Managing Your Medicines Endorsed by Primary and Community Care Pharmacy Network Managing Your Medicines was written in association with Dr Peter Rivers of the Pharmacy Academic Practice Unit at the University of Derby. It is endorsed by the Primary and Community Care Pharmacy Network (PCCPN). This edition of the leaflet was updated by Dr Rivers and members of the PCCPN National Committee. This leaflet has been produced with the support of a grant from Ask About Medicines, the independent campaign to increase people’s involvement in decisions about their medicine use. To find out more visit www.askaboutmedicines.org If you would like this leaflet in another format, such as large print or audio tape, please contact the Information Resources Team on 020 7278 1114. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Contents Getting medicines on prescription Section 1 Buying medicines Section 2 Medicine names Section 3 Getting the best from your medicines Section 4 Remembering to take your medicines Section 5 Safe keeping Section 6 Expiry dates Section 7 Reducing side-effects Section 8 Falls Section 9 Other types of medicines Section 10 Reviewing your medicines Section 11 Disposing of medicines Section 12 Taking your medicines safely Section 13 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– We're all used to getting a prescription from the doctor when we're not well. It's a fact of life that, as we get older, we are more likely to need medicines prescribed by the doctor. In many cases these medicines are prescribed to make sure that we don’t get ill and may need to be taken for the rest of our lives. Most of the advice given in this leaflet applies to people of all ages. However, there are several reasons why older people should take extra care with medicines. For example, as we become older, we will probably need smaller doses of medicines. This is because our liver and kidneys become less efficient at removing medicines, so that some medicines stay active in the body for longer. Don't worry about this – it's quite normal. It just means that you must be very careful not to take more of a medicine than your doctor tells you to. This leaflet explains how to use your medicines safely and effectively. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 1 – Getting medicines on prescription Once you reach 60 you don't have to pay for prescription medicines. Just fill in and sign the form on the back of the prescription that says that you are exempt from prescription charges. If you find filling the form in difficult, ask a friend or relative to help you. You may be exempt from prescription charges, whatever your age, if you receive treatment for certain long-term conditions, such as diabetes. Ask your pharmacist for advice. If you’re under 60 and have to pay for your prescription, you might find it cheaper to buy a prescription pre-payment certificate. This will cover all your prescription charges for varying periods of time. Application forms are available from most pharmacies, or from your doctor. You can also apply for a prescription pre-payment certificate on line at: www.ppa.org.uk/ppa/ppc_faq.htm When you are given a prescription, you should collect your medicines as soon as possible. Some pharmacists and doctors offer services to make collecting your prescriptions easier: * Some pharmacies will collect your prescription from your doctor’s surgery so it is ready to pick up from the pharmacy of your choice. Ask your pharmacy if it offers this service. * If you are unable to leave your home it is worth asking if your pharmacist can deliver your prescription to you at home. Check whether or not there will be a charge for this. * Some local voluntary agencies may also be able to collect your medicines for you. * If your medicines have stayed the same for a long time, you could use a repeat dispensing service. This means that you don’t have to go to the surgery every time you need more medicines, you just have to go to the pharmacy. Ask your doctor for more information. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 2 – Buying medicines It is important to check that any medicines and herbal medicines you buy are safe to take together and with any prescribed medicines you’re taking. This is because different medicines and remedies may contain the same ingredients. For example, a medicine that your doctor has prescribed and one that you buy may both contain paracetamol. In this way, you could take more than the recommended daily dose of paracetamol without realising it. You should also check that any medicines you buy, including herbal medicines, won’t interfere with your prescribed medicines. Some medicines can interact with each other which could stop them from working properly or all together. This could make you ill. Always check with your pharmacist that any medicines you buy, including herbal medicines, are safe to take with your prescribed medicines. Many pharmacists now keep records of medicines that are sold as well as dispensed to patients. This helps to make sure that the best possible advice is given. It is not advisable to buy medicines from unregulated websites – the medicines may not be safe to use and could react badly with other medicines you are taking.  If you want to buy medicines over the internet, you should make sure you are buying your medicines from a UK website run by a legitimate pharmacy. You can do this by looking for the name and address of the pharmacy running the website and by checking that the pharmacist and pharmacy are registered with the Royal Pharmaceutical Society of Great Britain (RPSGB). You should avoid websites which offer to supply prescription-only medicines without a prescription. To check whether a pharmacist or pharmacy is registered, visit the RPSGB website at: www.rpsgb.org and select the link ‘Search our registers’.  Always make sure that you check with your doctor or a pharmacist before you take any medicines you have not been prescribed. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 3 – Medicine names Most medicines have two names. These are the trade name (or brand name) and the approved name (or ingredient name). The trade name is the one given to a medicine by its manufacturer. For example, imagine a fictional brand of coffee called 'Blue Valley'. Here, 'Blue Valley' is the trade name while 'coffee' is the approved name. The trade name is designed to be catchy and easy to remember. With most medicines, it doesn't matter what particular brand (trade name) you use. With some medicines, though, you need to keep to the same brand. This depends on a number of things – what your medical condition is, the range of medicines available, and your particular needs. Ask your doctor if you need to stick to the same brand. If you do, your doctor should prescribe using the brand name. Different brands of the same medicine may look different. If you are unsure about anything always ask the pharmacist or doctor. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 4 – Getting the best from your medicines * Always read the label on your medicines. If the instructions are not clear, ask your pharmacist or doctor to explain them. Ask your doctor to write the full instructions on your prescription, and not just 'as directed', as this can be confusing. The telephone number of your pharmacy may be on the label. You can ring this number to ask for advice about your medicines. * The words on medicine labels should be large enough for you to read. If you have problems reading labels you should discuss this with your pharmacist or doctor, who may be able to provide large-print labels. A few can also provide Braille labels. * Always read the patient information leaflet before starting to take your medicines, and don't throw away the packaging from your medicines until you've finished taking them. * If the instructions on the label tell you to take the medicine on an empty stomach, this means that you should try to take the medicine at least an hour before, or two hours after, your meal. * Always drink plenty of cool liquid with tablets and capsules – a full glass of water is ideal. * Always take tablets and capsules when standing or sitting as upright as possible. This helps to stop them getting stuck in your throat. * Don’t crush tablets or open your capsules and dissolve them in a drink without checking with your pharmacist. This could stop them from working properly and in some cases could even be dangerous. If you find tablets difficult to swallow, ask your pharmacist or doctor whether your medicine comes in a tablet that can be dissolved in water, or in a liquid form. * Most tablet bottles have child-resistant caps, which can be very difficult to open, especially if you have arthritis or can't get a strong grip on the container. You can ask your pharmacist for ordinary screw tops when handing in your prescription. * There are also aids that you can get to help with such things as eye drops, tubes of ointment and measuring liquids. * If you have problems with the packaging of medicines discuss them with your pharmacist. Do not re-pack your medicines into old bottles as this may affect them badly and make them work less efficiently –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 5 – Remembering to take your medicines Everyone finds it difficult to remember to take medicines. There are a few things you can do to make it easier. The main thing is to work out what times suit you best. Mealtimes are often a good time to take medicines because you're likely to have a drink with your meal. If you need to take your medicine on an empty stomach, try to get into a routine of taking it at the same times each day. Some people find it helpful to write down the times on a calendar and tick them off each time they take a dose. The pharmacist may be able to provide you with a chart to help remind you when to take your medicine. Another way of remembering is to use a memory aid container or compliance aid. These are containers with small compartments that help you to organise your medicines so that you take them at the right time. There are many different types of memory aid containers. For example, some containers have an alarm to remind you when to take your medicines. Others can have a recorded message from your doctor or pharmacist, telling you how many tablets to take and when to take them. Some open and close more easily than others, which can be important for someone with arthritis. Ask your pharmacist for advice on the different types of memory aid container or compliance aid and how they work, or contact the Disabled Living Foundation on 0845 130 9177. You may have to buy these memory aids yourself but you might find it's worth it if you're having problems remembering to take your medicines. Take your time choosing the best one for you. It is very important to put the right medicines in the correct parts of the container. You could ask a friend, relative or carer to double-check against your prescription to be sure that the container is filled correctly. Take extra care if your prescription has changed recently. If you are in any doubt, ask your pharmacist to check the contents again. Some people find it useful to draw up their own chart to help them remember to take their medicines. You could design your own headings. They could be things such as: * What time do I need to take my medicine? * Do I need to take my medicine on an empty stomach? You could have as many headings as you like, depending on the kind of things that you need to remind yourself of. Remember to update your chart if you ever change your medicines, and that you may need different instructions for different medicines. You could ask your pharmacist for advice. Community pharmacists now provide a Medicines Use Review service, which means that you may be able to make an appointment with your local pharmacist to discuss how you take your medicines and any problems you may be having. The pharmacist may then make suggestions to your doctor, with your agreement, as to how your prescription might be amended to help you. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 6 – Safe-keeping Never share or give your medicines to anyone else. They have been prescribed for you and may be harmful to other people. Never keep your medicines where children can reach them. Ideally, medicines should be kept in a locked cupboard. If this isn't possible, make sure all your medicine containers are closed properly. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 7 – Expiry dates Like foods, all medicines have a limited shelf-life, called an expiry date or ‘use-by’ date. So it is best to get them in small quantities and to make sure you don't use them after the expiry date. There may be a date stamped on the container, or the letters EXP followed by a date. For example, EXP 1/07/08 would mean 'do not use after 1 July 2008'. If you can't find a date on the medicine container, as a general rule you shouldn't keep tablets or capsules for longer than a year. Liquids should only be kept for six months. If in doubt, check the expiry date with your pharmacist. Some medicines go off very quickly once they're opened. The label will tell you not to use them after a specified amount of time. It is important to follow this advice. Medicines will last longer if they are kept cool and dry. When choosing a place to store your medicines, try to avoid hot and steamy places like the bathroom or kitchen. Don't worry too much if the best place to store medicines is in the bathroom – but remember that warm, steamy conditions will reduce the shelf-life. Some medicines need to be kept in the fridge. The pharmacist will tell you if you need to do this. The best way to avoid taking out-of-date medicines is to make sure you return them to your pharmacist once you've finished with them – don't hold on to them for a 'rainy day'. Your pharmacist will make sure they are disposed of safely. ––––––––––––––––––––––––––––––––––––––––––––––––––------------------------------ Section 8 – Reducing side-effects There is no such thing as a medicine without any possible side-effects. Sometimes it might be worth putting up with some mild side-effects if it means that your infection or illness gets better. And, of course, some people may never experience any side-effects at all. Stomach upsets are a common side-effect. You can reduce the risk of getting a stomach upset by taking your medicine while you're eating, or just after a meal. If you're not going to eat a main meal, take them with a snack or milky drink. However, some medicines work better when taken on an empty stomach – say, one hour before a meal, with a glass of water. If this is the case, the directions on the label will usually tell you to take before food. Always check with your pharmacist or doctor. If you think that you are experiencing side-effects you should mention it to your doctor even if it seems trivial. What you may feel is trivial could be important. It is easy to forget to ask the doctor about things like this, so it may help to write down the questions you want to ask before you go, to act as a reminder during your consultation. If you do experience side-effects, the amount of medicine that you're taking might need adjusting, or your doctor might want you to try a slightly different medicine that is less likely to cause side-effects. You should avoid alcoholic drink if you are taking certain types of medicine. Ask your pharmacist or doctor for advice on whether you can drink alcohol while taking your medication. If you do experience symptoms that you think might be side-effects from your medicines, get in touch with your doctor or pharmacist immediately. –––––––––––––––––––––––––––––––––––––––––––––––––------------------------------- Section 9 – Falls Some medicines can make you feel drowsy or unsteady on your feet, and this might mean you're more likely to lose your balance and fall over. It's important to be aware that some medicines might make you feel like this. Take care when getting out of a chair or the bath. If you take sleeping tablets be extra careful if you have to get out of bed during the night and when you first get up in the morning. Feeling dizzy when you stand up is more common as you get older, and some medicines can make the problem worse. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 10 – Other types of medicines You should take just as much care with other types of medicines, such as ear, eye and nose drops, inhalers and creams, as with the medicines that you swallow. Ear, eye and nose drops Ear, eye and nose drops can cause side-effects just like tablets and capsules. Make sure you use the dose that's written on the container and never share your drops with anyone else. Once an eye drop container is opened, you shouldn't use it for longer than four weeks. This helps to prevent germs from getting into the eye drops. You also need to be careful to stop infections being passed from one eye to the other. Try not to touch your eye when putting in your drops, and if you have a separate container for each eye make sure that you stick to using the same one each time. This will help prevent passing any infection from one eye to the other. To check how to put in your eye drops, ask your pharmacist. If you need to use two different eye drops at the same time. make sure you leave at least five minutes between using the different drops. This is to make sure that the first drops aren’t washed out and can start to work. If you usually wear contact lenses, ask your pharmacist or doctor if they should be removed for the time you are using eye drops. If you find it difficult to put in your own drops, ask a friend, relative or carer for help, or think about using eye drop holders, which can make things much easier. Your pharmacist can advise on these. Creams and ointments Creams and ointments should also be treated with care. Always wash your hands before and after applying a medicated cream (unless the cream is for your hands, in which case do not wash afterwards). If you are applying cream to someone else, protect your hands with disposable gloves. This is important. Although the cream is meant to help someone else get better, it may contain ingredients that are harmful to you. Wearing gloves also helps prevent infections passing between people. You can buy disposable gloves from a pharmacy or you may be able to ask your doctor to add them to your prescription. When applying creams or ointments, you only need to use a small blob, and you should rub it in gently, unless the directions say otherwise. Never offer your prescription cream or ointment or any other type of medicine to someone else – it could be harmful. Inhalers Inhalers are a very good way of getting medication straight into your lungs to help with your breathing. However, they can be difficult to use and some people don’t manage to take in the right amount of medication. If you have problems gripping and squeezing your inhaler, a special attachment can make the inhaler easier to use. Or you could use an inhaler which works as soon as you breathe in. Ask your pharmacist or doctor for more information. If you have problems with your inhaler, or if it doesn't seem to be working properly, check with your pharmacist that you are using it correctly. If you still have problems, tell your doctor. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 11 – Reviewing your medicines If you take medicines regularly, you should have an annual clinical review of your medicines once a year. This is because you may no longer need your medicine or the dose may need to be changed. Do tell your doctor if you think your medicines aren’t working properly or could work better for you. The review may be done by your doctor or by a nurse or pharmacist. If your medication is the same all the time you might be able to get repeat prescriptions without seeing the doctor. This system does not mean that you cannot see your doctor whenever you need, but you must make sure that you still see your doctor regularly to agree that the repeat service can continue. When you request a repeat prescription, ask only for the medicines you need. If you stock up on all your medicines at once and have a great many, it can be easy to get muddled; also, some might go out of date before you have a chance to use them. If you think you've experienced any side-effects from your medicines, do mention it to your doctor or pharmacist, however unimportant you think it might be. It's important to have your medicines checked every now and then by your doctor or pharmacist, to make sure that they're not out of date, and that none of them are interfering with your other medicines. You could take all your medicines with you when you go for your next doctor's appointment or for your Medicines Use Review at the pharmacy. Your medicines may need to be changed if your health changes or if you have to go into hospital. It is very important that you take all your medicines with you if you go into hospital, including any you have bought yourself. Having a complete list of medicines helps your doctor and pharmacist to make a proper assessment of your care. In some areas doctors, pharmacies and ambulances will have Green Bags specially designed to use for your medicines when you go into hospital. You should make sure that this bag of medicines stays with you every time you move around the hospital. Regular checks are essential so that you and your doctor can be sure that your medicines are working to your benefit. It's also important to check that you're not taking any medicines that are out of date or that interfere with any of your other medicines. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 12 – Disposing of medicines If your medicines are out of date, or if you no longer need to take or use them, take them to a pharmacy for safe disposal. Don't throw medicines out with household rubbish. If you find it difficult to get out and about, ask a friend or relative to return the medicines to a pharmacy for disposal. –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Section 13 – Taking your medicines safely Do follow the instructions on the label. If you don't understand them, ask your pharmacist or doctor to explain. Do take medicines at mealtimes to help you remember them (unless the directions tell you to take them on an empty stomach). Do ask your pharmacist for advice. If you buy any medicines over the counter, check that the ingredients do not duplicate or interfere with what you are already taking. Do check whether you need to stick to the same brand of medicine when offered repeat prescriptions. Do make regular appointments with your doctor to make sure that the medicines that have been prescribed for you are still appropriate. Do make sure that you fully understand the directions that the doctor or pharmacist has given you. Don’t crush your tablets or open capsules and dissolve them in a drink without first checking with your pharmacist or doctor. Never take more than the dose stated on the label of your medicine container. Never share your medicines or give them to anyone else. Avoid taking extra medicines in addition to those prescribed by the doctor. Always take medicines you no longer need or use back to a pharmacy. July 2007