Audio podcast - Understanding medicines

The key to dealing with medicines effectively is to understand them. This information aims to explain a little more about how medicines are organised in the UK, understanding your prescription and who to ask for more information.

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Medicines can be confusing. On the one hand, we are told that they can cure an illness or improve our symptoms, but on the other, they can be dangerous if taken incorrectly. The key to dealing with medicines effectively is to understand them.

Pharmaceutical, or medicine making companies, are always carrying out research to find completely new medicines, or discover new ways of using existing ones. It is never a quick process to develop a new medicine – the one’s that make the news have usually been in development for 10’s of years, costing millions of pounds before they are released.

How medicines are developed:

All medicines contain an active ingredient. Some active ingredients are man-made, but many are derived from nature, such as extracts from plants. For instance, the cancer medicines vincristine and vinblastine contain an active ingredient that is found in periwinkle plants.

The pharmaceutical industry has to find a way to produce the active ingredient in large enough quantities to make the medicine. This might mean making an artificial version of the active ingredient, or if it is plentiful, purifying it. Once the pharmaceutical company has solved this puzzle, the next stage is to find out how to mix the active ingredient with other substances to form a liquid, tablet, capsule or other form of medicine. The medicine then goes through several stages of testing to make sure that it works as it was designed to do, and to find out about any possible side effects. These tests are called clinical trials and can last for many years.

Once the clinical trials have been completed, the medicine is submitted to the Medicines and Healthcare Products Regulatory Agency (MHRA). All medicines and medical products have to be regulated by the MHRA who monitor them continually, and can withdraw one if concerns are raised.

Anyone can report side-effect or problems with medicine products to the MHRA; you don’t have to be a doctor or pharmacist. More information about this is available from the MHRA.

Difference between prescription only medicines and over the counter medicines in the UK:

There are two main categories of medicine available in the UK; prescription only medicines (POMs), or over the counter medicines (OTC).

POMs can only be given to patients with a prescription signed by a doctor, or other registered prescriber. These medicines tend to be ones that need closer supervisions or regular monitoring by a doctor. Doctors often prescribe medicines for which there is an OTC alternative, so if you pay prescription charges it’s worth asking the pharmacist if there is an OTC version.

OTC medicines are those that you can buy without a prescription. Such as; mild painkillers, cough and cold remedies and antacids. You can buy some of these from a supermarket, but others can only be bought from a pharmacy. Even though you can buy OTC medicines without a prescription you should still take care, taking them in the wrong way, or combining with other medicines, can still have serious side effects.

Prescriptions, what the writing means, and what happens when you take it to your community pharmacy:

Your prescription is an order from the prescriber to the pharmacist saying that you need a particular medicine. You may also hear a prescription be called a “script”. These days most prescriptions are generated by computer so the pharmacist no longer has to decipher a doctor’s handwriting.

The prescription should contain your name and address, and age if you’re under 16 years old. The name of the medicine will follow next, usually with the name and strength first, followed by the dosage. Finally, the number of tablets or capsules, or length of the treatment course is included.

In years gone by, some parts of the prescription used to be written in Latin, but this rarely happens now.

When you take your prescription to the community pharmacy, you should fill in the back of the form if you are collecting the medicine on someone else’s behalf, or you are receiving certain benefits.

Remember: children in England under 16, or under 19 in full-time education, receive free prescriptions. If you live outside of England, the situation may be different, so check with your pharmacist.

The pharmacist may ask you some questions to check whether the medicine prescribed could interact with any other medicines that you are taking, this includes OTC medicines, herbal, and complementary medicines too. The medicine will then be dispensed by the pharmacist who will count out the number of tablets or capsules, or measure the amount of liquid, adding a label to the package or bottle.

When you receive your medicine, check that you understand you label. It should contain your name, and the date that it was dispensed, along with instructions for taking the medicine. It will also give special instructions for instance; if the medicine should be taken after food or on an empty stomach. The pharmacist will check that you understand the instructions before you leave the pharmacy.

Patient information leaflets:

Patient information leaflets are provided by the manufacturer of the medicines, and have to be given to patients when the medicines are dispensed. They have to conform to a certain format and contain particular information.

The patient information leaflets describes; the medicine, its active ingredients, how it should be taken and the possible side effects that could happen. The majority of side effects are identified when the medicine is being tested, and they are all included in the patient information leaflet. They can make for worrying reading, but remember that some of the reported side effects are extremely rare.

Sometimes the patient information leaflet might not mention the reason that you are taking the medicine, or may be misleading. This is because some medicines were developed to treat one condition but were found to help a completely separate condition.

If you are concerned about what is written in the patient information leaflet, please talk it over with your pharmacist.

Unlicensed medicines for children and what this means:

Some medicines use to treat children’s illnesses are said to be unlicensed, which means that the reason that they are being used is not covered by the licence.

Manufacturers might not have included children in the clinical trials used to test the medicine, so cannot include them in the licence application. In other circumstances, medicines may not have a licence at all, often because they are used to treat very rare conditions. Despite this, you can be assured that your doctor has only prescribed an unlicensed medicine because they think that it will benefit your child, and no licenced alternative is available.

Recently some changes have come about to increase the number of medicines being developed and tested specifically for children. For instance; medicines that can be used for children will be given a licence once the company has given details of the investigations that it is planning. Investigations into children’s medicines through Europe will also be recorded centrally so that testing is not repeated unnecessarily.

Generic medicines (that is, unbranded medicines) can also take out a licence under the Paediatric Use Marketing Authorisation, or PUMA scheme. Medicines that are newly developed, and/or only used to treat a small number of people will also be able to take out a licence. This is unlikely to impact on you as a parent, but in the long term will mean that fewer unlicensed medicines will need to be used.

Alternative and complimentary medicines are often available over the counter in health food shops. But, like mainstream medicines they can still have harmful effects if taken improperly.

Herbal and complementary medicines:

Herbal or homeopathic medicines are known as alternative or complimentary medicines. These are different to mainstream medicines as they are not subject to the same rigorous testing and there is some debate about whether they are effective and if so, how they work.

They are often available over the counter, sometimes with little information about them available. For instance, some vitamins can be harmful if taken in too higher dose and others are not recommended for children at all. Some can interact with how prescribed medicines work, for example; St John’s Wort.

Whether you decide to give your child alternative and complimentary medicines is up to you, but it is important that you tell your doctor about all the medicines that your child is taking. This will let them work out if there are any possible interactions.

Your pharmacist should always be your first port of call if you have any questions about medicines. Most community pharmacies have a quiet room where you can talk to a pharmacist in private and many hold a selection of health information leaflets as well.

Ref: 07F270 © GOSH Trust November 2007
Compiled by the Pharmacy department in collaboration with the Child and Family Information Group