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Fact or fiction? Common medicine misconceptions

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recommendations should ideally be based on evidence,  not on out of date misconceptions, writes pharmacist John Bell

The advice we give our customers is always well intentioned; but very often it’s based on our own personal beliefs or those of our friends and family. Sometimes we pass on information that we’ve heard the pharmacist provide a patient. However, even this might be out of date or irrelevant. Here are a few common misconceptions about medicines and medical conditions – and what really are the facts.

Myth. Steroid creams and ointments should always be used sparingly; they thin the skin.

Fact. Studies have shown that indeed topical corticosteroid preparations can cause skin atrophy (thinning), but only when used for a prolonged time under extreme circumstances.

When used properly, even in children, there is no cause for concern; they are not dangerous and there is no skin thinning. The word “sparingly” should never be applied to directions for topical steroids. Instead, we should give more specific directions as to the quantity to use. For instance, the amount of cream or ointment measuring from the tip of the finger to the first joint (one finger-tip unit) should be enough to cover the area equivalent to both palms.

Myth. Ibuprofen should always be taken with food to avoid stomach upset.

Fact. All non-steroidal anti-inflammatory medicines (NSAIDs) taken orally can cause potentially serious gastrointestinal adverse effects; but this applies to prescription doses and generally when used over a long period of time. Studies indicate that when taken according to non-prescription recommendations, ibuprofen (Nurofen) and diclofenac (Voltaren) are no more likely to cause dyspepsia than paracetamol.

The recommendation to take ibuprofen or diclofenac with water, but not necessarily with or immediately after food, is reflected in the counselling advice in the latest edition of the Australian Medicines Handbook (AMH). When taken on an empty stomach these medicines are likely to work more quickly.

Myth. Green snot means antibiotics are necessary.

Fact. Mucus is important for normal body function; it keeps our tissues “well-oiled” and lubricated. We churn out over a litre of usually clear mucus every day. When the mucus becomes more sticky and, very patriotically, green and/or yellow, it’s just our immune system jumping into action, with the green colour-tinged white blood cells, to repel the irritants from an allergy or an infection.

With upper respiratory tract infections (URTIs), such as colds or flu, we know they are almost always caused by viruses; and even on those rare occasions when bacteria are involved, antibiotics are of little use. If the snot is a worry, regardless of colour, symptomatic treatments are the answer – not antibiotics. We could recommend a saline nasal irrigation, a decongestant spray (maximum five days) or even an intranasal corticosteroid.

Myth. Severe pain needs a pain reliever with codeine.

Fact. Codeine, a member of the opioid family, is a strong pain reliever.  However, for most people, at non-prescription doses, it is unlikely to provide extra pain relief over and above that provided by the single ingredient analgesics. A 30mg dose of codeine is generally considered the minimum necessary for analgesic effect; and at this dose, when taken regularly, side effects (constipation, nausea) are not uncommon.

The combination ibuprofen/paracetamol products – now Pharmacy-Only (such as Nuromol) have been shown to be more effective than either ibuprofen or paracetamol alone; and in some studies, at least equivalent in efficacy to ibuprofen or paracetamol with codeine.

Inflammatory pain (toothache, period pain, sports injuries) will often respond better to the anti-inflammatory pain relievers: diclofenac, ibuprofen or naproxen. The Pharmacist-Only paracetamol/metoclopramide combinations (Metomax or Anagraine) are a good choice for migraine pain.

This is an edited extract of an article which appeared in PS in 2016.

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