The good news is there are ways that people can save money – and save the government and taxpayers money at the same time. We look at some of the cost-saving measures you can take.

1. Understand how the Pharmaceutical Benefits Scheme works

Many commonly prescribed medicines in Australia are subsidised by the government under the Pharmaceutical Benefits Scheme (PBS). The of a medicine under the PBS is generally capped at two different prices: in 2022 this is $6.80 for people who are eligible for a concession (including holders of pensioners, health care, seniors’ health and Department of Veterans’ Affairs cards); and $42.50 for everyone else.Ìý

Given that some medicines can cost hundreds or thousands of dollars, the savings to consumers are enormous.

Track your spending in case you reach the safety net

If you buy a lot of medicine, safety nets also apply, so you pay a reduced price after reaching certain spending limits in a calendar year.Ìý

• For concessional patients this is $244.80, and after that PBS listed medicines are free.Ìý
• For general patients the safety net threshold is $1475.10, after which PBS listed medicines are charged at the concession rate of $6.80.Ìý

If you do go through a lot of medication it’s a good idea to ask your pharmacist for a prescription record form so you can keep track of your spending and receive safety net benefits.

Extra charges to be aware of

For some medicines, extra charges may apply, which can take the cost of medicine over the co-payment amounts. These charges include brand premiums, therapeutic group premiums or special patient contributions, and after hours and delivery fees. These extra fees don’t contribute to your safety net total.

• Therapeutic group premiums and special patient contributions affect very few medicines, and if you’re affected, you can ask your doctor about ways you might be able to reduce the cost – you might be able to change medicines or get an exemption.
• Brand premiums apply to products where a cheaper brand is available but you’ve opted for a more expensive one. You may be able to avoid the brand premium by asking your doctor or pharmacist to switch you to a cheaper, equivalent brand.

2. Shop around for discounts

The co-payment is the maximum price you have to pay. When a PBS medicine costs less than the co-payment, you simply pay the full price. It can be worth shopping around as some pharmacies are able to cut costs by dealing directly with manufacturers, and/or reducing overheads, and sell it cheaper than others.

If your medicine isn’t covered by the PBS, your doctor may write you a private prescription, and you pay the full price. Private prescription costs don’t contribute to your safety net, though you may get a rebate from your private health insurance company so be sure to check.

Under current laws, PBS medicines that are subsidised by the government cannot be discounted, unless it’s supplied as a non-PBS (private) prescription. Pharmacies can and do supply PBS prescriptions as private ones to save you money on the purchase. It also saves the government money, but remember, it won’t count towards your safety net.

If the safety net applies to you, check whether the prescription has been processed as PBS or private – a prescription record form (PRF) sticker is provided for PBS medicines.

3. Buy generic medicines

A generic drug is a copy of a branded drug. It is chemically equivalent to its branded counterpart but usually costs less. Generic drugs must meet the same standards of quality, safety and efficacy as branded drugs. The generic and brand drug may even be made in the same factory by the same manufacturer.Ìý

Some generic drugs may look different to their branded equivalent because they may have different inactive ingredients, also known as excipients, which include coatings, binders, fillers, colourings and so on. However, the active ingredient used is exactly the same, with the same dosage as the branded version.Ìý

Australian regulations require that the generic drug work in exactly the same way as the brand drug – that it’s ‘bioequivalent’. This means the active ingredient in both branded and generic versions must reach the blood system at the same speed and concentration.

While there is potential for excipients to alter the action of the active drug, these bioequivalency requirements mean any given medication should be unaffected by this. However, some people may have sensitivities to certain excipients, such as gluten or lactose, so it’s important to check these ingredients if you decide to switch to a generic brand. Excipients may also affect how the drug works in some individuals, though it’s uncommon.

Generic medicines can be a lot cheaper than the brand product, though for some you may only save one or two dollars. Generic medicines can save you money even if you don’t buy the generic version – having a generic competitor drives prices of the original brand product.

People paying the concessional prescription rate of $6.10 probably won’t save money buying a generic product, unless the price of the generic is lower than $6.10. However, it will save the government – and taxpayer – money.

4. Buy combination medicines

For some conditions, such as high blood pressure or diabetes, it’s common to take more than one type of medicine to manage the condition. Instead of taking two or more pills, these medicines are sometimes combined in a single tablet, which not only saves you money – instead of paying two or more co-payments, you only pay one – it’s also a lot more convenient.

The downside, though, is that for various technical reasons to do with pharmaceutical pricing, combination medicines often end up than the total cost of the individual drugs.

Think twice before…

Buying a medicine new to the market

If your doctor prescribes a medicine that’s new on the market, chances are it will cost you more – new medicines are patent-protected so there won’t be a generic equivalent yet.

But surely newer is better, and therefore worth the cost? Well, not necessarily. Often new medicines are not much different to older ones. In fact a survey of over 3000 new medicines introduced in France from 1981 to 2004 found only 10% had any advantage over existing therapies, and the advantage was mostly small.

Using medicine after its expiry date

Many people take medicine that’s past its expiry date to save money and a trip to the doctor and/or pharmacy for new medicine. Advice on taking expired medicine varies greatly, with some arguing it’s probably safe and worth taking when absolutely necessary and others saying it’s not worth the risk.

There are two issues with expired medicine – safety and potency. There are some expired medicines that are definitely unsafe to take, either due to a critical loss of potency or potential for degradation into undesirable products. These include epinephrine (EpiPen), insulin, some kinds of antibiotics, oral nitroglycerin for angina and eye drops.

The expiry date still applies to unopened medicine. Some medicines start to lose potency after the package has been opened, and should be used within a year of opening, even if that’s before the expiry date. Some, such as antibiotic suspensions and eye drops have a shorter life once opened – check the label for specific instructions.

Yet many medicines stand up well over time. A US military study found that many medicines were still good up to twenty years or more after their expiry date. Another study of medicines found in a pharmacy, some 40 years out of date, were still safe and effective.

Even so, the says it’s not worth risking it.

“Most medicines will slowly deteriorate over time, which can make them less effective and in some cases harmful,” warns NPS MedicineWise Chief Executive Dr Lynn Weekes.

“Australians can take their unwanted, unused or expired medicines to their local pharmacy for safe disposal. Disposing of medicines with their local pharmacist will ensure medicines do not end up in waterways or landfill”.

Storage conditions also affect longevity – the humidity of the bathroom cabinet or the heat of the car glove box will increase the rate of degradation. The tablets stored for the US military and in the pharmacy as mentioned above were kept in optimal conditions.Ìý

How not to save money

There are some things that look like they’ll save you money – but at what price?

Buying online from overseas

In general, Australian medicine prices compare favourably with many other developed countries. However, there are some medicines that are cheaper overseas and it may be tempting to buy them online.

The Therapeutic Goods Administration (TGA) warns that may not meet the same safety, quality or efficacy standards as ones bought in Australia. Potential risks include fake or counterfeit medicine, undisclosed ingredients, medicines past their use-by date or drugs that are contaminated or the wrong strength.

Fake online pharmacy scams

If you’ve ever received an email offering cheap prescription medicines with no prescription required, it could be a scam. At best they may steal your credit card details or upload damaging files to your computer, such as spyware or keystroke loggers. At worse, they might actually send you some medicine that either doesn’t work or even harms your health.

The ACCC has tips on how to spot .

Top tips for saving on medication

• Ask your doctor and/or pharmacist if there’s a less expensive version of your medicine – a different brand, a generic or an older out-of-patent medicine.
• Ask your doctor for a medication review – you may be taking medicine you no longer need. This is a good idea for health reasons, as well as to save money.
• Ask whether you’re entitled to exemptions from having to pay added premiums.
• If you take a particular medication regularly, try shopping around. Some larger chains will buy in bulk, allowing them to discount medicines that cost less than the general co-payment.
• Australian-based online pharmacies may offer a good deal if you need several medicines and don’t need them in a hurry – just make sure the savings are worth the postage costs.
• Don’t be tempted by cheap medicines from overseas.
• The .

The post How to save money on medicine appeared first on ÌÇÐÄVlog.

But is there really any difference between what are all just paracetamol or ibuprofen tablets? Do you get a painkiller that’s more effective when you pay more?

The short answer is no, not really. But given the plethora of painkillers on the market, it’s easy to be fooled.Ìý

ÌÇÐÄVlog investigated the OTC pain-relief market and found drug companies have successfully convinced consumers to pay nearly nine times more than they have to (based on prices at supermarkets and pharmacies in late February to early March 2020) for a humble ibuprofen or paracetamol tablet.

What’s the difference between branded and generic medicine?

When it comes to paracetamol and ibuprofen, there’s no difference in quality between branded and generic. Whether you pay three cents or 26c a tablet, the same dosage of paracetamol will work in exactly the same way. The same goes for ibuprofen.

This may sound like common sense, but it doesn’t seem to be guiding the way we shop for pain-relief drugs.

In fact, we’re more likely to choose Panadol or Nurofen, despite the rise of cheaper pain-relief alternatives on sale.

According to a 2019 survey, 12.4 million Australians buy pain relief products each month, with Panadol and Nurofen accounting for more than half those sales.Ìý

Limited manufacturers

Beyond branded paracetamol and ibuprofen, OTC pain-relief medicines sold in Australia are made by a limited number of companies. Various drug companies manufacture generic painkillers, to which private labels add their own branding.

For example, from its factories in India, Nova Pharmaceuticals manufactures OTC paracetamol and ibuprofen for Coles (private label) and Woolworths (Help@Hand and Essentials). Each paracetamol tablet contains 500mg of active paracetamol, and each ibuprofen tablet contains 200mg of active ibuprofen.Ìý

Although the inactive ingredients may differ, they don’t affect the efficacy of the drug (but check with your pharmacist if you have any allergies or intolerances)

Can some painkillers work faster than others?

Many painkillers on pharmacy shelves are marketed as”rapid action” or “rapidly absorbed” on their packaging. Panadol has various “fast” formulations such as Panadol Optizorb and Panadol Rapid. Nurofen also makes similar claims with its Zavance and Quickzorb range.

Both Nurofen and Panadol’s fast-absorbing drugs can cost up to almost double the price of their regular counterparts. But are they really any faster than regular painkillers, and are they worth the mark-up?

“Most of the hype about ‘faster-acting’ paracetamol or ibuprofen is just that – hype,” says Dr Louis Roller, associate professor in pharmacy practice at Monash University.Ìý

The sentiment is echoed by Gregory Peterson, professor of pharmacy at the University of Tasmania, who says that “on the whole, there is very little convincing evidence for any differences in speed or efficacy between the various forms of ibuprofen or paracetamol”.

Are liquid capsules absorbed faster?

The variety of premium products can be very confusing for consumers. Nurofen’s Zavance liquid capsules are generally the most expensive Zavance product on the market and are claimed to be “absorbed faster than standard Nurofen” – even though they have the same active ingredient (ibuprofen) as standard Nurofen tablets and caplets.Ìý

When we asked Zavance’s parent company, Reckitt Benckiser, about this, a company spokesperson said it’s because the active ingredient is absorbed faster in liquid format capsules than in the standard solid kind.

There is evidence that liquid capsules are absorbed faster than tablets, and Peterson suggests a soluble product, or aspirin, may be faster acting than solid tablets, too. But Roller says that most painkillers, whatever their format, are well absorbed anyway – within 15 to 30 minutes.

Ibuprofen vs paracetamol: What to take when

Panadol and Nurofen are the two main competitors in OTC painkillers, but they actually work differently to relieve pain.Ìý

Ever since ibuprofen went on sale in Australian supermarkets in 2004, ibuprofen has given paracetamol some competition. But it’s not always the best drug for the job.

In many cases, paracetamol and ibuprofen can be used interchangeably. Although it’s still not known exactly how paracetamol works, it’s considered safer than ibuprofen for most individuals, according to Peterson. It also costs less.Ìý

Anti-inflammatory

There are instances where ibuprofen may be a better choice. As an anti-inflammatory, it’s preferred for inflammatory injuries such as sprains. And it’s also recommended for headaches if you get them several times a week (some painkillers themselves cause headaches if you take them too often – but ibuprofen doesn’t).

Conversely, ibuprofen should be avoided by people with stomach ulcers and other gastric problems, high blood pressure, heart failure, asthma or those who are pregnant.

Combination paracetamol/ibuprofen

Peterson says there is clear evidence of the better effectiveness of a combination of one paracetamol and one non-steroidal anti-inflammatory drug (such as ibuprofen) for acute pain such as headaches, compared with either drug alone. (This finding doesn’t apply to persistent or chronic pain.)

Nuramol and Maxigesic are two branded OTC pain-relief products that combine ibuprofen and paracetamol in one tablet. You can also buy generic combination tablets, or simply take separate branded or generic paracetamol and ibuprofen tablets together.Ìý

But Roller says these combinations need to be monitored by a pharmacist because ibuprofen isn’t clinically suitable for everyone.

What’s the right dose of paracetamol or ibuprofen?

For adults and children 12 years and over:

• paracetamol: 4000mg in 24 hours (eight standard 500mg paracetamol tablets or six slow-release 665mg tablets).*
• ibuprofen: 1200mg of ibuprofen in 24 hours (six standard 200mg ibuprofen tablets).

*There is increasing evidence that the maximal safe dosage of paracetamol varies, especially for people who fast or drink alcohol excessively. Speak to your doctor if you have any concerns.

Prescription-only codeine

In 2018, low-dose codeine tablets were reclassified to require a prescription from a GP.

This was because “the risks associated with codeine use are too high without oversight from a doctor,” said the TGA at the time. “Codeine can cause opioid tolerance, dependence, addiction, poisoning and in high doses even death.”Ìý

The change hasn’t stopped GPs from prescribing codeine for those who may need it. But, for others, regular OTC medications such as paracetamol and ibuprofen can be just as effective without carrying the same risks as codeine.Ìý

Are pain-relief medications safe?

A large proportion of the analgesics we found on Australian shelves are made in India (often for non-Indian companies). It’s a country where pharmaceutical manufacturing has come under increased scrutiny in the past from the US Food and Drug Administration (FDA).Ìý

In 2013, Indian drug manufacturer Ranbaxy was found guilty of violating Good Manufacturing Practices (GMP) regulations, as well as making false claims to the FDA and falsifying documents.

Check the number

However, all the experts ÌÇÐÄVlog spoke with said OTC pain-relief medicines in Australia are well regulated, and that there’s no cause for concern about country of origin.Ìý

If it’s got theÌý number on it, which all OTC painkillers such as paracetamol and ibuprofen are required to have, it’s been through a rigorous regulation process by Australia’s Therapeutic Goods Administration (TGA).

How is pain-relief medication regulated?

According to a spokesperson for the TGA, its laboratories don’t test painkillers before approving them for sale, but rather assess them for safety, quality and efficacy, based on information and data submitted by companies.

Drug manufacturers in Australia are also required to demonstrate compliance with GMP, which is usually done through an inspection.

Overseas drug manufacturers must also prove compliance with GMP by means of documentation, or occasionally an on-site inspection if they can’t provide documentary evidence. Based on the company’s documentation and advice from TGA experts, the TGA decides whether or not to approve the product.

Tips for buying pain-relief medication

• When comparing medicine costs, look at products with the same or comparable active ingredients in the same dosage.
• Generally, the cheapest products come in tablet or caplet form.
• Supermarkets can be more convenient than pharmacies for buying OTC medicines, but they don’t always have the variety, higher dosage or larger pack sizes that pharmacies do.
• If you want something faster acting, choose a soluble product or the cheapest liquid capsule.
• According to recent studies, one standard paracetamol (500mg) and one ibuprofen (200mg) combined may work better than either product alone for acute pain, such as headaches, migraines and sprains. More generally, paracetamol costs less than ibuprofen, and is considered to have fewer adverse side effects.
• If you have any allergies or intolerances, speak to an in-house pharmacist or your GP about the ingredients in a painkiller before you take it.

The post Panadol and Nurofen vs generics: Which is better? appeared first on ÌÇÐÄVlog.

On this page:

• Paracetamol 500mg
• Ibuprofen 200mg
• Aspirin 300mg
• Hayfever and allergies
• Diarrhoea relief (loperamide hydrochloride 2mg)
• Cold and flu medication
• How we did our survey
• Supermarkets vs pharmacies
• What are over-the-counter (OTC) medicines?
• Generic vs branded medicines

But should you buy them from the supermarket or from a pharmacy? To find out which is cheapest, we compared the price per pill* of common OTC products with the same amount of active ingredients from Coles, Woolworths, Aldi, Amcal, Priceline Pharmacy and Chemist Warehouse.

*For simplicity, we’re saying ‘price per pill’, but the individual product may be a tablet, capsule, caplet, etc.

Notification (September 2021): To minimise the risk of poisoning,ÌýNSW Poisons Information CentreÌýrecommends that you only buy and keep the medicines you’re likely to use in the immediate future. A single packet of 20 tablets should be sufficient for this, as any ongoing use should be assessed by a health professional.Ìý

They alsoÌýrecommend to check your medicine cupboard regularly and return any medicines which are expired or no longer needed to the pharmacy for safe disposal.

Pain relief

We looked at paracetamol, ibuprofen and aspirin pain relief medication.

Paracetamol 500mg

Brands compared: Amcal Paracetamol, Coles Paracetamol, Essentials Paracetamol, Help@Hand Paracetamol, Herron Gold, Hedanol, Mendeleev Paracetamol, Panamax, Priceline Paracetamol, Pharmacy Care Paracetamol, Panadol, Panadol Extra, Panadol Mini Caps, Panadol Optizorb, Panadol Rapid, Value Choice Paracetamol.

Cheapest vs most expensive

Generally, you’re better off buying bulk packs of paracetamol in standard tablet form from pharmacies. The cheapest option we found was a 100 pack of Sanofi Panamax, which cost 2c per pill at Chemist Warehouse.Ìý

Cheap paracetamol tablets are also available at just 3c per pill in bulk (100 pack) sizes at Priceline and Amcal pharmacies and 20-pill packs at Aldi. Coles and Woolies have 20-pill packs for 4c per pill.Ìý

The most expensive option? Panadol Rapid (10 pack) at both Amcal and Priceline, at 35c per pill.Ìý

Need to know

As well as 500mg products, pharmacies also offer higher-dose, modified-release paracetamol tablets – mainly marketed at people with osteoarthritis – such as Amcal Osteo Relief, Osteomol 665 Paracetamol, Panadol Osteo and Paracetamol Osteo-Tab, which contain 665mg of paracetamol.Ìý

Amcal, Chemist Warehouse and Priceline each had a 665mg option for as little as 6c per pill.

Modified-release paracetamol is released more slowly into the body than immediate-release paracetamol. But due to health risks associated with its misuse, as of 1 June 2020 modified-release paracetamol will no longer be available over the counter. Instead, you’ll have to speak to a pharmacist before buying.Ìý

Should I pay more for caffeine?

Some paracetamol products also contain 65mg of caffeine. This is because caffeine can increase the number of people who report good pain relief by compared with the analgesic alone.Ìý

But caffeine comes at a cost. The cheapest combination product we found was Priceline Paracetamol and Caffeine (40 pack) at 22c per pill. If you’d prefer to buy Panadol Extra, you could pay as little as 29c per pill for a 40 pack in Chemist Warehouse – or as much as 50c per pill for 10 caplets in Coles and Woolworths. That’s a whopping 48c more per pill than Panamax, the cheapest 500mg paracetamol-only option.Ìý

You might think that’s not a bad price to pay for boosting pain relief. But you can get the same results by simply drinking a cup of coffee alongside your paracetamol, as a typical cup of espresso contains about 145mg of caffeineÌý (a dose is two 65mg tablets). That said, given the cost of a barista-made coffee, it’s probably cheaper just to buy the tablets!

Ibuprofen 200mg

Brands compared: Advil, Coles Ibuprofen, Essentials Ibuprofen, Hedafen Ibuprofen, Help@hand Ibuprofen, Herron Blue, Mendeleev Ibuprofen, Nurofen, Nurofen Quickzorb, Nurofen Zavance, Priceline Ibuprofen, Priceline Ibuprofen Sodium, Rafen.

Cheapest vs most expensive

Aldi, Coles and Woolworths all had the cheapest ibuprofen (24 packs of Hedafen Ibuprofen, Coles Ibuprofen and Essentials Ibuprofen, respectively) at 6c per pill.Ìý

Interestingly, that’s better value than all the bulk packs, and a saving of 44c per pill compared with the most expensive option: Nurofen Zavance (10 pack) at Priceline.

Need to know

Some of the ibuprofen products we looked at contain slightly different active ingredients: ibuprofen sodium dihydrate or ibuprofen lysine.Ìý

Studies have shown that these formulations give faster pain relief than standard ibuprofen. But it’s worth remembering that regular ibuprofen is pretty fast acting and 342mg ibuprofen lysine and 256mg ibuprofen sodium dihydrate are the equivalent of 200mg ibuprofen.

This is something to consider if you’re just looking for the cheapest pain relief, as the cheapest ibuprofen sodium dihydrate and ibuprofen lysine options were 10c and 17c more per pill respectively than the cheapest regular ibuprofen product.

Aspirin 300mg

Brands compared: Aspro Clear, Coles Aspirin, Disprin, Solprin, Woolworths Essentials Aspirin.

Cheapest vs most expensive

Cheap aspirin is available for 4c per pill at Coles and Woolworths (24 packs of Coles Aspirin and Essentials Aspirin) and Chemist Warehouse and Priceline (96 packs of Solprin). That’s 17c per pill less than the most expensive option: Aspro Clear (24 pack), which is 21c per pill at Coles, Priceline and Woolworths.Ìý

Need to know

Coles, Woolworths, Amcal, Priceline Pharmacy and Chemist Warehouse also had an extra strength option (aspirin 500mg). Of those, Chemist Warehouse had the cheapest on offer: Disprin Max (16 pack) at 25c per pill.Ìý

Aldi doesn’t sell any aspirin products.Ìý

Low-dose aspirin 100mg

Brands compared: Amcal Aspirin 100, Amcal Aspirin EC 100,Ìý

Astrix, Cardiprin, Cartia, Coles Low Dose Aspirin, Mayne Aspirin, Priceline Aspirin Low Dose, Spren 100.Ìý

Cheapest vs most expensive

Generally, 112 packs from pharmacies are your best buy. The cheapest we found was Mayne Aspirin (112 pack), which costs just 2c per pill at Chemist Warehouse. That’s a savings of 16c per pill compared with the most expensive option: a 28 pack of Cartia at Priceline.

Need to know

If you want to buy in bulk, you’re better off buying multiple packs of Mayne Aspirin from Chemist Warehouse. The biggest pack size we found was a 180 pack of Cardiprin, available at both Amcal and Chemist Warehouse, which works out as 9c per pill.

Hayfever and allergies

We looked at OTC hayfever and allergy medications containing three different types of active ingredients.

Fexofenadine hydrochloride (120mg)

Brands compared: Coles Hayfever Allergy Relief Fexofenadine, Telfast

Cheapest vs most expensive

A 30 pack of Telfast came in at just 65c per pill at Chemist Warehouse.Ìý Packs of 5 Telfast pills were the most expensive, costing $1.40 per pill at both Woolworths and Priceline.

Need to know

Unlike supermarkets, which only had 120mg pills pharmacies also stocked stronger and weaker forms of fexofenadine hydrochloride, with 60mg (Telfast) and 180mg (Telfast, Priceline Pharmacy Fexofenadine, Amcal Fexo 180, Pharmacy Care Fexo 180) available in Amcal, Priceline and Chemist Warehouse.Ìý

Amcal had the cheapest 60mg option, which was Telfast (20 pack) at 35c per pill.

Generally, it’s cheaper to buy the 180mg options in bulk: 70-pill packs range in price from 40c to 43c per pill compared with 10-packs at $1 to $1.60 per pill.Ìý

Cetirizine Hydrochloride 10mg

Brands compared: Amcal Cetirizine, Coles Cetirizine, Help@Hand Hayfever Relief, Pharmacy Care Cetirizine, Priceline Pharmacy Cetirizine, Zyrtec Rapid Acting.

Cheapest vs most expensive

Two 70-pack products tied for cheapest: Amcal’s own-brand Cetirizine and Pharmacy Care Cetirizine (also from Amcal), both costing 41c per pill. Amcal also had the most expensive option – a 14-pack of Zyrtec Rapid Acting, which cost $1.71 per pill.

Need to know

You might expect a product that claims to be “rapid acting” to cost more than a regular own-brand equivalent. But we found Zyrtec Rapid Acting for as little as 50c per pill in 70-pill packs at Chemist Warehouse – $1.21 cheaper than the most expensive option at Amcal.

Loratadine 10mg

Brands compared: Amcal Loratadine, Claratyne, Pharmacy Care Loratadine, Priceline Pharmacy Loratadine.

Cheapest vs most expensive

Priceline Loratadine (100 pack) costs 40c per pill, a whopping $1.86 less per pill than a 10 pack of Claratyne at Amcal, which comes in at $2.26 per pill.

Need to know

Priceline was the only store we looked at that had loratadine 10mg available in packs of 100. Chemist Warehouse’s biggest pack size was 75, Amcal’s was 60, and Coles’ and Woolies’ was just 10.Ìý

Diarrhoea relief (loperamide hydrochloride 2mg)

Brands compared: Amcal Anti Diarrhoea, Coles Anti-diarrhoea, Diareze, Gastrex, Gastro-Stop, Imodium, Imodium Zapid, Priceline Diarrhoea Relief.Ìý

Cheapest vs most expensive

Priceline Diarrhoea Relief (20 pack) was the cheapest overall at just 35c per pill. By contrast, Imodium Zapid (six pack) cost $1.87 from Amcal.

Need to know

Supermarkets only had six and eight packs available. Pharmacies also carried six and eight packs, as well as larger packs of 12 and 20, which tended to be better value.

Some supermarkets and pharmacies also stocked chewable and dissolving tablets. We compared these products and found Priceline Diarrhoea Relief Plus to be the cheapest chewable (active ingredient: loperamide hydrochloride 2mg, simethicone 125mg), at 83c per pill. Amcal had the most expensive option: Imodium Advanced at $2.02 per pill.

Generally, it’s cheaper to buy your diarrhoea relief as capsules or tablets rather than chewable or dissolving tablets.

Cold and flu medication

Supermarkets and pharmacies have a wide range of different cold, cough, sinus and flu medications with various combinations of active ingredients, some of which are only available in pharmacies.Ìý

If you’re not sure which product is right for you, speak to a health professional about your symptoms.Ìý

For our comparison, we looked at a nasal decongestant, two pain relief plus decongestant medicines, and a day/night option.

Nasal decongestant (phenylephrine hydrochloride 10mg)

Brands compared: Amcal Nasal Decongestant PE, Codral Cold Relief Decongestant, Dimetapp Nasal Decongestant, Pharmacy Care Nasal Decongestant PE, Priceline Decongestant, Sudafed PE Nasal Decongestant.

Cheapest vs most expensive

A 24 pack of Priceline Decongestant is 29c per pill. Nasal decongestants were better value in pharmacies than in supermarkets – 20 packs of Codral or Sudafed will set you back about 70c per pill at both the big two.

Pain relief and decongestant (paracetamol 500mg, phenylephrine hydrochloride 5mg)

Brands compared: Amcal Sinus Pain Relief PE, Coles Cold & Flu Pain Relief + Pe Decongestant Capsules, Codral Cold and Flu, Codral Relief Cold & Flu + Decongestant, Demazin PE Multi Action Cold & Flu Relief, Ease A Cold Non Drowsy Cold & Flu Plus Decongestant, Help At Hand Cold & Flu Relief, Panadol Paracetamol Cold + Flu Plus Decongestant, Priceline Cold & FLu Relief, Sudafed PE Sinus + Pain Relief, Vicks Action Cold & Flu Day Relief.Ìý

Cheapest vs most expensive

The cheapest way to buy pain relief and decongestant products is in 48 packs at pharmacies. Demazin PE Multi Action Cold & Flu Relief cost as little as 28c per pill at Chemist Warehouse.Ìý

Generally, we found the bigger the pack size the better the value, although the exceptions were Amcal and Priceline, whose home-brand 24 packs cost about 40c per pill.Ìý

The most expensive product we saw was Codral Relief Cold & Flu + Decongestant, which cost about 90c per pill at Priceline and Woolworths.

Need to know

When comparing the costs of the cheapest combined product with the cheapest stand-alone paracetamol plus the cheapest phenylephrine hydrochloride (PE) products, the combined option was cheaper by 3c per pill.

Some paracetamol and PE products also contain 100mg guaiphenesin (an expectorant that thins and loosens mucus, easing congestion). We found that 16 packs of Codral Relief 6 Signs Cold & Flu ranged in price from 87c to 97c per pill.

Pain relief and decongestant (ibuprofen 200mg, phenylephrine hydrochloride 5mg)

Brands compared: Nurofen Cold & Flu PE, Nurofen Cold & Flu Multi-Symptom Relief Tablets, Sudafed PE Sinus + Anti Inflammatory Pain Relief.

Cheapest vs most expensive

Sudafed PE Sinus + Anti Inflammatory Pain Relief is 43c per pill for a pack of 48 at Chemist Warehouse. A 20 pack of the same product costs about 78c per pill at Woolworths or Coles.

Day/Night tablets (paracetamol 500mg, phenylephrine hydrochloride 5mg, chlorpheniramine maleate 2mg)

Brands compared: Amcal Cold & Flu Relief PE Day Plus Night, Codral PE Cold & Flu Day & Night, Demazin PE Multi Action Cold & Flu Relief Day & Night, Dimetapp PE Sinus Day/Night, Mendeleev Cold & Flu Day/Night, Priceline Day + Night Cold & Flu Relief PE, Sudafed PE Sinus + Pain Relief Day/Night, Vicks Action Cold & Flu Day & Night Relief.

Cheapest vs most expensive

Mendeleev Cold & Flu Day/Night (48 pack) is 21c per pill at Chemist Warehouse. A 24 pack of either Codral PE Cold and Flu Day/Night or Sudafed PE Sinus + Pain Relief Day/Night costs 62c per pill at Amcal.

Need to know

Only available in pharmacies.

How we did our survey

Prices (non-sale) were those promoted on each supermarket or pharmacy’s website or in-store in Sydney branches in late February to early March 2020. We only compared products with the same or comparable amounts of active ingredient on a price per pill basis (for ease, we treated tablets, caplets, capsules,etc, as comparable). We didn’t look at liquid elixirs or products aimed at children.Ìý

Different dosage forms

Most OTC medicines we looked at had multiple dosage form options to choose from, such as tablets, capsules, mini-caps, caplets, liquid capsules, dissolving tablets, chewable tablets and enteric-coated pills. Our price comparison looked at the cheapest product per unit, no matter what form it came in.Ìý

Generally, the cheapest products were those that came in tablet or caplet form.

But although other dosage forms such as mini capsules, effervescent tablets, chewable tablets and liquid capsules can be more expensive, the price per pill varies from store to store, so it’s worth shopping around to find the best price if you prefer one form to another.Ìý

Supermarkets vs pharmacies

Sometimes you don’t have time to go to the pharmacy and just want the convenience of grabbing your pain relief alongside your potatoes from your local supermarket.Ìý

Supermarkets sell a number of OTC medicines (although Aldi only had paracetamol and ibuprofen on offer), but it’s worth remembering they don’t always have the variety, higher dosage, or larger pack sizes that pharmacies do. You can also get expert advice from an in-house pharmacist.Ìý

You might assume that supermarkets are cheaper than pharmacies, but we found that this wasn’t always true.Ìý Yes, some own-brand supermarket options equalled or beat pharmacies on price, but when comparing brand for brand and size for size, pharmacies would often work out cheaper per pill. So it’s worth shopping around, especially if you buy OTC medication regularly.

What are over-the-counter (OTC) medicines?

OTC medicines are non-prescription, non-complementary medicines used to treat mild health problems such as headaches, aches and pains, sore throat, nose congestion, fever, fungal infection or an upset stomach. They’re available at pharmacies, with selected products available in supermarkets, health-food shops and other stores.Ìý

All OTC medicines are either listed or registered with the Australian Register of Therapeutic Goods. Listed medicines are available off the shelf for people to buy. Registered medicines are considered higher risk and while many are also available off the shelf, some are only available from a pharmacist after a consultation.Ìý

Generic vs branded medicines

When it comes to active ingredients, there really isn’t any difference between a branded medication and it’s generic equivalent. According to the Therapeutic Goods Administration, generic medicines must contain the “the same quantitative composition of therapeutically active substances” as the originator medicine.Ìý

Not buying a big name brand can lead to some serious savings. For example, Panadol and Nurofen are, respectively, the first and second most-bought pain relief brands in Australia. When comparing 500mg paracetamol, the cheapest Panadol product was at Chemist Warehouse – a 100 pack of Panadol tablets costing 13c per pill. That’s 11c per pill more expensive than the cheapest non-Panadol product.

A comparison of 200mg ibuprofen products told a similar story when we looked at the price of various Nurofen products: Amcal and Chemist Warehouse had the cheapest option – Nurofen (96 pack) at 16c per pill. That’s 10c more than the cheapest non-Nurofen product.

That said, if you have allergies or intolerances, you should always talk to a pharmacist and check the inactive ingredients in case it contains something you’re allergic to.

For more information, read our guide on generic vs branded prescription medications.

The post Where to find the cheapest paracetamol, ibuprofen and more appeared first on ÌÇÐÄVlog.

On this page:

• Altered absorption
• Increased adverse effects
• The upshot?

Long practised in many different forms for religious and cultural reasons, fasting regimes are now followed by different groups of people for their perceived health benefits. For example, alternate-day fasting can help reduce weight, decrease insulin resistance and stave off diabetes. Meanwhile, the 5:2 diet, where participants eat normally for five days of the week with two days on a reduced-kilojoule intake, claims to increase life expectancy, protect against certain cancers and dementia and help with weight loss – though evidence is lacking.

As the potential health benefits of this type of diet become more widely known, so people with certain health problems, such as diabetes, obesity, high cholesterol or cardiovascular disease may be tempted to try such a regime in order to manage or even reverse some of their health problems.

Chances are, however, these people may be taking regular medication to manage their health problems, and the potential effects of fasting on medication have been addressed by senior pharmacists Gina McLachlan and The-Phung To in the 16 February issue of the .

McLachlan and To explain that the concerns generally fall into two categories: altered absorption, and increased gastrointestinal side effects or other adverse effects from taking the medication on an empty stomach.

Altered absorption

Tablets and capsules start to disintegrate in the stomach, and then move into small intestine, from where many drugs are absorbed into the bloodstream. Food slows down the rate at which medication leaves the stomach and enters the small intestine, and in turn affects how quickly the drug reaches the bloodstream.

If it’s absorbed too quickly – as could happen on an empty stomach – the blood levels may become too high, and have an excessive response. Conversely, food can increase the absorption of drugs. For example, only about one-quarter of the drug telaprevir, for treating hepatitis C, is absorbed when taken while fasting compared to taking with a meal.

While more investigation is needed, some examples of medicines for which changes in absorption may prove problematic are tretinoin (for acne), anti-retrovirals, anti-parasitic drugs and some angina medications.

Increased adverse effects

Taking some drugs on an empty stomach can increase the risk of side effects such as gastrointestinal upsets, as the food helps protect the stomach from components of the drug. You’ve probably seen labels on medicine warning it has to be taken with food – ibuprofen and aspirin are common examples.

Another example is someone with diabetes who starts a fasting diet, which may provide benefits in terms of weight loss and improved insulin sensitivity. The flipside, warn McLachlan and To, is that diabetes medications glibenclamide, glimepiride and insulin carry a high risk of hypoglycaemia if continued as normal when fasting.

Medications for which adverse effects may be increased if taken while fasting include some types of antidepressants, antibiotics and immunosuppressants.

The upshot?

“We urge all people who are taking regular medication and considering starting – or already on – a fasting or other calorie-restrictive diet to speak to their pharmacist or doctor to discuss whether the diet may affect their medication,” says McLachlan.

The post Fasting diets may affect medication appeared first on ÌÇÐÄVlog.

On this page:

• Who is at risk?
• Why so many drugs?
• Unnecessary medicines
• Taking medicines incorrectly
• Under-medicating
• The solution
• Medicine audit
• Be fully informed
• Lifestyle medication
• More information

Adverse drug events account for more than 400,000 GP visits and 190,000 hospital admissions annually. These figures are conservative and don’t necessarily include hospitalisations for injuries, such as car accidents or falls, that may have been a result of medication issues.Ìý

While it’s hard to put a total dollar cost to the health system of medication-related problems, in 2008 hospital admissions alone were estimated at $660 million. Yet about half of these hospitalisations were likely avoidable.

Who is at risk?

The most commonly implicated drugs are cardiovascular medicines, anticoagulants, anti-inflammatories and chemotherapy medicines. People most likely to be affected are those who:

• take five or more medications together
• use 12 or more doses per day
• have had significant recent changes to their treatment regimen
• require ongoing monitoring of medication effects
• have language difficulties, problems with dexterity, poor eyesight or dementia
• attend several different doctors.

Many elderly people are at risk of adverse events from medicines, which can result in hospital admissions. Not only are they more likely to suffer adverse drug events, but their recovery is likely to be poorer.

Why so many drugs?

People these days are relying more heavily on medications than ever before, with the average number of daily drug doses per person more than doubling in the past 20 years. There are several reasons for this:

• The trend to treat single conditions with several drugs.
• Risk factors for disease are increasingly managed with medication.
• Lifestyle-related conditions, which are on the increase (such as heart disease, high cholesterol, high blood pressure and diabetes), are more conveniently treated with medicines than with a better diet or more exercise.
• We’re living longer and acquiring more health conditions along the way that need treatment.
• Prescription medicines, while helpful in treating or preventing relevant health conditions, often have side effects, and sometimes the side-effect costs outweigh the benefits of the drug. A classic example is benzodiazepines – prescribed to help people sleep, they also increase the risk of falls and broken bones in elderly people.

Polypharmacy

Polypharmacy is the term for people taking many medications – with an accepted clinical definition of “many” being five or more. It’s estimated that up to 40% of Australians over 65 are on five or more medications, sometimes with dire consequences. If all drugs have a small chance of side effects, taking different medications combined increases the overall risk and introduces the additional danger of interactions between medicines.

One example is warfarin, a commonly prescribed anticoagulant that interacts with some anti-fungal pills and creams, anti-arrhythmic drugs, thyroid drugs and diuretics, among others, to increase the risk of bleeding. Over-the-counter medicines such as aspirin and herbal medicines such as St John’s wort can also interact with prescription medicines.Ìý

On the other hand, taking a few different medicines for some conditions can help reduce the dose of each, and therefore reduces the risk of side effects. And when treating infectious diseases, such as tuberculosis and HIV, multiple drugs can reduce the development of drug-resistant strains. However, drug combinations in these sorts of situations have usually been adequately tested.

Promotions

When prescribed appropriately, medicine is usually helpful for most people – but that’s not always the case. When in doubt about the potential effects of a particular medicine on a patient, a doctor often relies on information from clinical trials, journal articles and drug company advice. They may also be influenced by marketing and promotions, opinion leaders and treatment guidelines that recommend prescribing for specific diseases, without taking individual circumstances into account.

There is plenty of evidence to suggest pharmaceutical representatives and other forms of promotion have a heavy influence on prescribing habits. The consequence is increased prescribing of expensive new drugs (whose benefits and side effects are often uncertain) and decreased prescribing of older, more cost-effective generic drugs.

Beers Criteria

In 1991, the Beers Criteria – a list of medicines considered inappropriate for elderly people – was developed by geriatrician Dr Mark H. Beers. It has been updated and reviewed since then, most recently in 2012. The risks of medicines on this list, which include sedatives, muscle relaxants, antihistamines and antidepressants, are greater than any potential benefits, yet a study in 2005 found 21% of Australian veterans aged 70 or older were prescribed at least one of the medicines on the list in the previous three months.

Part of the problem is that in the drug trial phase, they’re likely to be tested on people with a single condition rather than those with multiple conditions taking a variety of medicines. Middle-aged men are often chosen due to otherwise reasonable health and no confounding hormonal effects. Once the drugs are out in the real world, however, unknown problems may surface. TheÌý (NPS) recommends trying a dose half that of a typical adult dose when prescribing for older people.

Unnecessary medicines

Sometimes doctors may feel it’s not their responsibility to withdraw medications prescribed by another doctor, so patients may be prescribed something for a temporary condition that has since resolved. One of our members alerted us to another problem resulting from lack of clear communication between doctor and patient: that of when to stop taking medications with repeat prescriptions. This has also led to patients being prescribed a new brand of a particular medicine — or given a generic instead of a brand – but taking both the old and the new at the same time.

A review of 31 studies looking at withdrawing certain medications from older patients found that in many cases, anti-hypertensives, benzodiazepines and antipsychotics could be successfully reduced or eliminated with no adverse effects, and sometimes lead to improvement in quality of life. In another study, GPs were trained to review medications of elderly people, and following that training were able to successfully reduce the number of medications taken by their patients.

Taking medicines incorrectly

Lack of information, instructions that are difficult to understand and complex regimens can lead to patients not taking medicines correctly. (CMI) leaflets are available from pharmacists, doctors and the National Prescribing Service for all prescription medications (they’re sometimes found in the medicine’s packaging too), but are not always offered or asked for.

Nor do prescribers always get it right. Australian researchers found that 10% of adults with chronic illness were given the wrong medicine or dose in the previous year. Other research has found about 20% of prescriptions among the general community were of the incorrect dose.

Under-medicating

So far, the problems discussed refer largely to over-medication, where too much, too many or the wrong kinds of medicines are taken. Another significant issue is under-medication. There are several reasons for people not taking medicines, including confusion and forgetfulness, or neglect on the part of their carer. Medical professionals may also have prescribed too low a dose, or have missed a condition altogether. Patients who suffer side effects may also stop taking medicines, as, conversely, do patients who feel better, before they’re actually fully recovered.

It’s estimated about one in five adults with chronic illness skips a dose or doesn’t fill a prescription due to cost. Many older people, and others who require lots of medicine, have a concessionary status that entitles them to low-cost medicines. They pay a nominal amount for prescriptions, called a co-payment, and when they (or their family) have spent a certain amount — up to the safety net threshold – in a one-year period, prescriptions are free for the rest of that year.

Even a small increase in the co-payment amount can reduce medicine taking. In 2005, an increase from $3.70 to $4.60 had a noticeable effect on the number of prescriptions being filled, with low-income members of the community choosing to forgo certain medicines. Subsequent research on this found that the greatest drop was for medicines prescribed for chronic but asymptomatic conditions, such as:

• anti-platelet medicine (to prevent blood clots)
• osteoporosis treatments
• combination (prevention and symptom control) asthma medicines and proton-pump inhibitors (used to treat gastro-oesophageal reflux).

While some of these can be replaced by over-the-counter medicines, there’s no way of knowing to what extent this occurred.

The solution

There’s no single solution to the problem of adverse drug events or over- and under-medication. What’s needed is a greater recognition of the problems caused by polypharmacy, and a move to reduce prescription of unnecessary medicines, as well as systemic changes.

Geriatrician Professor David Le Couteur recommends the following strategies:

• Have a single doctor — usually your GP — manage and oversee all your medical issues and medications.
• If any new symptom occurs, consider whether this might be due to an adverse reaction to a medication.
• Conduct a medicine audit.
• Discuss with your doctor (or pharmacist) whether new medications are justified and current medications are still required.

Medicine audit

It’s important to regularly assess all the medicines you’re taking — not just prescription products, but also over-the-counter and herbal medicines, and even dietary supplements. This can reduce the likelihood of interactions or taking unnecessary or inappropriate medicines.

The US has “brown bag days”, where elderly people take all their medicines to their doctor to check for necessity and inter-drug interactions, as well as expired use-by dates. This simple but effective approach could be useful here.

People whose medication regime puts them at risk — including polypharmacy, age, recent hospitalisation, recent changes to medication and/or having multiple doctors – are entitled to a Medicare-funded Home Medicines Review. In cooperation with the patient’s GP, a suitably qualified pharmacist visits the patient at home, reviews their medication regimen and provides the GP with a report. The GP and patient then agree on a medication management plan. Talk to your doctor or pharmacist about this service.

Be fully informed

Take medicines only as directed. If your doctor hasn’t explained how they should be taken, or you’ve forgotten, ask the pharmacist. For complex medication regimes, ask the doctor or pharmacist to put it in writing.

Read the prescription label when you get the medicine, and confirm your understanding of it with the pharmacist. If it’s a new medicine, make sure you’re aware of any possible side effects. Ask for the CMI leaflet if it’s not included with the medicine. If your new medicine makes you feel unwell, tell your doctor.

And we can’t stress this enough: inform your doctor of all medicines you’re taking, including over-the-counter medicines and herbal remedies and supplements. They may seem harmless because they’re not prescription-only, but even “natural” supplements are still made of chemicals, and they can interact with other medicines.

Lifestyle medication

Ask your doctor about lifestyle changes that may help reduce the need for medication. The majority of the 10 most commonly prescribed PBS medicines – the ones the government subsidises – are for conditions that can be caused by poor lifestyle choices, or managed with appropriate lifestyle changes.

• Medications to reduce high blood pressure and treat angina comprise three of the top 10 medicines prescribed. Poor diet, being overweight, smoking, excessive alcohol consumption and lack of exercise all contribute to high blood pressure and heart disease.
• Proton pump inhibitors, taken to reduce the effects of gastro-oesophageal reflux and stomach ulcers, make up two of the top 10 medicines prescribed. Dietary factors, cigarettes, alcohol, obesity and overeating can cause reflux, or make it worse, as can medications for blood pressure, anticholinergics and anti-inflammatories.
• Three of the top 10 medicines prescribed are statins, costing taxpayers over $1 billion per year. They’re taken to reduce cholesterol levels and the risk of heart disease. Lifestyle improvements, including a better diet and more exercise, could substantially reduce this bill.
• Two types of medication used for managing type-2 diabetes, the latest lifestyle-related disease epidemic, feature in the top 10, with the main one, metformin, clocking up 3.4 million prescriptions per year.

These illnesses and conditions can’t always be prevented or managed with lifestyle changes, but a high proportion could. People often find it more convenient to pop a pill than change their lifestyle, and doctors know that withholding medicine will simply mean ill-health and higher costs further along the line in the form of hospital admissions, disability and premature death.

More information

The is a government-funded body responsible for providing health professionals and members of the public with information and advice about medicines. It has a lot of useful information for consumers, including the printable, wallet-sized .

What ÌÇÐÄVlog wants

• Greater recognition of and adherence to Beers Criteria medicines when prescribing for the elderly.
• Greater consideration of non-pharmacological therapies in conjunction with or instead of drugs.
• A reduction in the role of pharmaceutical marketing to doctors and in hospitals, and reduced role of drug companies in creating treatment guidelines.
• A review of the role of pharmacists in primary care. As more health professionals acquire prescribing rights, pharmacists will increasingly become gatekeepers for individuals’ medication regimes. Research has shown closer collaboration between GPs and pharmacists, and improved medication reviews by pharmacists, can help identify and resolve medication-related problems.

Case study

Repeat scripts spark alarm

Andrew Ross* tells how taking his father for a medicine review revealed a major flaw in prescribing practices.

“My late father was an elderly man with his faculties intact. One day when visiting him, I came across his medication ritual. He would line up all his medications and take them one or two at a time, depending on the instructions. After one series of dosages, he would line up the next and set his alarm clock so as not to forget, and so on. He knew why he was taking each medication, and showed me his bathroom cabinet which was full of nothing but medicines.”

Despite his father’s objections, Andrew made an appointment for both of them to see his father’s doctor.

“At this appointment I asked the doctor what medications my father should currently be taking. The doctor named four, all for managing his blood pressure and blood coagulation. I then told the doctor how many and what medications my father was taking regularly. The doctor was dumbfounded and asked Dad why. Dad replied, “I had the repeats and you never said to stop taking them.”

The doctor then alerted everyone in the practice to their duty of care regarding prescribing medications, particularly repeat prescriptions. The doctor had assumed patients would stop taking one medicine when prescribed another.

“The doctor, a GP who specialises in geriatrics, has since discussed this with his peers and discovered almost none told patients when to stop taking medicines, unless there was a contraindication,” says Andrew.

* Name changed

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On this page:

• Bananas
• Grapefruit
• Milk
• Black liquorice
• Kale and other leafy greens
• Air-dried sausages or aged cheese
• Coffee
• Alcohol
• Talk to your doctor

And indeed, for most people, eating plenty of fresh fruit, vegetables and low-fat dairy is good for their health, while having a glass of wine or two or a cup of coffeeÌýis no drama either.

But what many may not know is that some foods interact badly with certain medications. This means your meal could end up reducing the efficacy of your drugs, or worse still, could become a health nightmare.

Which foods and drugs don’t mix?

Read on to find out (though the usual disclaimer appliers: this is a non-exhaustive list, so talk to your doctor before making any changes to your diet or your medication).

Bananas

Don’t eat them if you takeÌýACE inhibitors such as captopril, enalapril and fosinopril among others. ACE inhibitors lower blood pressure and treat heart failure by opening up blood vessels, so blood flows more efficiently.

Why not?ÌýBananas (as well as oranges, leafy greens and certain salt substitutes) are high in potassium. Too much potassium can cause an irregular heartbeat and heart palpitations. Avoid eating large amounts of foods high in potassium if you’re on ACE inhibitors, and tell your doctor if you’re taking potassium supplements or diuretics.

Grapefruit

Don’t eat it if you takeÌýaÌýrange of medicines including some lipid-altering agents/statins – which lower the rate of production of bad cholesterol – anti-anxiety medicine buspirone, the anti-malaria drug quinine, the antibiotic erythromycin, or triazolam –Ìýa medication used to treat insomnia. See theÌýÌýwebsite for an exhaustive list of medicines that don’t mix well with grapefruit.

Why not?ÌýChemicals in grapefruit interfere with how your body metabolises certain drugs, which can result in more of the medicine ending up in your bloodstream. It can increase the chance of side effects if you’re on the lipid-altering statins.

Milk

Don’t drink it when you takeÌýsome antibiotics including tetracycline, ciprofloxacin (quinoloneÌýantibiotics), and certain osteoporosis medication, such as alendronate (Fosamax).

Why not?ÌýCalcium can interfere with the effects of some antibiotics, so you shouldn’t take these at the same time as eating foods high in calcium, like milk, yoghurtÌýor cheese. Supplements containing calcium should also be avoided for a few hours before and after taking these antibiotics.

Black liquorice

Don’t eat it if you takeÌýglycosides like digoxin, which treat heart failure and abnormal heart rhythms.

Why not?ÌýLiquorice contains glycyrrhizin. Mixing digoxin with glycyrrhizin can cause irregular heartbeats and could even lead to a heart attack. Herbal liquorice extract can also interfere with a host of other medications including insulin, certain antidepressants, oral contraceptives, blood thinners, and some other medications.

Kale and other leafy greens

Be careful if you takeÌýanticoagulants/blood thinners such asÌýwarfarin. They lower the chance of blood clots forming or growing larger in your blood or blood vessels, and are used to treat people with certain types of irregular heartbeat, prosthetic heart valves and those who’ve had a heart attack.

Why?ÌýKale and other leafy greens are chock-full of vitamin K, which can make anticoagulants less effective. Foods high in vitamin K include green vegetables, egg yolks, chickpeas and lentils. They shouldn’t be cut out of the diet entirely, but it’s important to eat a steady and consistent amount of vitamin K-rich foods.

Also avoidÌýlarge amounts of cranberry juice or cranberry products while using anticoagulants, because they can change the effects of warfarin, and limit garlic and ginger because they can increase the chance of bleeding.

Air-dried sausages or aged cheese

Don’t eat them if you take Monoamine oxidase inhibitor (MAOI) drugs like phenelzine, tranylcypromine, or procarbazine, which may be prescribed for depression or as a chemotherapy treatment for Hodgkin’s disease or lymphoma.

Why not?ÌýTyramine, found in some proteins, is particularly concentrated in foods that have been aged, matured or fermented, like salami, pepperoni, pastrami, bacon, and mature cheese such as camembert, gouda, mozzarella and aged feta, among others. But MAOI drugs compromise your body’s ability to process tyramine, putting you at risk of side effects including a sudden and severe increase in blood pressure, severe headaches, chest pain, rapid heartbeat, nausea and vomiting, among others.

Coffee

Don’t drink it if you useÌýclozapine, an antipsychotic.

Why not?ÌýCaffeine can increase the amount of certain antipsychotics in your blood, and put you at greater risk of side effects. You should also exercise caution if you’re on bronchodilators for asthma – consuming a lot of caffeine can inhibit their effect in an emergency.

Alcohol

Don’t drink it if you takeÌýa host of different medications, but particularly sedatives like certain antihistamines, painkillers including morphine, codeine and paracetamol, diabetes medication, drugs for HIV/AIDS and antibiotics. The more medications or drugs that are combined with alcohol, the greater the risk. Make sure you read any warnings or ask your doctor or pharmacist before drinking if you’re on any medication.

Why not?ÌýIt may seem like the pharmacist is being a killjoy when they give you a warning about alcohol, but alcohol can be toxic when mixed with the wrong medications. It can increase side effects –Ìýincluding the risk of gastrointestinal damage after taking painkillers – as well asÌýreducing or increasing the effects of certain other medication. Some of the common symptoms of a bad interaction between alcohol and medication include: drowsiness, dizziness, impaired motor control, memory problems, nausea, stomach cramps or vomiting. And you don’t need to drink a lot to feel the effect – these symptoms can appear after as little as one drink.

Talk to your doctor

The advice provided here is a guide only, and is not an exhaustive list of medications that interact badly with food or drinks. And not all quantities of food will lead to side effects, so talk to your doctor before starting a new medication or cutting out an important element of your diet. You can also get in touch withÌýÌýif you have any questions about your medications.

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