Not sure what kind of medication you have? Miss Lim Paik Shia, Principal Clinical Pharmacist, Mr William Sin Wai Lian, Senior Pharmacist and Mr Wan Choon Nam, Pharmacist, at Singapore General Hospital, give detailed answers to your questions.
When it comes to prescribed or over-the-counter medication, better be safe than sorry. For example, do you know if your medication may interact with health supplements or TCM remedies? What side effects should you look out for? How to tell if you have an allergic reaction? Is it ever ok to take a “drug holiday”, ie to stop taking your medication at times?
Miss Lim Paik Shia, Principal Clinical Pharmacist, Mr William Sin Wai Lian, Senior Pharmacist and Mr Wan Choon Nam, Pharmacist, from the Department of Outpatient Pharmacy at Singapore General Hospital, give detailed answers to your questions.
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Dear William,
All medicine will expire in 6 month? What is the basis when the doctor tell you to discard all your medicine after 6 month of opening?
Thanks.
Regards,
Pamme
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
All medicines that are legal and registered under Singapore Health Science Authority (HSA) must have a printed expiry date which could expire more than 6 months or less. An expiry shelf life of a medicine can be defined as the date past which the medicine is no longer expected to be safe and effective. Different medicine may have various expiry dates depending on the physical and chemical stability of product. Having said that, the medicines should be kept properly based on recommended storage conditions (eg: Store at room temperature; Do not store above 25°C; Refrigerated at 2-8°C). Certain medications have a shorter shelf life after opening or use the following tips to check the medicines should be discarded after 6 months of opening:
- Check the expiry date, discard when it is expired
- If the medicines are not expired but the appearances (shapes, colours), tastes or smells different to when you first got it, discard it
- Always write down the date of first opening for some shorter expiry date medicines such as prepared antibiotic mixtures, eye drops, injections, which usually will be expired in few weeks depending on the products
- If you are still unsure about it, you may take it to your pharmacist for further advice
Question by jagjittalwar
My wife is 39 years old. She is diagnosed with hypothyroidism and on medication dosage of eltroxin 50microgram. Is the dosage right? or she has to change it as she is feeling fatigueness in body. Kindly advise.
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
The dosage is right as in healthy adults younger than 50 years, therapy may begin at full replacement doses. The average full replacement dose of levothyroxine sodium is 1.7 mcg/kg/day administered in a single daily dose. Therefore initially dose is 50-100 mcg daily, adjusted at 3-4 week intervals by 50 mcg until normal metabolism is steadily maintained. Usual dose is about 100-200 mcg/day. Having said that, the dose of levothyroxine will be adjusted based on blood test results: free thyroxine (T4) and thyroxine stimulating hormone (TSH). Fatigue could be presented due to hypothyroidism or rarely caused by the side effect of levothyroxine. Therefore, it is advisable to continue the prescribed dose until follow up with her doctor.
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Can Cialis be taken for long periods? Are there any natural treatments for it?
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
Cialis is used to treat benign prostatic hyperplasia (BPH), pulmonary hypertension and erectile dysfunction (ED). For BPH, it is used with finasteride and the recommended duration is ≤ 26 weeks. For pulmonary hypertension, it can be continued if deemed appropriate by physician. As for ED, it can be used once daily or as needed use. Physician will complete thorough review of diseases, medications, efficacy and tolerability before continue prescribing Cialis. Natural treatment is not recommended as it has limited clinical effectiveness data.
Question by sbdtys
May I know do the following medications interact with these supplements?
- Vitamin D 100IU
- Calcit Ultra
- Glucosamine 1500
- Nexium 20mg
- Gaviscion
- Lactoforte
- Cozaar 100mg
- Madopor
- Clonazapam
Thanks, CK
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
Generally these supplements are safe to take with the medications prescribed. Theoretically, Nexium (esomeprazole) could reduce the absorption of calcium. Nexium (esomeprazole) is prescribed to reduce stomach acid. The absorption of some calcium supplements, particularly calcium carbonate, may be impaired when stomach acid is reduced. However the Calcit Ultra that you mentioned contains calcium citrate, which may be less affected by reduced stomach acid.
Question by fred
Currently I'm prescribed the following medications: a) Co-Diovan 80/12.5 b) Crestor 10mg with 1 tab a day. In addition I'm also taking supplements: ViaHealth Super GarlicPlus With Lecithin and Wheat Germ Oil - only once a day although reccommended for 3-a-day and EnerVon with Vitamin C once a day. Question: Any effects on these combination? Any diet that I should take care of?
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
Those supplements are generally safe to take with the medications prescribed. In terms of diet, a healthy and balanced diet is recommended to optimize the blood pressure and cholesterol control. Take less oily foods, reduce saturated fats intake, consumes more fresh fruit and vegetables. Limit the intake of salt to less than 100 mmol/L per day (less than 5 g of salt per day). Alcohol consumption should be limited to three units per day (21 units per week) for men and two units per day (14 units per week) for women.
Question by lumserene236
I am taking Thyroxine 50mg for hypothroid and Pharmaton health supplement. Sometime I get stomach pain and nausea after taking the supplement. Is it due to drug interaction.? Thanks.
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
Pharmaton contains Calcium and Iron, which may reduce the absorption of levothyroxine. As long as both of them are taken consistently together or separated, levothyroxine dose can be adjusted accordingly. However, if you have persistent inadequate thyroxine level despite the treatment, you may consider to separate both of them 4 hours apart and thyroxine tablet should be taken on empty stomach in the morning. Stomach pain and nausea are not the common side effects of levothyroxine, and it is very unlikely due to the drug interaction between the drug and supplement. According to the information from product insert (MIMS), some patients take Pharmaton may experience gastrointestinal intolerance (eg, abdominal discomfort, constipation, diarrhoea, nausea and vomiting). I would suggest you to take Pharmaton after food or stop it as for now and continue monitoring your stomach upset symptoms. If symptoms persist after stopping Pharmaton, you may consider to consult a physician for further investigation.
Question by lucycleeve
Hello, I am a mother of three children and was recently warned to cease taking the contraceptive pill my my GP as I am 'too old' (I am 39 yo). Can you please comment on the risks of older women taking the pill? I don't have any other risk factors. Thanks.
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
Eligibility criteria of oral contraceptive pills (OC) use is based on personal characteristics and reproductive history, co-existing diseases and risk factors. It is not recommended to be used in women aged 35 years or older who smoke, migraine, history of venous thrombosis and pulmonary embolism, cardiovascular disease, uncontrolled hypertension, obese. Risk factors include venous thromboembolism, cancer and others. Hence, the decision to continue or stop OC use is tailored to individual woman needs as well as their medical condition and risk factors.
Question by mlewsk
I am currently on 40mg simvastatin daily. Also prescribed 100mg aspirin but I take it only if my heart feels 'clogged' or 'congested'. I hate taking pills of any kind but I have no choice. I have made drastic lifestyle and diet changes since 2 years ago. Sometimes I deliberately skip a dose. Without the statin, the LDL remains high. Next blood test review is coming soon. Is the PLAC test available in Singapore at the polyclinics? Thanks.
Answered by Miss Lim Paik Shia (Senior Pharmacist), Mr Wan Choon Nam (Pharmacist) & Mr William Sin Wai Lian (Pharmacist), SGH
PLAC test is not available in Singapore polyclinics. Both of the prescribed medications are used to reduce the risk of developing cardiovascular disease (CVD) or stroke. Statin is also used for optimizing total cholesterol and LDL cholesterol (bad cholesterol) levels. Generally, reduction of risk of developing CVD involves a combination of lifestyle modifications, drug treatment and effective management of any overt underlying medical condition - eg, diabetes, hypertension, hyperlipidaemia. However the benefits of both medications are only exerts when patient takes them regularly as prescribed by the doctor. Hence it is advisable to adhere to the regimen prescribed by the doctor to gain the full benefit.
Ref: R14
