Say “acetaminophen” and chances are that the name would not be familiar to those around you. But say “paracetamol” and most people would recognise it as a medication for fever. Ditto for Panadol and Tylenol, the trade names under which the drug is sold.
All three are similar — a widely available over-the-counter (OTC) medication used to provide temporary relief of fever and mild-to-moderate pain. For many other types of drugs, the story is the same: they can be known by different chemical, generic or trade names. “Even as a pharmacist, I find them a mouthful to remember. You might take two similar medicines, and that can cause an overdose,” said Dr Lim Kiat Wee, Senior Principal Clinical Pharmacist, Singapore General Hospital (SGH). Confusion over their names aside, not knowing exactly what the drugs are can cause serious problems. Overdosing on paracetamol, for instance, can cause liver damage, said Dr Lim. Medications bought OTC at pharmacies without a doctor’s prescription can be taken safely, but they should still be taken with care as all medications and supplements can cause side effects, especially when taken in excess or with other drugs.
Some drugs, supplements and even food can either stimulate or inhibit the production of enzymes in the liver, said Dr Lim. “If enzyme production is inhibited, the drug starts to accumulate and become toxic, causing more side effects. If enzyme production is stimulated and the drug is cleared from the body faster than it should, then you wouldn’t be treated optimally,” she said.
For those on prescribed medications for existing medical conditions, extra care must be taken when consuming OTC drugs or supplements. Dr Lim advises consumers to read the label carefully, taking heed of the medication’s active and inactive ingredients, how it should be taken (amount and number of times to take a day), whether it should be taken before or after meals, as well as the possible side effects or reactions with other drugs or food. “There are so many different brands (of a drug) in the market. Within the same brand, there are also different ingredients and the actual dose per tablet may vary from one product to another,” said Dr Lim.
When in doubt, ask a doctor or pharmacist. A pharmacist is not just someone who packs medication and advises on dosage and other drug-related instructions. Pharmacists are healthcare professionals who ensure that medications contribute to the best possible health outcomes while minimising adverse effects; they provide advice ranging from whether prescribed tablets are too difficult to swallow to what happens if a dose is missed, as well as medication side effects and drug interactions.
“If your prescription requires you to take one tablet three times a day and you’ve missed your afternoon dose but it’s already close to your next dose, which is the evening dose, skip your afternoon dose and go ahead with your scheduled evening dose,” said Dr Lim. Following the dosing instructions is important for certain medications, such as antibiotics, for maximum effectiveness, she added.
What about needing to take the medication after food? “When a patient is required to take the medication after a meal, there are usually two reasons. Firstly, this type of medicine may cause a stomach upset if taken on an empty stomach,” said Dr Lim. “Another reason is that taking this group of medication after a meal improves its absorption, meaning the medication will be more effective.” If the patient has no appetite and cannot eat a proper meal before taking his medication, Dr Lim suggests having a snack, such as a cup of milk with a slice of bread, before taking the medication.
For people who have trouble swallowing large pills, pharmacists can provide guidance on whether a chewable or liquid form is available. “We advise patients against breaking certain pills into smaller pieces. For example, pills that have an extended or prolonged release mechanism allow the active ingredient to be slowly released into the body. Cutting or breaking the pill damages that mechanism,” said Dr Lim.
For more on OTC meds, tune in to SGH’s Perfectly Imperfect Health podcast on this issue. Visit this weblink https://for.sg/perfectly-imperfecthealth-meds
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