The Drugs Controller General of India has asked the manufacturers to add “box warning” on its label, suggesting that its use to be restricted to 10 days.  If longer clinical use is necessary then liver function test should be assessed periodically.

Manufacturers are directed to incorporate the said box warning in a conspicuous manner on label, carton, package insert and other promotional literature of the drug.

Aciclovir belongs to a group ofmedicines called “anti-virals”. Itworks by stopping the production ofthe virus that causes herpes andshingles.Aciclovir does not get rid of the virusfrom your body. There is no evidence that thismedicine is addictive. This medicine is not expected toaffect your ability to drive a car oroperate machinery, but make sureyou know how it affects you beforedriving.

When you must not take itDo not take this medicine if:

• You have had an allergicreaction to aciclovir, valaciclovir or any of theingredients listed at the end ofthis leaflet. Symptoms of an allergic reactionmay include shortness of breath,wheezing or difficulty breathing;swelling of the face, lips, tongue,throat or other parts of the body,rash, itching or hives on the skin.

• The expiry date (EXP) printed onthe pack has passed.

• The packaging is torn, showssigns of tampering or it does notlook quite right.

Before you start taking thismedicine, tell your doctor if:

1. You have allergies to:

• any other medicines

• any other substances, such asfoods, preservatives or dyes.

2. You have or have had anymedical conditions, especially thefollowing:

• kidney or liver problems

• neurological disorders such asmuscle weakness, paralysis,seizures, confusion, etc

• altered electrolytes (salts) in yourbody

• lack of oxygen in your blood

• severe side effects from acytotoxic (anti-cancer) medicine.

3. You are currently pregnant or youplan to become pregnant. Yourdoctor will discuss the risks andbenefits involved.

4. You are currently breastfeedingor you plan to breastfeed. Yourdoctor will discuss the risks andbenefits involved.

5. You are planning to have surgeryor an anaesthetic.

6 .You are currently receiving orare planning to receive dentaltreatment.

7. You are taking or are planning to take any other medicines. Thisincludes vitamins and supplements that are available from your pharmacy, supermarket or health food shop.

Some medicines may interact withaciclovir . These include:

• probenecid, a medicinecommonly used to treat gout

• diuretics, also called fluid tablets

• interferon, used to treat multiplesclerosis, hepatitis, leukaemia, Hodgkin’s lymphoma and otherdiseases

• methotrexate given by injectioninto the spine to treat cancer andleukaemia

• cimetidine, used for stomachproblems

• mycophenolate mofetil, used bypeople with organ transplants. If you are taking any of these youmay need a different dose or youmay need to take different medicines.Other medicines not listed abovemay also interact with aciclovir.

Things you must do

Drink plenty of fluids. If you feel that your condition is notimproving or is getting worse, seeyour doctor.

Tell your doctor that you are taking this medicine if:

• you are about to be started on anynew medicine

• you are pregnant or are planningto become pregnant

• you are breastfeeding or areplanning to breastfeed

• you are about to have any bloodtests

• you are going to have surgery orare going into hospital. Your doctor may occasionally dotests on your blood or urine to checkfor side effects and see how yourkidneys are working. Go to yourdoctor regularly for a check-up. Tell any other doctors, dentists andpharmacists who are treating you that you take this medicine.

Things you must not do

Do not:

• Give this medicine to any one else, even if their symptoms seem similar to yours

• Take your medicine to treat anyother condition unless yourdoctor or pharmacist tells you to

• Stop taking your medicine, orchange the dosage, without firstchecking with your doctor. Things to be careful of Genital herpes can be caught from, orspread to, your partner during sexualactivity. It is important to remember that this medicine will not keep youfrom spreading herpes to others. Be careful when driving or operatingmachinery until you know how this medicine affects you.

Tell your doctor or pharmacist ifyou notice any of the following and they worry you.

This list includes the more common side effects. Mostly, these are mild:

• Stomach problems such as nausea (feeling sick), vomiting (beingsick), diarrhoea, constipation,stomach pain

• Changes in taste sensation, loss ofappetite, weight loss

• Dizziness/giddiness or headache

• Difficulty sleeping

• Mild skin reactions (e.g. rash,itching, hives, overreaction to thesun)

• Increased hair loss

• Weakness, fatigue, lack ofenergy, tiredness

• Aching, leg pains, muscles pains,joint pain, muscle cramps

• Menstrual problems.

Tell your doctor as soon as possibleif you notice any of the following.

These may be serious side effects.You may need medical attention.

Most of these side effects are rare.

• confusion

• depression, agitation, irritability

• unusual thoughts or actions,hallucinations (seeing, feeling orhearing things that are not there)

• shakiness/trembling

• difficulty speaking

• uncoordinated movements, i.e.unsteady walking

• fever, sore throat, swollen glands

• blood problems (e.g. feeling tiredand weak, fever, frequentinfections, unusual bruising orbleeding or swelling aroundwounds)

• fluid retention

• eye problems (inflamed eye).

If you experience any of the following, STOP taking your medicine and contact your doctor immediately or go to the Accident and Emergency department at your nearest hospital. These are very serious side effects and are usually very rare.

You may need urgent medical attention or hospitalisation.

• Yellowing of the skin and/or eyes(jaundice) or other liver problems with a collection of symptoms which may include: mental confusion, drowsiness, restlessness, itching andunconsciousness

• Kidney problems e.g. too much ortoo little urine, or pain whenurinating, or pain in the kidneys

• Troubled breathing

• Chest pain, fast heart beat(palpitations)

• Convulsion (fits)

• Becoming unconscious or in acoma• Signs of serious allergic reaction(see below)

• Signs of a blood clot such as aswollen and painful area in yourleg, and swelling in your foot or ankle. Other side effects not listed abovemay occur in some patients.

Storage

Keep your medicine in its original packaging until it is time to take it. If you take your medicine out of its original packaging it may not keep well. Keep your medicine in a cool dry place where the temperature will staybelow 25°C. Do not store your medicine, or anyother medicine, in the bathroom ornear a sink. Do not leave it on awindow sill or in the car. Heat anddampness can destroy somemedicines.Keep this medicine where childrencannot reach it. A locked cupboard at least one-anda-half metres above the ground is agood place to store medicines.

Call your doctor at once if you have any of these serious side effects:

• easy bruising or bleeding, unusual weakness;
• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or
• fever with chills, body aches, or flu-like symptoms.

Less serious side effects may include:

• stomach pain;
• nausea, vomiting;
• headache, dizziness; or
• temporary hair loss.

Most Important

You should not use this medication if you are allergic to albendazole, or to similar medications such as mebendazole.

Before using albendazole, tell your doctor if you are allergic to any drugs, or if you have liver disease or have ever had abnormal liver function tests.

You should not use albendazole if you are pregnant or planning to become pregnant during treatment. Use an effective form of birth control while you are using albendazole, and for at least 1 month after your treatment ends.

Take albendazole with food to lessen stomach upset.

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Albendazole will not treat a viral infection such as the common cold or flu.

Albendazole can lower the blood cells that help your body fight infections. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cells do not get too low, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

Medicines affecting albendazole are

1. Cimetidine
2. Dexamethasone
3. Praziquantel
4. Theophyllline

This is not a complete list other medicines may also interact.

“Pharmacists should move from behind the counter and start serving the public by providing care instead of pills only. There is no future in the mere act of dispensing. That activity can and will be taken over by the internet, machines, and/or hardly trained technicians. The fact that pharmacists have an academic training and act as health care professionals puts a burden upon them to better serve the community than they currently do.”

(From: Pharmaceutical care, European developments in concepts, implementation, and research: a review.1,p.x.)

This information will help you when taking any medicine. In addition to these guidelines, you need to have specific information about each medicine you are taking. Your doctor or pharmacist  can give you that information
Before Taking Your Medicine

Before you take any new medicine, tell your doctor if:

• You have ever had an allergic or unusual reaction to any medicine, herbal product, food or other substance. Ask your doctor or pharmacist if you have questions.

• You are on a low salt, low sugar or any other special diet. A special diet can change how a medicine works.

• You have surgery or emergency treatment, tell your doctor or dentist about medicines you are taking. Be sure to include any vitamins, herbals or other over the counter medicines. Many herbal or supplement products can interact with other medications or increase the risk of bleeding during some procedures.

• You are pregnant or if you plan to become pregnant. The use of any medicine during pregnancy must be carefully considered. Your obstetrician or pharmacist will be able to tell you of the safety of any medicines you take during pregnancy.

• You are breastfeeding. Some medicines pass into the breast milk and can cause undesirable side effects in your baby.

• You have taken any prescription, over the counter medicines, herbal products or dietary supplements in the past few weeks. Medicines can change how other medicines work.
What You Should Know About Your Medicines

• Please ask questions about medicines you are taking. Write down your questions and take them with you to your doctor’s visit. Your pharmacist also can answer questions about the medicine when the prescription is filled.

• Learn both the generic and brand names.

In most cases, generic medicines are the same as brand name medicines, but there are some exceptions. Your pharmacist will be able to tell you which medicines can be substituted with a generic and which should not.

• Make a list of all your medicines and keep it with you. Show the list to your doctors and dentist at every visit. Your medicine list should include:

Prescription medicines

Over the counter medicines

Vitamins and herbals such as St. John’s Wort, garlic, ginkgo biloba and vitamin E

Dietary supplements and homeopathic remedies such as juices, teas and other products used

Sample medicines

Skin patches, eye drops, inhalers, creams and ointments

Internal and external medicine delivery pumps such as an infusion pump or insulin pump.

• Write down the answers to the following questions about each of your medicines so you can refer to them as needed:

Why am I taking the medicine?

What does the medicine do?

What is the strength of my medicine?

How much do I take?

What time should I take it?

Should I take this medicine with food?

Is it safe to take with other medicines that I am taking, including over the counter medicines, vitamins or herbals?

What food, drink or activities should I avoid while taking it?

What are the usual side effects and what do I do if they occur?

Should I stop taking any of my medicines for any specific reason, such as for adverse effects or before any types of procedures?

What do I do when I forget to take my medicine?

What do I do if I take too much medicine or accidentally overdose?

When should I expect the medicine to start working? How can I tell it is working?

Are there any tests that I need to have while taking this medicine?

How long do I take it?

Proper Use of Your Medicine

• Take your prescribed medicines at the right time and for the full length of time. If any unusual side effects occur, call your doctor.

• If you take medicine each day, ask for a refill several days before your supply is gone.

• Take over the counter medicines as directed on the label. Talk with your pharmacist before you choose an over the counter medicine. If the medicine does not work within the time it claims, call your doctor.

• It is important to take your medicine(s) exactly the way it is prescribed, even if you feel better. In some cases, the medicine may need to be given for years or the rest of your life to control a disease or problem.

• Do not stop taking your medicines without checking with your doctor.

• Always read the label before taking any medicine. Check the date on the bottle and throw out those medicines that have expired.

How to Store Your Medicine

• Store your medicines away from heat and direct sunlight. Do not put medicines in bathroom cabinet, because heat and moisture may cause them to change. Store medicines in a kitchen cabinet, away from heat, but where children cannot get to them. Do not store medicines in the  refrigerator or freezer unless you are told to do so.

• Outdated medicines or any prescription medicine not used for more than one year should be thrown out. Check with your pharmacist about how to get rid of them safely. Do not throw old medicines in the trash can.

Precautions

• Do not give your prescription medicine to other people. This can be very dangerous and it is against the law. The medicine is for your problem and may not be the correct treatment for another person.

• If you take more medicine than prescribed, call the poison control center, your doctor or pharmacist right away. Keep local telephone numbers close to the telephone.

• Check all your medications before leaving the pharmacy. Read the name, strength, and instructions for each medication.

Calcium

Supplies your body with calcium if you need more than you get in your diet. Also helps prevent osteoporosis (weak or brittle bones). This medicine is a mineral that your body needs to work properly.

When This Medicine Should Not Be Used:

You should not use this medicine if you have had an allergic reaction to calcium.

How to Use This Medicine:

• This medicine is taken by mouth.
• Most calcium supplements should be taken with food. Drink a full glass of water with each dose, unless you are on kidney dialysis. If you are using this medicine as a phosphate binder for kidney dialysis, do not drink extra water with each dose.
• Carefully follow your doctor’s instructions about any special diet.
• If you need to take more than one dose each a day, take each dose at evenly spaced times, unless your doctor has told you otherwise.

If a dose is missed:
• If you miss a dose or forget to use your medicine, use it as soon as you can. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up for a missed dose.

How to Store  This Medicine:
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
• Keep all medicine away from children and never share your medicine with anyone.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.
• Make sure your doctor knows if you are also using other supplements or medicines that contain calcium.
• Calcium can change the way other medicines work if you take them at the same time. If you need to use other medicines, take them at least 2 hours before or 2 hours after you take your calcium supplement. This is particularly important if you are also using phenytoin, a quinolone antibiotic, such as ciprofloxacin or levofloxacin  or a tetracycline antibiotic to treat an infection.
• Do not take your calcium supplement with a high-fiber meal (such as bran, whole-grain cereal or bread, fresh fruits). Do not smoke cigarettes or cigars. Do not drink large amounts of alcohol or caffeine (for example, more than about 8 cups of coffee).

Warnings While Using This Medicine:
• Make sure your doctor knows if you are pregnant or breast feeding
• Make sure your doctor knows if you are allergic to shellfish
• Tell your doctor if you have kidney disease or have ever had kidney stones
• Make sure your doctor knows if you have had problems with too much calcium (hypercalcemia) or too little calcium in your blood (hypocalcemia). Some health problems that can cause hypercalcemia are sarcoidosis or problems with your parathyroid gland.
• Some health problems can affect how much calcium you should take. Tell your doctor if you have stomach or digestion problems, such as on-going diarrhea, not absorbing nutrients properly, or not having enough acid in your stomach.
• If you are using a large amount of calcium or using it for a long time, your doctor might need to check your blood on a regular basis. Be sure to keep all appointments.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:
• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Headache that will not go away, dry mouth, loss of appetite, severe constipation, nausea and/or vomiting, problems with memory loss or confusion.

If you notice these less serious side effects, talk with your doctor:
• Mild constipation, gas.

If you notice other side effects that you think are caused by this medicine, tell your doctor.

Aspirin

Use

• Treatment of pain, headaches, cramps and headache.
• Also used to stop blood clotting and to prevent a heart attack.

How to take this medicine
• This medicine is taken by mouth.
• This medicine should be taken with food or milk.
• If the tablet is enteric coated to protect the stomach, swallow tablet whole and do not crush.
• Most patients take this medicine once a day to stop blood clotting and to help protect the heart. Your doctor will tell you how much medicine to use and how often.
• Do not stop taking this medicine unless your doctor tells you to.

Side effects may include:
• Stomach pain
• Low iron in the blood
• Bleeding
• Hives
• Rash
• Asthma-like symptoms

Call your doctor right away if you have any of these side effects:
• Very bad stomach pain
• Bloody vomit or vomit that looks like coffee grounds
• Blood in your stools or urine
• Bleeding gums
• Confusion
• A skin rash
• Wheezing or difficulty breathing
• Ringing in the ears
• Swelling of the face or eyelids

Warnings
• Do not use aspirin if you have had an allergic reaction to aspirin or to pain and arthritis medicine, such as ibuprofen or naproxen (Naprosyn).
• Aspirin should not be given to children or teenagers with fever, chickenpox or symptoms of the flu, or viral infection. It can cause a serious disease called Reye’s syndrome.
• Talk with your doctor if you drink any alcohol. This may make you sick to your stomach and cause stomach bleeding.
• Tell your dentist that you are taking aspirin before each visit. This may make you bleed more.
• Tell your doctor if you have had ulcers, stomach bleeding, anemia, gout or asthma. You may not be able to take aspirin.

If you miss a dose:
• It is very important that you do not miss any doses of this medicine.
• Take the missed dose if it is only 2 or 3 hours from the time you were supposed to have a dose.
• Skip the missed dose if it is almost time for your next regular dose, then go back to your regular schedule.
• Do not take two doses at the same time.

Drugs and foods to avoid
• Talk to your doctor or pharmacist before using any over the counter, vitamins or herbal medicines.
• You may be at increased risk for bleeding if you are also taking any of these medicines:

warfarin (Coumadin, Jantoven)

clopidogrel (Plavix)

prasugrel (Effient)

ticlopidine (Ticlid)

dipyridamole (Persantine)

Storage
• Store this medicine at room temperature.
• Keep away from heat, moisture and direct light.
• Keep all medicine out of the reach of children.
• If the tablet changes color or there is a strong vinegar smell, check the expiration date or get the new medicine.

For questions about this medicine, contact your doctor, pharmacist or
transplant coordinator.

Dear friends,

We are professionals.  Our aim is to provide pharmaceutical care to patients in a hospital setting.  We have to show our professionalism to patients and other healthcare professionals at the same time.

Therefore, we are starting patient education series from today.  These are small points that can be conveyed to patients when dispensing medicines.  I know almost all of us aware of these facts about medicines, but we need brushing up and that’s why we are starting this patient care series.

Salbutamol

When You Should Not Use this Medicine:

You should not use this medicine if you have had an allergic reaction to
salbutamol or other drugs like salbutamol (such as ephedrine, epinephrine).

How to Use and Store this Medicine

Keep all medicine out of the reach of children.

Tablets:

• May be taken with or without food.
• Store at room temperature, away from heat, direct light, and moisture.

Extended-Release Tablets:

• Swallow tablets whole; do not crush or chew.
• May be taken with or without food.
• Store at room temperature, away from heat, direct light, and moisture.

If you miss a dose:

• Take the missed dose as soon as possible.
• Take the rest of the doses for the day at regularly spaced time intervals.
• You should not use two doses at the same time.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Tell your doctor if you are taking heart or blood pressure medicine or medicine for depression.

Warnings:
Tell your doctor before taking salbutamol if you have high blood pressure or heart disease, a thyroid problem, or diabetes.

• If you are pregnant or breastfeeding, talk to your doctor before taking this medicine.
• If this medicine does not help your breathing or if your condition gets worse while you are using it, call your doctor.

Side Effects
Call your doctor right away if you have any of these side effects:

• Chest pain
• Fast pounding heartbeat
• Severe headache or tremors
• Your skin starts to look pale or blue
• Wheezing or trouble breathing
• Seizures

If you have problems with these less serious side effects, talk with your
doctor:

• Restlessness, nervousness, or shakiness
• Headache, nausea, or vomiting
• Mild dizziness or drowsiness
• Trouble sleeping
• Loss of appetite or change in taste
• Pain or difficulty going to the bathroom (urinating)
• Muscle cramps

If You Have Other Side Effects That You Think Are Caused by this Medicine,
Tell Your Doctor