6272009?login=true">laboratory studies show</a>. </p>
<p>This means molnupiravir <a href="https://www.tga.gov.au/sites/default/files/lagevrio-pi.pdf">can’t be used</a> in pregnancy or by breastfeeding mothers and it is recommended women of childbearing age use contraception while taking it. It theoretically could also cause <a href="https://academic.oup.com/jid/article/224/3/415/6272009?login=true">mutations</a> that, under rare circumstances, could lead to health issues in the mother and foetus.</p>
<p>There is also a <a href="https://journals.asm.org/doi/abs/10.1128/JVI.01348-19">theoretical risk</a> mutations in the viral genome could lead to new viral variants resistant to the medication, or that can evade our immune response.</p>
<p>Molnupiravir is only used for a short time and this should be safe. </p>
<p>But concerns about inducing new viral variants or viral resistance limit its use in immunosuppressed people, who may need longer treatment courses, or in vulnerable people who have been exposed to the virus but do not yet show signs of infection.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/take-at-home-covid-drug-molnupiravir-may-be-on-its-way-but-vaccination-is-still-our-first-line-of-defence-169246">Take-at-home COVID drug molnupiravir may be on its way — but vaccination is still our first line of defence</a>
</strong>
</em>
</p>
<hr>
<h2>Pfizer’s treatment</h2>
<p>The other newly approved agent is a combination of two drugs – nirmatrelvir and ritonavir – called Paxlovid. </p>
<p>Nirmatrelvir blocks the action of an enzyme the virus uses to replicate <a href="https://www.science.org/doi/abs/10.1126/science.abl4784">while</a> ritonavir (which is also used in an HIV drug) boosts the levels of nirmatrelvir to maintain its effectiveness.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1459642431243100160"}"></div></p>
<p>Trial results for this agent have <a href="https://www.nejm.org/doi/10.1056/NEJMoa2118542">only just been published</a>. The trial involved
2,246 unvaccinated people with at least one risk factor for severe COVID-19. Within five days of diagnosis, they were treated with either the drug or placebo.</p>
<p>Treatment resulted in an 89% reduction in COVID-19-related hospitalisations, or deaths from any cause, compared to placebo, in people treated within three days of symptoms starting. You would need to treat 16 people to prevent one hospitalisation or death. There were no serious adverse events. </p>
<p>This treatment is also not recommended in people who are pregnant or breastfeeding. </p>
<p>It can interact with many other medicines. And as it’s removed from the body by the liver and kidneys, it is not suitable for people with <a href="https://www.tga.gov.au/sites/default/files/paxlovid-pi.pdf">serious liver or kidney disease</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pfizers-pill-is-the-latest-covid-treatment-to-show-promise-here-are-some-more-171589">Pfizer's pill is the latest COVID treatment to show promise. Here are some more</a>
</strong>
</em>
</p>
<hr>
<h2>Who will get them?</h2>
<p>A word of caution. These antiviral drugs have only been assessed in unvaccinated people. So we’re not really sure how effective these agents will be if you’re vaccinated. With high levels of vaccination in Australia, including our most vulnerable populations, this may be an issue.</p>
<p>Initially, there is likely to be constraints on their supply and they will be prioritised for those most at risk of severe COVID-19.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1491516945555857408"}"></div></p>
<p>For the vulnerable people we are most concerned about – such as people in residential aged care and with serious health problems – these antivirals may be too little too late. </p>
<p>That’s because by the time some people have become infected and develop symptoms, their immune response to infection causes severe disease. So elderly people may not get the same benefit as younger people from these antiviral agents.</p>
<h2>We need to use them wisely</h2>
<p>This new generation of antivirals is not a replacement for vaccination, masks or improved indoor ventilation. These measures prevent people from being infected in the first place. </p>
<p>If we use these antivirals unwisely, they will have side effects and may lead to the virus becoming resistant, just as we see with bacteria becoming resistant to antibiotics.</p><img src="https://counter.theconversation.com/content/176235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Wark receives funding from NHMRC Australia, Medical Research Futures fund, the US NIH. He has also received independent investigator funding from Glaxo Smith Kline and Vertex.</span></em></p>These new antivirals are another way of managing COVID-19. But they’re not a panacea, and could even makes things worse.Peter Wark, Conjoint Professor, School of Medicine and Public Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1545522021-07-13T20:11:31Z2021-07-13T20:11:31ZHow do you teach a child to swallow a pill? Hint: use lollies<figure><img src="https://images.theconversation.com/files/410240/original/file-20210707-21-12b5x7.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pill-child-mouth-1035027634">from www.shutterstock.com</a></span></figcaption></figure><p>When was the last time you swallowed a pill, be it a tablet or capsule? This morning or sometime in the past week? Now, can you remember the very first time you had to take a pill? Probably not. </p>
<p>Unlike your first kiss, there is usually nothing remarkable about the first time you take a pill. But taking solid medicines orally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065591/">does not come naturally</a> and chances are you had to be taught how to do it. And because you don’t remember how you were taught it can be hard for parents to figure out how to teach their kids to do it too.</p>
<p>But here’s how to make the learning process fun and safe.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-burp-137493">Curious Kids: why do we burp?</a>
</strong>
</em>
</p>
<hr>
<h2>Is this necessary?</h2>
<p>Before trying to teach your child to swallow a pill, first see if your child really needs to learn.</p>
<p>Most medicines commonly used by children under 12 years of age are readily available as formulations other than pills. These include liquids, <a href="https://link.springer.com/chapter/10.1007/978-1-4419-1087-5_4">suspensions</a>, chewable tablets and <a href="https://www.healthline.com/health/general-use/how-to-use-rectal-suppositories">suppositories</a>. The liquids and suspensions usually come in palatable flavours. </p>
<p>Doctors can also write prescriptions to allow pharmacists <a href="https://www.nps.org.au/australian-prescriber/articles/extemporaneously-compounded-medicines-1">to compound (make up)</a> some drugs usually available as a pill into a suspension instead. </p>
<p>If these options aren’t available, you will need to teach your child to swallow a pill. You’ll also need to go down this path as your child gets older, their weight increases, and some of the child-friendly formulations are no longer suitable. That’s because the higher doses often needed can be impractical to give using children’s products. So it would be much easier and cheaper to use a tablet or a capsule.</p>
<p>However, don’t be tempted to <a href="https://theconversation.com/health-check-is-it-ok-to-chew-or-crush-your-medicine-39630">crush or break a pill for them, or ask them to chew it</a>, unless your pharmacist has given the go-ahead for that medicine. This can affect the way the medicine is absorbed, which could lead to an overdose.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-is-it-ok-to-chew-or-crush-your-medicine-39630">Health Check: is it OK to chew or crush your medicine?</a>
</strong>
</em>
</p>
<hr>
<h2>Turn it into a game</h2>
<p>Teaching relaxation techniques, learning by imitation or modelling, and learning by repetition and exercise are all useful ways to teach pill swallowing. However, <a href="https://www.hamiltonhealthsciences.ca/wp-content/uploads/2019/08/SwallowPillsHelpChild-lw.pdf">turning it into a game</a> is popular.</p>
<p>First of all, this method is NOT suitable for children under five. The mechanics of swallowing are too difficult for them to understand and both you and the child are likely to end up frustrated. Also, the younger they are, the smaller their throat and the likelihood something will get stuck.</p>
<p>The basis of the game is to start your child trying to swallow very small, everyday foodstuffs and work your way up to things the size of a pill. Lollies (candy) are best because you don’t have to convince your child to play the game.</p>
<p>More importantly, lollies are water soluble so if there are any problems you can ask your child to have a big drink of water to break it apart. If you don’t know if the lolly is water soluble, test it first in a glass of water to see if it dissolves.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sickly-sweet-or-just-right-how-genes-control-your-taste-for-sugar-113455">Sickly sweet or just right? How genes control your taste for sugar</a>
</strong>
</em>
</p>
<hr>
<h2>Ready, steady, go!</h2>
<p>Start your child on the smallest sized lolly. Ask them to sit up straight, facing forward, without tilting their head up or down. Ask them to take a sip of water before each lolly, to get them prepared for the swallowing action. Then ask them to place the lolly on their tongue (<a href="https://www.hamiltonhealthsciences.ca/wp-content/uploads/2019/08/SwallowPillsHelpChild-lw.pdf#:%7E:text=small%2C%20like%20a%20candy%20sprinkle,try%20a%20slightly%20larger%20candy.&text=Work%20up%20to%20a%20candy,your%20child%20will%20be%20taking.&text=candies.">towards the back is best</a>) and take another sip to wash it down.</p>
<p>If they can swallow that, move up to the next size. But if they can’t, ask them to chew and swallow it, and try again.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pile of snake lollies (candies)" src="https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410242/original/file-20210707-15-1x14tog.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Snake lollies can come in handy and your child is unlikely to complain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/snake-candies-close-1222479028">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Our version of the game uses lollies available in Australia, increasing in size: sprinkles (such as hundreds and thousands), Nerds, Tic Tacs, M&Ms (normal, not peanut or crispy), and then snakes.</p>
<p>With snakes, you can cut off and swallow the head, about the size of a pill, before cutting up pieces of the body to the same size.</p>
<h2>Some dos</h2>
<ul>
<li><p><strong>do joke around and make the activity fun</strong>. Get family involved as children need to be comfortable when playing</p></li>
<li><p><strong>do make sure it’s the only activity they are doing</strong>. You want your child’s full attention</p></li>
<li><p><strong>do give praise</strong>. The game is all about building confidence</p></li>
<li><p><strong>do put the lolly into a soft food stuff if you want</strong>. Some children find lollies, or even real pills, easier to swallow if they are in a small spoonful of pureed fruit or custard. Don’t use peanut butter as that is sticky and hard to swallow</p></li>
<li><p><strong>do consolidate their skill when they are finally successful</strong>. Once they can swallow a tablet or capsule sized lollie, keep your child’s confidence up by asking them to swallow an age-appropriate vitamin pill every now and then.</p></li>
</ul>
<h2>Some don'ts</h2>
<ul>
<li><p><strong>don’t stop on a stuck point</strong>. If your child has difficulty with a particular sized lolly that day drop back down to the size they can do so you finish on a win</p></li>
<li><p><strong>don’t use a sultana or peanut-based lolly</strong>. These do not dissolve in water and if they get stuck, become be a choking hazard</p></li>
<li><p><strong>don’t ask children to lay on their back</strong>. <a href="https://www.everydayhealth.com/specialists/healthy-living/when-a-pill-gets-stuck/#:%7E:text=Never%20take%20a%20medication%20when,pill%20is%20%E2%80%9Cchased%E2%80%9D%20down.">This can make it more difficult to swallow</a>. Instead just have them sit up straight. If they like, they can tilt their head forward to place the lolly in their mouth, and then when they are ready to swallow, they can tilt their head slightly back to help it go down.</p></li>
</ul>
<h2>Final take-home advice</h2>
<p>Teaching your child to swallow a pill is not easy and is likely to take weeks. Most kids will get stuck at one size of lolly at some stage. And they’ll likely not be able to swallow the largest lolly the first time they try.</p>
<p>This is normal, so persevere and keep the game fun. Your child will get there.</p><img src="https://counter.theconversation.com/content/154552/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Elise Schubert is a registered pharmacist and also receives a scholarship from the University of Sydney and Canngea Pty Ltd. </span></em></p>Here’s how to make the learning process fun and safe.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyElise Schubert, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1537962021-01-31T18:55:13Z2021-01-31T18:55:13ZDoctors must now prescribe drugs using their chemical name, not brand names. That’s good news for patients<figure><img src="https://images.theconversation.com/files/381267/original/file-20210129-21-1wumjzy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6006%2C4007&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shuterstock</span></span></figcaption></figure><p>From today (February 1), when you receive a prescription in Australia, it will list the name of the medication’s <a href="https://www.pbs.gov.au/info/general/active-ingredient-prescribing">active ingredient</a> rather than the brand name. So, for example, instead of receiving a prescription for Ventolin, your script will say “salbutamol”. </p>
<p>This national legislation change, called <a href="https://www.safetyandquality.gov.au/sites/default/files/2020-12/fact_sheet_-_active_ingredient_prescribing_-_guidance_for_australian_prescribers_0.pdf">active ingredient prescribing</a>, is long overdue for Australian health care. </p>
<p>Using the name of the drug — instead of the brand name, of which there are often many — will simplify how we talk about and use medications. </p>
<p>This could have a range of benefits, including fewer <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.12805">medication errors</a> by both doctors and patients.</p>
<h2>What is an active ingredient?</h2>
<p>The <a href="https://www.tga.gov.au/book/prominence-active-ingredients-medicine-labels">active ingredient</a> describes the main chemical compound in the medicine that affects your body. It’s the ingredient that helps control your asthma or headache, for example. </p>
<p>Drugs are tested to ensure they contain exactly <a href="https://www.tga.gov.au/publication/australian-regulatory-guidelines-prescription-medicines-argpm">the same active ingredients</a> regardless of which brand you buy.</p>
<p>There’s only one active ingredient name for each type of medical compound, although they may come in different strengths. Some types of medications may contain multiple active ingredients, such as Panadeine Forte, which contains both paracetamol and codeine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/prescribing-generic-drugs-will-reduce-patient-confusion-and-medication-errors-77093">Prescribing generic drugs will reduce patient confusion and medication errors</a>
</strong>
</em>
</p>
<hr>
<h2>There can be several brand names</h2>
<p>Until now, doctors and other prescribers have used a mixture of brand and active ingredient names when prescribing medicines. An Australian study found doctors used brand names for <a href="https://www.publish.csiro.au/AH/AH12009">80.5% of prescriptions</a>. </p>
<p>Different brands are available for most medications — <a href="https://www.mja.com.au/journal/2011/195/11/whats-name-brand-name-confusion-and-generic-medicines">up to 12</a> for some. Combined with active ingredient names, this equates to thousands of different names — too many for any patient, doctor, nurse or pharmacist to remember. </p>
<figure class="align-center ">
<img alt="A senior man taking a tablet. There are a variety of medications on the table." src="https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381268/original/file-20210129-23-15x62ie.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older people are at higher risk of making medication errors, as they tend to take more medications.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Here’s an example of the problem.</p>
<p>I ask John, a patient whom I’ve just met, whether he takes cholesterol medications, commonly called statins. The active ingredient names for this group of medications all end in “statin” (for example, pravastatin, simvastatin).</p>
<p>“Ummm, I’m not sure, is it a blue pill?” John asks.</p>
<p>“It could come in many colours. It might be called atorvastatin, or Lipitor,” I reply. “Perhaps rosuvastatin, or Crestor, or Zocor?”</p>
<p>“Ah yes, Crestor, I am taking that,” John exclaims, after deliberating for some time.</p>
<p>This is a common and important conversation, but could be simpler for both of us if John was familiar with the active ingredient name.</p>
<p>And while we did eventually come to the answer, this medication could have easily been overlooked, by both John and myself. This may have significant implications and interact with other medicines I might prescribe.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-heard-covid-is-leading-to-medicine-shortages-what-can-i-do-if-my-medicine-is-out-of-stock-153628">I've heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?</a>
</strong>
</em>
</p>
<hr>
<h2>Cause for confusion</h2>
<p>The main problem with using brand names for medications is the potential for confusion, as we see with John.</p>
<p>A prescription written using a brand name doesn’t mean you can’t buy other brands. And your pharmacist may offer to substitute the brand specified for an equivalent generic drug. So, people often leave the pharmacy with a medication name or package that bears no resemblance to the prescription.</p>
<p>When the terms we use to describe medicines in conversation, on prescriptions and what’s written on the medication packet can all be different, patients might not understand which medications they’re taking, or why. </p>
<p>This often leads to doubling up (taking two brands of the same medication), or forgetting to take a certain medication because the name on the package doesn’t match what’s written on your medication list or prescription.</p>
<p>Confusion resulting from using brand names has been associated with serious medication errors, including <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/211398?casa_token=hA41G4MI1ZQAAAAA:JJTT5NB6FOTsn-ZluZclU9Xxx942FN1mcbjcJ-zJlhJ6SNJc8GoIL0eyE1fdb55JV1s1gzu9aNg">overdoses</a>. Elderly people are the most susceptible, as they’re most likely to take multiple medications.</p>
<p>Even when the confusion doesn’t cause harm, it can be problematic in other ways. If patients don’t understand their medicines, they may be less likely to be proactive in making decisions with their doctor or pharmacist about their health care.</p>
<p>Health professionals can also get confused, potentially leading to <a href="https://www.ismp.org/resources/progress-preventing-name-confusion-errors">prescribing errors</a>.</p>
<h2>What are the benefits of active ingredient prescribing?</h2>
<p>The main benefit of the switch is to simplify the language around medications. </p>
<p>Once we become accustomed to using one standardised name for each medicine, it will be easier to talk about medicines, whether with a family member, pharmacist or doctor. </p>
<p>The better we understand the medications we’re using, the <a href="https://www.sciencedirect.com/science/article/pii/S0025619614003875?casa_token=s6dZMe3HH58AAAAA:ZEY1c6ltPyfJBMuOw6XHH6PdGdAuLpkn6s3WP0gmoSo8UwC7pD-vpwMwqqjp81V9KCbp6PcTtw">fewer errors we make</a>, and the more control we can take over our medication use and decisions.</p>
<figure class="align-center ">
<img alt="A pharmacist studies a woman's prescription." src="https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381269/original/file-20210129-13-6xid6s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A pharmacist can let you know which brands of your medication are are available.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>This change will also serve to promote choice.</p>
<p>When you’re prescribed a medicine with a certain name, you’re more likely to buy that brand. In some cases there may be generic medicines that are cheaper and just as effective. Or there may be other forms of the medication that better suit your needs, such as a capsule only available in another brand.</p>
<h2>Not too much will change</h2>
<p>This new rule is not expected to lead to extra work for doctors, pharmacists or other health professionals who prescribe medicines, as most clinical software will make the transition automatically.</p>
<p>Doctors can elect to still include the brand name on the prescription, if they feel it’s important for the patient. But aside from some limited exceptions, the active ingredient name will need to be listed, and will be listed first.</p>
<p>Some active ingredient names may be a bit longer and more complex than certain brand names, so there might be a period of adjustment for consumers. </p>
<p>But in the long term, this change will streamline terminology around medicines and make things easier, and hopefully safer, for everyone.</p>
<p>Next time you receive your prescription, have a look at the name of the active ingredient. Remember it, and use that name when you talk to your family, doctor and pharmacist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/boomers-have-a-drug-problem-but-not-the-kind-you-might-think-127682">Boomers have a drug problem, but not the kind you might think</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/153796/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Grant received funding from the National Health and Medical Research Council.</span></em></p>The language used to describe medications is confusing, with multiple names for the same drug. A change to prescribing rules from today should go a long way to addressing this issue.Matthew Grant, Palliative Medicine Physician, Research Fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1536282021-01-20T19:07:54Z2021-01-20T19:07:54ZI’ve heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?<figure><img src="https://images.theconversation.com/files/379646/original/file-20210120-15-1rkrr09.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-eastern-male-pharmacist-wearing-protective-1827869804">from www.shutterstock.com</a></span></figcaption></figure><p>You’ve just come from your monthly GP appointment with a new script for your ongoing medical condition. But your local pharmacy is out of stock of your usual medicine. Your condition is serious, and without it, your health is likely to suffer. What can you do?</p>
<p>While <a href="https://www.tga.gov.au/hubs/medicine-shortages">medicine shortages</a> happen from time to time, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235598/">researchers</a> and <a href="https://www.abc.net.au/news/2021-01-20/australia-post-coronavirus-medication-shortage/13065076">the media</a> report COVID-19 is causing more shortages than normal for many life-saving medicines. In Australia, <a href="https://www.abc.net.au/news/2021-01-20/australia-post-coronavirus-medication-shortage/13065076">media reports indicate</a> this includes some medications used to treat hyperthyroidism, high blood pressure, or allergies.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1351605107289296896"}"></div></p>
<p>Unfortunately, you’ll only likely find out if this applies to you when you reach the pharmacy. If that happens, there are a few ways you may be able to obtain your prescription.</p>
<p>But if the stock shortage will last for an extended period of time, and you cannot find a supply, your doctor may need to consider prescribing a different medication. </p>
<h2>Why are there shortages?</h2>
<p>Unfortunately, medicine shortages are an all too common problem of the modern health-care system. When our medicines come from a global supply chain — where raw ingredients are made in one country, processed into medicines in another, then freighted by sea or air to Australia — a single break in the supply chain can result in medicines going out of stock.</p>
<p>So there have been calls for Australia <a href="https://www.afr.com/politics/federal/australia-looks-to-boost-drug-manufacturing-20200413-p54je6">to set up its own medicines manufacturing base</a>. But even if we do, that doesn’t help now during COVID.</p>
<p>Medicines shortages is a <a href="https://www.who.int/medicines/publications/druginformation/WHO_DI_30-2_Medicines.pdf?ua=1">growing issue globally</a>. That’s because of increasing demand, higher quality standards and fewer manufacturing sites. </p>
<p>Shortages have also been exacerbated in 2020 due to COVID-19. When workers are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30459-1/fulltext">locked out of the factory</a> because of a local outbreak, medicines don’t get made. And when we <a href="https://www.freightaustralia.gov.au/annual-report/the-year-that-was/covid-19-impacts-on-freight">restrict the number of flights into Australia</a>, that prevents medicines from arriving.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-law-wont-safeguard-medicine-supply-itll-only-ensure-we-know-theres-a-shortage-103100">New law won't safeguard medicine supply – it'll only ensure we know there's a shortage</a>
</strong>
</em>
</p>
<hr>
<p>When a manufacturer knows there is likely to be a medicine shortage, for any reason, they are required to inform the Australian Therapeutic Goods Administration (TGA) so pharmacies can make other arrangements, such as stocking up on alternatives or sourcing supply from other companies.</p>
<p>When the medicine shortage is considered to have a critical patient impact, or if it is in the interest of the public to know about the shortage, then the information is added to the TGA’s <a href="https://apps.tga.gov.au/prod/MSI/search">shortages website</a>, which the public can search.</p>
<p>But this information is only useful at the government and wholesaler level; local GPs and community pharmacists don’t have the time to check the site every day.</p>
<p>Dealing with shortages efficiently is important because their impacts are wide ranging. Shortages <a href="https://doi.org/10.1371/journal.pone.0215837">result in</a> higher costs to patients when they have to buy branded rather than generic formulations; more drug errors due to the different strengths and brands dispensed; more side-effects and higher death rates because of changes to less appropriate medicines; and more complaints from patients.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist taking medicine off shelf" src="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/379676/original/file-20210120-19-ot4pnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There’s not always enough medicine to go round. And shortages can affect a patient’s health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-filling-prescription-pharmacy-drugstore-1281072733">www.shutterstock.com</a></span>
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</figure>
<h2>What if your local pharmacy is out of stock?</h2>
<p>It is best to speak to your pharmacist about your options when your medication is out of stock. There may be other brands still available and appropriate to swap. Alternatively, your pharmacist could dispense a different strength of the same medication. <a href="https://www.psa.org.au/coronavirus/regulatory-changes/">Regulations</a> brought in during the pandemic have allowed pharmacists to do this to help with medicine supply. </p>
<p>If there are no appropriate substitutes, in rare instances a local compounding pharmacy can manufacture certain products in store.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-manage-your-essential-medicines-in-a-bushfire-or-other-emergency-127516">How to manage your essential medicines in a bushfire or other emergency</a>
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<p>If none of your local pharmacies stock your medicine, your next option is for an <a href="https://mymedkit.com.au/">Australian online pharmacy</a> to fill your script. It may be able to ship your medicine from another city or state.</p>
<p>It is not legal or safe for you personally to order prescription medications from online overseas suppliers. This is because they may not have been manufactured to Australian standards, and may be unsafe. But your pharmacist may do so on your behalf, under a special provision called <a href="https://www.tga.gov.au/ws-s19a-index">section 19A</a>.</p>
<p>If all else fails, you may need to contact your doctor about changing to a different medication. There are often many alternatives in the same drug class that work in the same, or very similar, way.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">Health Check: what should you do with your unused medicine?</a>
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<p>Finally, and especially during COVID-19, for a large number of medicines pharmacists are only allowed to provide a <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">maximum of one month’s supply</a> to each patient. </p>
<p>So if your medicine is actually in stock and you want extra, just in case, then by law they may not be able to dispense it to you. This is to prevent panic buying and to ensure the wider community has steady access to medicine; that is, to prevent further shortages.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-people-stockpiling-toilet-paper-we-asked-four-experts-132975">Why are people stockpiling toilet paper? We asked four experts</a>
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<img src="https://counter.theconversation.com/content/153628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Elise Schubert is funded by a scholarship from the University of Sydney and Canngea Pty Ltd. </span></em></p>COVID-19 has resulted in higher than normal levels of medicine shortages. Here’s what to do if your local pharmacy is out of stock.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyElise Schubert, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1485262020-10-22T04:35:04Z2020-10-22T04:35:04ZE-prescriptions are coming. But what are they? And is this the end of paper ones?<figure><img src="https://images.theconversation.com/files/364884/original/file-20201022-16-nddiip.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnancy-medicine-pharmaceutics-health-care-people-316712879">Shutterstock</a></span></figcaption></figure><p>Electronic prescriptions (or e-prescriptions) <a href="https://www.digitalhealth.gov.au/news-and-events/news/electronic-prescriptions-roll-out-expands-across-metropolitan-sydney">are being rolled out</a> in stages across Australia after being used in Victoria during the pandemic.</p>
<p>E-prescriptions have been common in countries such as the <a href="https://www.sciencedirect.com/science/article/pii/S1386505613000233?via%3Dihub">United States</a> and <a href="https://link.springer.com/chapter/10.1007/978-3-642-23315-9_8">Sweden</a> for more than ten years. In Australia, a fully electronic paperless system has been planned for some time. </p>
<p>Since the arrival of COVID-19, and a surge in the uptake of <a href="https://theconversation.com/telehealth-in-lockdown-meant-7-million-fewer-chances-to-transmit-the-coronavirus-141041">telehealth</a>, the advantages of e-prescriptions have become compelling. </p>
<p>So what are they? How does it all work? And is this the end of paper prescriptions?</p>
<h2>How do e-prescriptions work?</h2>
<p>Now, most doctors use a function in a patient’s electronic medical records to print out their prescription in the surgery. Patients then take it to the pharmacy for dispensing. The pharmacy needs to store this paper prescription <a href="https://www.health.nsw.gov.au/pharmaceutical/pharmacists/Pages/faq-recordkeeping-storage-privacy.aspx#:%7E:text=All%20records%20of%20prescriptions%20dispensed,where%20the%20prescription%20was%20dispensed.">for two years</a>.</p>
<p>However, with e-prescribing, doctors can use <a href="https://www.psa.org.au/ep/">their medical software package</a> to write and transmit that prescription as a “token” to the patient’s phone. This can be as an SMS or email, containing a QR code. </p>
<p>Patients are then free to choose which pharmacy to take the token to for dispensing. They can present their phone to be scanned, or forward the SMS or email to the pharmacy.</p>
<p>The pharmacy imports the code into its dispensing program, unlocks the prescription, checks it, and dispenses the medication.</p>
<p>If patients accidentally delete the email or SMS, they will have to contact their doctor to have their token cancelled and reissued. This is not that different to someone losing a paper prescription.</p>
<p>Although e-prescribing has been used during telehealth consultations in Victoria, for instance, it can also be used during a normal face-to-face consultation, once it rolls out in your area. </p>
<h2>What are the benefits of going paperless?</h2>
<p>Telehealth initially involved a lot of extra paperwork. Doctors would fax or email a prescription to a particular pharmacy for the script to be dispensed, then medication was delivered to patients at home.</p>
<p>The pharmacy needed to wait for the doctor’s surgery to mail the paper prescription, or had to collect it from the doctor’s surgery. It also had to store the prescription for two years after dispensing.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/video-and-phone-consultations-only-scratch-the-surface-of-what-telehealth-has-to-offer-146580">Video and phone consultations only scratch the surface of what telehealth has to offer</a>
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<p>However, regulations have now <a href="https://www.pbs.gov.au/pbs/news/2019/09/electronic-prescribing">changed</a> to legalise e-prescriptions with no need for paper.</p>
<p>This allows an efficient, contactless system for distributing medication, improving pharmacy workflows, and removing storage requirements.</p>
<p>For patients, it means not having to worry about paper copies, and offers the convenience of being able to send a code to the pharmacy of their choice.</p>
<h2>Is it accurate? Does it save time?</h2>
<p>When researchers evaluated other benefits of e-prescriptions, they had mixed results.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S1386505613000233?via%3Dihub">review of 19 studies</a> showed e-prescriptions may be clearer or more complete than paper handwritten prescriptions, reducing the need for pharmacists to contact doctors to clarify their instructions.</p>
<p>Another advantage is that e-prescriptions for addictive drugs, such as opioids, do not need doctors to write any details by hand (as is <a href="https://www.legislation.nsw.gov.au/view/whole/html/inforce/current/sl-2008-0392">currently required for paper scripts</a> for drugs of addiction).</p>
<p>However, e-prescriptions may <a href="https://pubmed.ncbi.nlm.nih.gov/18445369/">not reduce the time</a> it takes to process the prescription, as <a href="https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-9-8">new errors</a> may be introduced.</p>
<p>For instance, a <a href="https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-9-8">Swedish study</a> compared the number of times pharmacists had to contact the doctor to clarify information from new e-prescriptions, compared with computer-generated or faxed prescriptions. </p>
<p>The study found e-prescriptions were nearly eight times more likely to have issues about the dosage or how to take the medication. The authors believed this may be due to some electronic systems misinterpreting common shorthand doctors use (for example, lt3d for “one tablet three times daily”). </p>
<h2>Is this the end of paper scripts?</h2>
<p>About <a href="https://www2.deloitte.com/au/en/pages/technology-media-and-telecommunications/articles/mobile-consumer-survey.html#:%7E:text=91%25%20of%20Australians%20have%20a,and%2036%25%20market%20share%20respectively.">10% of Australians</a> do not have a smart phone. So paper prescriptions are still available and you can choose a paper one if you prefer or you don’t feel comfortable using the technology.</p>
<p>Some patients might find it a bit fiddly handling multiple e-prescriptions for multiple medications. At present, individual prescriptions are sent as separate emails or SMS messages and patients need some familiarity with searching their device to retrieve the right one.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person handing paper prescription to pharmacist" src="https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/364885/original/file-20201022-21-10edtse.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some people may prefer to stick with paper prescriptions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/confident-asian-young-female-pharmacist-lovely-1714542475">Shutterstock</a></span>
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<p>However, in the near future, you will be able to store all of your current prescriptions electronically in an “<a href="https://www.digitalhealth.gov.au/get-started-with-digital-health/electronic-prescriptions">Active Script list</a>”. This will allow a patient to have all their medications in one file and choose to give a doctor or pharmacist access to either add more prescriptions or dispense medication. Once this is in place, using an app to aggregate all this information may make this more usable.</p>
<p>Until then, some patients with multiple medications might prefer to stick with keeping their paper prescriptions together in a folder as it helps them keep their current medication list up to date.</p>
<h2>How about privacy and security?</h2>
<p>When it comes to their health data, people are often understandably concerned about privacy and security.</p>
<p>The Australian Digital Health Agency, the federal agency that oversees e-prescriptions, requires providers to conform to rigorous standards when managing sensitive data. </p>
<p>E-prescriptions must meet the <a href="https://www.liebertpub.com/doi/full/10.1089/omi.2020.0085">legal privacy requirements</a> in Australia’s <a href="https://www.legislation.gov.au/Details/C2014C00076">Privacy Act 1988</a> and <a href="https://www.qcert.org/sites/default/files/public/documents/au-bp-national_eauthentication_framework-eng-2009.pdf">eAuthentication framework</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/instant-prescriptions-might-be-the-way-of-our-digital-future-but-we-need-to-manage-the-risks-first-131308">Instant prescriptions might be the way of our digital future, but we need to manage the risks first</a>
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</em>
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<p>Countries that have had e-prescriptions for some time, such as Greece, have explored the issues around <a href="https://www.diva-portal.org/smash/get/diva2:1129929/FULLTEXT01.pdf">privacy</a>. Australia, being much later to adopt e-prescriptions, has had the opportunity to address these concerns as part of the implementation process. </p>
<p>And a review <a href="https://www.liebertpub.com/doi/full/10.1089/omi.2020.0085">comparing digital security of e-prescription systems</a> in eight countries showed Australia (with the US) had the highest level of digital security.</p><img src="https://counter.theconversation.com/content/148526/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Penm is is a member of the International Pharmaceutical Federation (FIP) Pharmaceutical Technology Forum. FIP is the the global body representing over 4 million pharmacists and pharmaceutical scientists. FIP is a non-governmental organisation that has been in official relations with the World Health Organization since 1948.</span></em></p><p class="fine-print"><em><span>Andrew Bartlett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Another use for your smartphone, this time to present to the pharmacists rather than a paper prescription.Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyJonathan Penm, Lecturer (Pharmacy), University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1391862020-06-02T15:55:57Z2020-06-02T15:55:57ZUse of antihypertensive drugs generates pressure-packed debate in COVID-19 era<figure><img src="https://images.theconversation.com/files/338636/original/file-20200529-78867-1m4zgg9.jpg?ixlib=rb-1.1.0&rect=90%2C99%2C5781%2C3872&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers have been trying to understand a possible link between blood pressure medications and COVID-19.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Since the beginning of the pandemic, everything and its opposite has been said about antihypertensive medications. Used in patients suffering from high blood pressure, these medications were first thought to aggravate the consequences of COVID-19 before being considered as a new therapeutic avenue for the same disease.</p>
<p>As a PhD candidate in pharmaceutical sciences at the faculty of pharmacy and the Institute for Research in Immunology and Cancer in Montréal, I believe it is important to observe the need for rigorous scientific research before disseminating conclusions on such a subject, especially during a health crisis.</p>
<h2>The different roles of ACE2</h2>
<p>COVID-19 occurs after infection with the virus <a href="https://doi.org/10.1038/s41586-020-2012-7">SARS-CoV-2</a>. In order to infect the human body, this virus must pass through a door on the cell surface: <a href="https://doi.org/10.1128/JVI.00127-20">angiotensin-converting enzyme 2 (ACE2)</a>.</p>
<p>This enzyme acts as a receptor for SARS-CoV-2. The virus binds to ACE2 — like a key that fits into a lock — and is then able to enter the cells to replicate and infect the body. Although SARS-CoV-2 has a significant impact on cells in the lungs, it is now clear that <a href="https://www.doi.org/10.1007/s11684-020-0754-0">other organs are affected</a>, such as the esophagus, kidney and heart.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334428/original/file-20200512-82357-10gnx7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A conceptual 3D illustration of the SARS-CoV-2 virus binding to ACE2 on a human cell, during an early stage of COVID-19 infection.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>But it turns out that the role of the ACE2 is not limited to providing SARS-CoV-2 with a passkey for the body. It works in concert with its close counterpart ACE1 to <a href="https://www.doi.org/10.1136/bmjopen-2018-026777">keep blood pressure in balance</a>.</p>
<p>ACE1 produces angiotensin-2, a protein involved in vasoconstriction (narrowing, or constricting, of blood vessels), which increases blood pressure. ACE2 then takes over to transform this protein into a derivative called angiotensin 1-7, which is, conversely, a powerful vasodilator, and opens — or dilates — blood vessels and lowers pressure.</p>
<p>Conditions such as being overweight, having high stress levels or having kidney disease can lead to high blood pressure (hypertension) and cause <a href="https://doi.org/10.1093/oxfordjournals.bmb.a072896">increased vessel constriction</a>. This forces the heart to work harder to pump blood through the arteries. Two types of antihypertensive drugs can lower blood pressure: <a href="https://doi.org/10.2165/00003495-199000392-00004">ACE inhibitors</a>, which target ACE1, and <a href="https://dx.doi.org/10.1080%2F08998280.2003.11927893">angiotensin 2 receptor blockers</a>, which prevent angiotensin 2 from binding to its receptor and acting as a vasoconstrictor.</p>
<p>Nevertheless, the COVID-19 pandemic has raised many concerns among patients on antihypertensive therapy about the risks associated with taking these drugs and the development of complications following viral infection.</p>
<h2>Well-founded fears</h2>
<p>Two studies carried out on rats in 2004 — thus outside the context of COVID-19 — showed that taking these antihypertensive drugs induced an <a href="https://doi.org/10.1161/CIRCULATIONAHA.104.510461">increase in the presence of ACE2</a> in the kidney and <a href="https://doi.org/10.1161/01.HYP.0000124667.34652.1a">the heart</a>. </p>
<p>This observation led to the hypothesis that these treatments would multiply the doorways by which the SARS-CoV-2 virus enters the body, leading to <a href="https://doi.org/10.1016/S2213-2600(20)30116-8">more severe effects</a> such as kidney and heart failure. The fears associated with taking antihypertensive medication <a href="https://doi.org/10.1093/eurheartj/ehaa235">reported in some media</a> have been as viral as SARS-CoV-2 itself and have spread internationally. So much so that messages have been disseminated by various relevant health authorities such as the <a href="https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19"><em>American College of Cardiology</em></a> and the <a href="https://doi.org/10.1093/eurheartj/ehaa235"><em>European Society of Cardiology</em></a> to prevent the discontinuation of these drugs.</p>
<h2>Questionable studies</h2>
<p>The American College of Cardiology states that at this time, “there is no experimental or clinical evidence to demonstrate the benefits or dangers of taking antihypertensive drugs in patients with COVID-19.” The statements at the root of these controversies are based on a <a href="https://doi.org/10.1093/eurheartj/ehi257">mixture of results</a> from <a href="https://doi.org/10.1161/01.HYP.0000237862.94083.45">both animal</a> and <a href="https://doi.org/10.1007/s00726-014-1889-6">human experiments</a>.</p>
<p>Moreover, the results of these studies are not reproducible and one study shows no change in the presence of ACE2 after taking antihypertensive drugs. These studies also alternate the administration of the two types of antihypertensive drugs described above, ACE inhibitors and angiotensin-2 receptor blockers, resulting in inconsistent physiological effects.</p>
<p>This may be the reason why <a href="https://doi.org/10.1093/ajh/hpu086">some clinical studies</a> in humans further qualify their judgement, suggesting that only some antihypertensive drugs would increase the amount of this receptor and should therefore be evaluated individually or by type. Health authorities believe that hypertensive patients are at risk because they have <a href="https://doi.org/10.1001/jamacardio.2020.1329">other conditions</a>, such as diabetes and cardiovascular diseases, that occur with age.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334479/original/file-20200512-82375-17gapli.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Stopping treatment is dangerous for people with hypertension. It can lead to heart failure or stroke.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In addition, <a href="https://doi.org/10.3238/arztebl.2018.0557">stopping treatment is risky</a>. It can lead to stroke or heart failure. Furthermore, even if the presence or activity of ACE2 was altered by antihypertensive medication, there are no relevant clinical studies to date that indicate that this would result in increased SARS-CoV-2 infection.</p>
<h2>A hope for treatment</h2>
<p>The debate took a new twist when some researchers hypothesized that, in reality, the use of antihypertensives may actually be beneficial in COVID-19 patients.</p>
<p>The universities of Minnesota and Kansas have launched two clinical studies to <a href="https://doi.org/10.1016/bs.podrm.2015.02.003">evaluate the therapeutic benefits of losartan</a>, a generic angiotensin-2 receptor blocker, in these patients.</p>
<p>They hypothesize that taking this antihypertensive could <a href="https://clinicaltrials.gov/ct2/show/study/NCT04335123?term=losartan&draw=2&rank=2">reduce the damage</a> to various organs including the lungs and heart, and possibly even reduce <a href="https://clinicaltrials.gov/ct2/show/study/NCT04312009">hospitalizations</a>.</p>
<p>These hypotheses are based on the results of studies conducted on a related virus, <a href="https://doi.org/10.1098/rstb.2004.1490">SARS-CoV</a> that caused the SARS outbreak in 2003. As <a href="https://doi.org/10.1038/s41586-020-2012-7">both viruses</a> bind to the same receptor (ACE2), it seems relevant to transpose the results observed in SARS-CoV to the new coronavirus.</p>
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<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/what-is-the-ace2-receptor-how-is-it-connected-to-coronavirus-and-why-might-it-be-key-to-treating-covid-19-the-experts-explain-136928">What is the ACE2 receptor, how is it connected to coronavirus and why might it be key to treating COVID-19? The experts explain</a>
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<p><a href="https://doi.org/10.1038/nm1267">One study</a> has shown that binding of SARS-CoV to ACE2 results in a decrease in the presence of ACE2. That leads to an accumulation of angiotensin-2. Because angiotensin-2 is a vasoconstrictor, this accumulation increases the risk of vasoconstriction and hypertension.</p>
<p>This phenomenon has been identified as one of the main reasons for pulmonary hypertension, contributing to major damage to the lungs after infection with various viruses, including <a href="https://doi.org/10.1038/nm1267">SARS-CoV</a>, <a href="https://doi.org/10.1038/ncomms4594">H5N1</a> and <a href="http://doi.org/10.1038/srep19840">syncitial virus</a>. </p>
<h2>Countering the effect of the virus</h2>
<p>If the same process exists for SARS-CoV-2, infection would lead to a decrease in the presence of ACE2 in the different organs where the receptor is normally expressed. This phenomenon could significantly increase blood pressure in these organs and cause acute damage to the lungs or heart.</p>
<p>The increase in ACE2 caused by antihypertensive drugs seems paradoxical in this context, but some researchers believe it may actually be <a href="https://doi.org/10.1002/ddr.21656">life-saving</a> by counteracting the effect of the virus on the receptor. By <a href="http://doi.org/10.1056/NEJMsr2005760">blocking angiotensin-2 receptors</a> in patients with COVID-19, antihypertensive drugs such as losartan may be able to counteract the exacerbated vasoconstriction that occurs after viral infection. Angiotensin-2 would no longer be able to exercise its vasoconstrictor activity, but would become a vasodilator through its conversion to angiotensin 1-7 by the enzyme ACE2.</p>
<p><a href="https://doi.org/10.1007/s11427-020-1643-8">To support this hypothesis, a study</a> found elevated levels of angiotensin-2 in the plasma of patients with COVID-19, correlated with high total viral load and significant lung damage. The study suggests that increased angiotensin-2 activity may be partly responsible for organ damage in these patients. However, this study is a small sample of patients and the authors call for larger cohorts in future studies.</p>
<p>The results of the clinical studies in Kansas and Minnesota will provide the first concrete information to clarify the real involvement of losartan, and perhaps this type of antihypertensive in general, in the evolution of COVID-19. At the same time, they will also provide the first answers as to whether this antihypertensive drug is taken at risk or, on the contrary, beneficial in the current context.</p><img src="https://counter.theconversation.com/content/139186/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fatéma Dodat ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The use of antihypertension medication during the coronavirus pandemic has been a subject of hot debate but people should be cautious about simple conclusions.Fatéma Dodat, Candidate au PhD en Sciences Pharmaceutiques, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1336882020-03-25T12:29:55Z2020-03-25T12:29:55ZMedical supply chains are fragile in the best of times and COVID-19 will test their strength<figure><img src="https://images.theconversation.com/files/322736/original/file-20200324-155666-1vd69rc.jpg?ixlib=rb-1.1.0&rect=630%2C0%2C4685%2C3186&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pipeline of pharmaceuticals is easily disrupted.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pharmacy-medicine-capsule-pill-in-production-line-royalty-free-image/1138523291">Gumpanat/iStock via Getty Images Plus</a></span></figcaption></figure><p>The COVID-19 pandemic has brought medical supply chains into the spotlight. There has been a national <a href="https://www.foxnews.com/health/fears-grow-possible-shortage-coronavirus-testing-materials">shortage of testing kits</a>, and at least <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update">one drug is already unavailable</a> because of the outbreak, though it hasn’t been publicly named.</p>
<p>As <a href="https://emilyltucker.wixsite.com/eltuck">operations</a> <a href="https://scholar.google.com/citations?user=AovKv2oAAAAJ&hl=en&oi=ao">engineers</a> who focus on how these supply chains work, we know that even in the best of times, the U.S. drug supply chain is relatively fragile. Shortages regularly occur, and the COVID-19 pandemic has the potential to further disrupt a system that patients depend on, sometimes for life or death.</p>
<p><iframe id="EhN7W" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/EhN7W/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>A snapshot of how drugs are made</h2>
<p>Drugs can be divided into two broad categories: brand name and generic. </p>
<p>Brand name drugs are those that are still patent-protected, like Chantix and Truvada. They’re typically very profitable for manufacturers. This generally leads to a reliable supply of such drugs, often with some degree of redundancy – companies may maintain extra capacity or contract with multiple suppliers to prevent disruptions from causing shortages.</p>
<p>Patents, on the other hand, no longer protect generic drugs like ibuprofen and azithromycin. The profit margins for generic pharmaceuticals are low, and the supply chains for generics with low demand are often fragile. <a href="https://www.fiercepharma.com/manufacturing/concern-for-drug-shortages-grows-as-covid-19-outbreak-drags">Almost 90% of the U.S. drug supply is generic</a>.</p>
<p>A typical pharmaceutical supply chain begins with a manufacturer of the active pharmaceutical ingredients, or API. API plants are often overseas. <a href="https://www.fiercepharma.com/manufacturing/concern-for-drug-shortages-grows-as-covid-19-outbreak-drags">China and India are major API producers</a>, particularly for generic drugs. The APIs are then shipped to plants where they are formulated into drugs for shipment to wholesalers, distributors, hospitals, pharmacies and patients.</p>
<p>Supply chains for generic drugs are often lean. Typically each stage <a href="https://www.gao.gov/assets/670/660785.pdf">holds little inventory</a>, ranging from a few weeks to a few months. The active pharmaceutical ingredient may be made by a single manufacturer, and the finished form of the drug is nearly always made at a <a href="https://doi.org/10.1038/clpt.2012.220">single manufacturing plant</a>.</p>
<p>Federal <a href="https://www.gao.gov/assets/680/678281.pdf">regulatory protections</a> require the API manufacturer, the plant and the line on which the drug is manufactured all to be reviewed by the Food and Drug Administration. This is often a lengthy process.</p>
<p>This leanness means that a problem at any stage can disrupt the entire supply chain for months. The <a href="https://www.gao.gov/assets/680/678281.pdf">average drug shortage lasts 14 months</a>, and some have lasted for over three years. Unfortunately these are not rare events and don’t only happen when there are worldwide pandemics. Within the U.S., <a href="https://www.ashp.org/Drug-Shortages/Shortage-Resources/Drug-Shortages-Statistics">hundreds of drugs have been short since 2015</a> – including cancer treatments, antibiotics and central nervous system agents. </p>
<p><iframe id="CMBR7" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/CMBR7/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Disruptions can take many forms, and this leads back to the COVID-19 situation. To curtail the spread of the virus, many <a href="https://www.fiercepharma.com/manufacturing/concern-for-drug-shortages-grows-as-covid-19-outbreak-drags">manufacturing plants in China were closed for weeks</a>. In late February, the FDA announced the <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update">first COVID-19-related drug shortage</a>. Other such shortages may well occur. </p>
<h2>Making sure the supply chain won’t snap</h2>
<p>The effects of COVID-19 extend beyond manufacturing. The pandemic may lead to spikes in demand, which may in turn cause shortages. This is what occurred for the test kits: Demand rapidly increased once people needed to be tested. If demand surges for medications as well – such as hydroxychloroquine and chloroquine, which are being eyed as <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html">treatments for COVID-19</a> – there may be shortages even if the supply is unaffected by plant shutdowns.</p>
<p>During the COVID-19 outbreaks, the public can reduce shortages by taking action to manage downstream effects. “Flattening the curve” is about reducing demand spikes to help health systems manage the crisis without becoming overloaded. By washing your hands, physically distancing and not hoarding, Americans can help to limit the spread of the virus and take some of the stress off of hospitals.</p>
<p>Other strategies include <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update">extending the available supply</a>. For example, the federal government or pharmaceutical companies could extend drug expiration dates if appropriate, or scientists could develop methods to test multiple people using the same kit.</p>
<p>At a broader scale, the U.S. should put resources into rapidly ramping up production where possible and keeping the supply chains as “connected” as they safely can be – for example, continuing to allow cargo to be shipped between continents even if passengers are not. </p>
<p>In the long term, there are <a href="https://doi.org/10.1080/24725854.2019.1646441">strategic steps manufacturers can take</a> to <a href="https://www.fda.gov/drugs/drug-shortages/report-drug-shortages-root-causes-and-potential-solutions">reduce drug shortages</a>. Decentralizing supply chains could help counter upstream disruptions. Rather than producing a drug in a single plant, companies could distribute production across multiple plants, ideally in different areas of the world. This could prevent a single problem from affecting the entire supply.</p>
<p>To increase supply and adaptability, the federal government could allocate additional resources to help shorten the time it takes for agencies to review whether manufacturing plants and suppliers are up to safety codes. Contracts to purchase drugs could also incorporate incentives for companies to maintain reliable supply chains. Many shortages are also caused by manufacturing quality issues; investing in higher quality manufacturing processes could reduce the frequency of disruptions. </p>
<p>Unfortunately, if supplies are not adequate, <a href="https://doi.org/10.1016/j.mayocp.2013.11.014">drugs may be rationed</a> or patients may not receive care. This, in effect, is at least part of what’s happening with COVID-19 testing kits, where <a href="https://www.usatoday.com/story/news/2020/03/11/coronavirus-covid-19-response-hurt-by-shortage-testing-components/5013586002/">demand is much higher than supply</a>. </p>
<p>There are strategies that pharmaceutical companies and the government can and should pursue to lessen the effects of the current crisis. However, until they invest in longer-term solutions, there will continue to be medical shortages. These are not easy choices in a time of high drug prices, but the COVID-19 pandemic should be a wake-up call to the vulnerabilities of medical supply chains.</p>
<p>[<em>You need to understand the coronavirus pandemic, and we can help.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-help">Read our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Tucker receives funding from the National Science Foundation Graduate Research Fellowship Program under Grant DGE 1256260. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.</span></em></p><p class="fine-print"><em><span>Mark Daskin has received funding from the National Science Foundation and also from General Motors (in the past) and Ford Motor Company (presently). He has also received internal funding from the University of Michigan. The latter is the only funding that is directly related to this article.</span></em></p>Drug shortages occur regularly in the US, even in the best of times. The pharmaceutical supply chain embodies ‘just in time’ shipping and has little built-in redundancy.Emily Tucker, Ph.D. Candidate in Industrial and Operations Engineering, University of MichiganMark Daskin, Professor of Industrial and Operations Engineering, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1342312020-03-23T02:45:28Z2020-03-23T02:45:28ZCoronavirus: how to access the medicines you and your family need<figure><img src="https://images.theconversation.com/files/321867/original/file-20200320-22636-1swirpn.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C998%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-holding-medicine-box-capsule-pack-743384119">Shutterstock</a></span></figcaption></figure><p>Panic buying of toilet paper, no meat or soap on <a href="https://www.abc.net.au/news/2020-03-16/coronavirus-shopping-strips-supermarket-shelves-bare/12057924">supermarket shelves</a>, and now an <a href="https://www.theguardian.com/world/2020/mar/12/massive-shortages-rural-pharmacies-low-on-essential-medications-amid-coronavirus-crisis">apparent run</a> on medicines such as asthma puffers and children’s paracetamol. </p>
<p>The COVID-19 pandemic is affecting us in ways we’ve never had to deal with before. So Australia <a href="https://www.health.gov.au/news/deputy-chief-medical-officers-press-conference-about-covid-19-0">has announced</a> measures to help people access their medicines.</p>
<p>These include limiting the number of medications people can buy, dispensing only a month’s worth of supply at a time, and placing some behind the counter.</p>
<p>And, of course, pharmacies are essential services so they <a href="https://theconversation.com/nsw-and-victoria-announce-shutdowns-as-federal-government-widens-and-ramps-up-income-support-134355">will remain open</a> during the forthcoming shutdown period. </p>
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<strong>
Read more:
<a href="https://theconversation.com/can-coronavirus-spread-through-food-can-anti-inflammatories-like-ibuprofen-make-it-worse-coronavirus-claims-checked-by-experts-133911">Can coronavirus spread through food? Can anti-inflammatories like ibuprofen make it worse? Coronavirus claims checked by experts</a>
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<p>There are also ways people who are self-isolating or at risk can access their medicines, from using apps, to government-funded free home delivery.</p>
<p>Here are some of your options for the weeks and months ahead.</p>
<h2>Purchase limits on essential medicines</h2>
<p>There are now <a href="https://www.health.gov.au/news/deputy-chief-medical-officers-press-conference-about-covid-19-0">purchase limits</a> on certain medicines.</p>
<p>Customers in pharmacies are <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">now limited</a> to one of the following per person (or one month’s supply, if relevant):</p>
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<li><p>asthma puffers (Ventolin) and other medicines used for the treatment of chronic obstructive pulmonary disease (COPD)</p></li>
<li><p>paracetamol</p></li>
<li><p>Epipen, to manage severe allergic reactions</p></li>
<li><p>some heart medicines, such as glyceryl trinitrate</p></li>
<li><p>some diabetes medicines, including insulin</p></li>
<li><p>some anti-epileptic medicines.</p></li>
</ul>
<p>Purchasing limits have also been placed on many other prescriptions. </p>
<p>Pharmacists have been directed to only dispense <a href="https://www.tga.gov.au/media-release/limits-dispensing-and-sales-prescription-and-over-counter-medicines">one month’s supply</a> for more than 50 different medicines used to treat a range of conditions, including: cancer, Parkinson’s, chronic pain, blood pressure, and contraceptives. </p>
<p>Children’s paracetamol will now be kept <a href="https://ajp.com.au/news/new-dispensing-limits-imposed/">behind the counter</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ibuprofen-and-covid-19-symptoms-heres-what-you-need-to-know-134064">Ibuprofen and COVID-19 symptoms – here's what you need to know</a>
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<h2>What to do if you can’t get to your local pharmacy</h2>
<p>If you have been directed to self-isolate or if it’s risky for you to shop at a pharmacy, there are still options.</p>
<p>If you are in isolation, are over the age of 70, of Aboriginal or Torres Strait Islander descent, or have a compromised immune systems or chronic health condition, <a href="https://www.ppaonline.com.au/programs/covid-19-home-medicine-service">you may be eligible</a> for a free service to deliver medicines to your home.</p>
<p>This scheme only covers the costs of delivery for <a href="http://www.pbs.gov.au/pbs/home">Pharmaceutical Benefits Scheme (PBS)</a> medicines. The scheme does not include everyday products like hand sanitiser or regular over-the-counter medicines.</p>
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Read more:
<a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">Why are older people more at risk of coronavirus?</a>
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<p>If you’re not eligible for the home medicines service, one way to get your prescription and non-prescription medicines delivered to your home is via an app like <a href="https://mymedkit.com.au/app">mymedkit</a>. </p>
<p>This Australian-based company allows you to take a photo of your prescription and upload it into the app, where the script is then filled by your local pharmacy. </p>
<p>You can choose what day and time you want it delivered so you can be there when it arrives. And if you don’t need prescription medicines, they can also deliver other products like vitamins, skincare creams, first aid kits, baby wipes and nappies.</p>
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Read more:
<a href="https://theconversation.com/instant-prescriptions-might-be-the-way-of-our-digital-future-but-we-need-to-manage-the-risks-first-131308">Instant prescriptions might be the way of our digital future, but we need to manage the risks first</a>
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<img src="https://counter.theconversation.com/content/134231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is also a director of the medicinal cannabis company Canngea Pty Ltd and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Andrew Bartlett is an associate lecturer in Pharmacy practice at the University of Sydney and a member of the Australian College of Pharmacists.</span></em></p>Pharmacies are essential services and will remain open, but some people will still have problems accessing medicines. Here’s what you can do.Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of SydneyAndrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.