Taking medicines safely and effectively (detailed factsheet)
This section has detailed information about some of the things that are useful to know and understand about taking medicines safely:
What is the problem?
Quite simply, if you do not take medicine properly, it might not help you get better, or it can even make you ill.
People not taking medicines properly is the reason for more than 1 out of every 20 emergency re-admissions to hospital.
We know that almost 1 in every 3 people do not take their regular medicines in the right way. Of these people:
- just over half of them do not even realise that they are taking their medicines in the wrong way
- just under half of them either choose not to take it, or decide to take it in a way that they think is better
There are more medicines around than ever before. People are also living longer, so they need more of those medicines for longer. So it is really important that people understand about taking them properly.
Why don't people take medicines properly?
There are all sorts of reasons. People can:
- forget to take the medicines
- take too much or too little
- take them at the wrong time
- take someone else's
- take other remedies that interfere with the medicine
The following information is to help you to have the confidence that you are taking your medicines safely.
Different types of medicines
What is a medicine and what is a drug?
Sometimes people talk about drugs and medicines as if they are the same thing. So what is the difference?
Drugs
This is something that is taken into the body and changes the way the body works. For example, alcohol and caffeine are all drugs as they alter the way the body acts after taking them.
Medicines
Medicines contain drugs in a specially prepared form for different reasons such as:
- to treat an illness
- to stop an illness occurring
- to relieve symptoms of an illness
- to improve the quality of life
There are three main legal classes of medicines:
General sales list medicines (GSL)
These can be sold anywhere such as the supermarket, corner shop or petrol station. They include things like a lot of the standard pills or hot drinks you might get for headaches, sore throats and colds.
Pharmacy medicines (P)
These can only be bought from pharmacies where a pharmacist is on duty. You will have to ask for them or the pharmacy team will recommend one to you. You won't need a prescription, but they won’t be on the main shelves of the shop. These might include stronger or bigger pack versions of some of the general sales list medicines.
Prescription only medicines (POM)
These can only be obtained from a pharmacist if you have a prescription and cannot be bought normally. These include some controlled drugs for medicinal use.
You may also use or hear about 'herbal medicines' like St Johns Wort. These aren't legally classified as medicines, but they can still affect other medicines, so you should let your doctor or pharmacist know if you are using them.
Different formulations of medicine
Medicines are available in different types (pharmacists may call them 'formulations'), such as liquids, tablets and eye drops.
The type of the medication determines how it should be used:
- is it a tablet, or a liquid?
- is it something you swallow, or spread on your skin?
- is it something that dissolves quickly or slowly?
Sometimes there is more than one formulation for a particular medicine so that you can choose one that is most suitable for you. For example, there are several different types of tablet:
Tablet
These are 'traditional' tablets made of compressed powder.
Caplet
These are shaped like a capsule and coated for easier swallowing.
Capsule
These can be powder, liquid or oil in a gelatine shell.
Enteric coated
These are for medicines that would be damaged by the acids in your stomach. They have a coating which is not affected in the stomach, but which dissolves in the small intestine.
Please note
You must not cut or crush these before you take them, because that will destroy the protective coating, and they will not work.
Time release
These release the medicine slowly. This allows you to take one tablet when otherwise you might have to take more during the day.
Please note
You must not cut or crush this sort of tablet as it will release all the medicine at once which could be dangerous.
Lozenge
These dissolve in the mouth.
Meltlets or wafers
These dissolve on the tongue.
So why do people take medicines incorrectly
There are many reasons why people do not take their medicines in the right way.
- Answer:
Many people do not know why they are taking their medicines, or what each medicine is for. This means you might still be taking a medicine which is no longer the right one for you, and that might do you more harm than good!
If you aren't sure, do not just guess. Many medicines can be used for more than one condition. You may know someone else who is taking the same medicine, but it might not be for the same condition!
If you don't know what your medicines are for, you should keep taking the medicine, but you should talk to your doctor, or ask your pharmacist about it. They will help you understand what it is you are taking, and they will be able to confirm whether you should still be taking it.
If you can, you should keep medicines in their original packaging because:
- it keeps the medicines in good condition
- the information on the label is really important
There is a lot of text on the label which must be there by law. It can be difficult to read and understand, but the instructions on there are really important.
It must include the following, all of which is a good idea to read and understand:
- what the medicine is (its form and its strength)
- total quantity dispensed (the amount of medicine in the box or bottle)
- how much to take
- when and how to take it
- warning or cautionary instructions (for example 'take with food')
- storage instructions - if needing refrigeration
- patient name
- pharmacy address and telephone number
- date of dispensing (the date that the pharmacist gave it to you)
- the expiry date of the medicine should be on the main container
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Sometimes you may find that the medicine you are prescribed for a condition has a different its name or looks completely different. If you are worried, check with your doctor or ask a pharmacist. It may be because it has changed from a 'brand name' medicine to a 'generic medicine'.
When a medicine is first invented, the company who invented it can call it whatever they want (which is usually referred to as brand name). Because they invented it, they have the right to be the only ones that are allowed to make it for certain number of years. This is known as a 'patent'.
When the patent expires, other companies can make the same medicine and call it whatever they want. If it is a supermarket or pharmacy chain, they usually choose the name of the active ingredient, and these are known as generic medicines.
For example, Nurofen is a branded medicine which has ibuprofen as its active ingredient, and a supermarket’s own label generic medicine is usually named as 'Ibuprofen'. Both branded and generic medicines in the UK must be made to the same standards, otherwise they cannot be sold to the public. However, generic medicines are usually much cheaper than the branded medicines.
When buying medicines have a look on the packet of branded medicines to see what the active ingredient is. Then find the supermarket's or the retailer's own label which has the same name as the active ingredient. Sometimes, the two medicines won’t look the same, for example the colour or shape of the tablet may be different. But if the generic (own label) medicine contains the same active ingredient in the same amounts as the branded medicine, then you can be sure that you are getting the same active medicine.
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Some medications come with the exact instructions for use every day, such as 'take 1 tablet by mouth every 8 hours.'
But they are not always as clear as that, they can often be confusing, and can be written in a way that could have more than one meaning. The following describes some of the more commonly written directions, and explains what they actually mean.
Take as directed
This is not helpful unless there are also written directions provided. The doctor or pharmacist should not expect a patient to be able to remember the dosing instructions. You should always check with the pharmacist or doctor to make sure that you fully understand and are able to check what the directions are.
One to be taken when required
Some medications are only used when required or as needed for a specific situation. This could be for pain killers, or for conditions such as such angina chest pains, the common cold, allergies, constipation, or pain. It's important to know the difference between daily and 'as needed' medicines.
To be taken an hour before food or on an empty stomach
When a label says take on an empty stomach it is because food in the stomach can stop the tablets work as well.
This can be an issue as many patients seem to think there should be food in the stomach to line the stomach, so the medicine will not cause stomach issues. This is true for some medicines such as ibuprofen but certainly not all. If the medicine says take on an empty stomach then that is what you should do.
Usually take one hour before eating any food. For example one hour before your breakfast (or leave about two hours after you have eaten a meal).
To be taken with or after food
In the opposite way, some medicines work better with food in the stomach. You should not take the medicine on an empty stomach.
It means you can take the medicine just before, right after, or while you are having a meal. This is because certain medications can cause an upset stomach if not taken with food. Also, some medications are absorbed better when taken with food.
One to be taken three times a day
When the medicine label on the medicine says to take three times day it generally means 'take every 8 hours'.
For example we divide 8 hours into 24 hours which gives us 3. Therefore four times a day would be 'every 6 hours,' (24 divided by 6 = 4).
However, you would not wake the patient during the night so:
- for four times a day you would take at breakfast, lunch, supper, and bedtime
- for three times a day you would take at breakfast, dinner and tea
Try to spread out the dose during waking hours.
One to be taken at night
Some medicines are better to take at night. This could be a sleeping tablet. However, some medicines work better while you are asleep such as cholesterol lowering medicines.
Other medicines are taken at night because the side effects will not be noticed by the patient if they are laying down asleep, such as dizziness.
Warning or cautionary instructions
Swallow whole - do not crush
Time release capsules or tablets that dissolve in the body over a long period of time must not be crushed or broken in half because the long release design will be altered or even stopped.
Take regularly and complete the course
This is usually seen on instructions for antibiotic medicines.
It means to take evenly throughout the day and finish all the medicine. This is really important to make sure that an infection is killed. Otherwise it increases the chance of infections developing resistance to the antibiotics. A big worry for the medical profession!
Take with plenty of water
This means a glassful. And it means cold water – not a hot cup of tea! Some medicines are made ineffective by heat. By drinking it with hot tea, you might stop the medicine working!
Apply sparingly
For a cream or ointment, this means apply it thinly. It usually needs about a fingertip's amount to cover size of a hand.
Shake the bottle
Do this thoroughly! It may be because the active ingredient tends to settle to the bottom.
- Answer:
Taking tablets and capsules
- Have a drink of cold water ready (some medicines are damaged by heat, so don’t use a cup of tea!)
- Make sure you are upright and comfortable.
- Take a sip of drink then place the medicine in the middle of the tongue and swallow. Keep the chin slightly downwards. (Some people throw their head back to help swallow tablets, it really doesn’t help!)
- Finish the drink.
Taking liquid medicines
- Shake the bottle. This is really important, sometimes the important part of the medicine will settle out into the bottom. If you just drink the liquid on top, you might not be taking any medicine!
- Measure the correct dose.
- If using an oral dose syringe expel the liquid to the middle of your tongue not back of throat. It could make you choke!
- Clean the bottle with damp tissue before replacing lid.
Taking soluble or dispersible tablets or powders
- Take the correct amount of tablets from original container.
- Place in a third of tumbler of cold water
- Swirl the solution gently in the glass to ensure adequate mixing.
- Some products do not taste nice so drink more water afterwards.
Using creams, ointments and gels
- Read the instructions and use only as instructed.
- Apply the medicine only where prescribed (for example your arm or leg).
- Use only the smallest quantity that will easily rub in.
- Use only for as long as stated in the prescription. Wear disposable gloves if you are applying the cream to someone else, otherwise you will be absorbing the medicine yourself!
- Transfer the quantity needed to the glove.
- Gently rub into the skin.
- Dispose of gloves in a sealed polythene bag and place in general waste container.
Eye drops
There are a number of gadgets that are available that can help you with things like eye drops. Take a look at our ‘interactive house’ to find out about the range of equipment that’s available.
If you don’t have one, there are some basic rules you can follow:
- follow the directions on the label
- wash your hands
- remove contact lenses, (then wait 15 minutes before you put them back in)
- shake the bottle
- be careful not to let the tip of the dropper touch any part of your eye
- make sure the dropper stays clean
- leave 5 minutes between drops
- tilt your head back and look at the ceiling
- using your index finger, pull down your lower eyelid to form a pocket
- gently squeeze 1 drop into the pocket
- gently close your eyes and lightly press on the inside corners of your eyes
- carefully blot away any excess liquid that may be on your skin
Eye ointment
- Apply the same way as you do with eye drops by forming a pocket with the bottom lid.
- Hold the tube above the eye and gently squeeze a 1 cm line of ointment along the inside of the lower eyelid.
- Blink eyes to spread the ointment over the surface of the eyeball.
- Wipe away any excess ointment with a clean tissue.
It is important to remember that your vision may be blurred when you open your eyes. Do not rub your eyes! The blurring will clear after a few moments if you keep blinking.
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Remembering when to take a medicine
Forgetting to take medicines (or forgetting if we have already taken medicine) happens to us all. It's a really good idea to find tips and tricks to help us to remember what to take and when to take it.
If you have a smartphone or a smart speaker with apps such as 'Alexa' or 'Siri' you can use them to set reminders to take medicines.
One good idea is to tie your medicine doses with a daily routine like:
- breakfast time
- after a shower
- when getting ready for bed
If you do that, try to keep the medicines in a place that acts as a reminder (like near the kettle, or by your toothbrush).
If medicine needs to be stored in the refrigerator, consider posting a sticky note reminder on the fridge as a reminder to take it when it's time.
Medicine reminder charts
Pharmacists recommend that medicine reminder charts are the best way of keeping track of doses of medicine. They are also sometimes known as medicine administration records (MARs).
Reminder charts are particularly helpful because they:
remind you of the actual times during their day to take your medicines
show which medicines can be taken at the same time. This helps to reduce the number of different times you take medicine per day
help you to link the taking of medicine to routine daily activities
This example uses meal times, but 'cleaning teeth' or 'reading the morning paper' may be more helpful.
You may be able to make the chart up yourself from the different medicine instructions. If not, it's worth asking at your local pharmacy, as they may be able to print you out a chart based on your own prescription.
You can also buy special dispensing boxes that you can put your pills in. Some of these are automated and can even remind you when to take your medicine. Take a look at our ‘interactive house’ to find out about the range of equipment that’s available. These can be really helpful if the ideas above don't work, but it's better not to take the medicines out of their original packaging until you need them, so pharmacists strongly recommend you try something like a medicine reminder chart first.
How long should you take your medicine for?
People sometimes think that when their medicine pack or bottle finishes that they don’t need the medicine any more. Or they may think that they can stop taking their medicine if they start feeling a bit better.
For example, people have been known to stop taking blood pressure tablets after one month's supply and then think they don’t need them any more. They do!
Many medicines are meant to be taken for long periods of time or even for the rest of your life. Suddenly stopping taking some medicines can be really dangerous. It's very important to keep taking a regular prescription medicine and not stop until you have checked with your doctor.
If you have a short course of antibiotics, it's also important to finish all of it to reduce the risk of developing antibiotic resistances.
If in doubt, ask your pharmacist. They will be able to check your prescription and will let you know if you need to talk to your doctor about continuing to use the medicine.
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Any medicine can cause some sort of side effect, even those bought in a supermarket. Some people will have a side effect with any medicine, where another person will not have any issues with any of them. You are more likely to get side effects if you do not take the medicine correctly.
If you do experience a side effect, it will usually not be serious and tends to disappear after taking the medicine a little while. If you are unsure you should speak to a pharmacist.
Most patient information leaflets now list the known side effects, and class them as:
- very common (more than 1 in 10 people are affected)
- common (between 1 in 10 and 1 in 100 people are affected)
- uncommon (between 1 in 100 and 1 in 1,000 people are affected)
- rare (between 1 in 1,000 and 1 in 10,000 people are affected)
- very rare (fewer than 1 in 10,000 people are affected)
You should tell your pharmacist or your doctor if you think you are affected by any of them – especially if it is one that is considered rare or very rare.
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It is better to leave medicines in their original packaging, but sometimes that can cause problems.
It is a legal requirement that all medicines are originally supplied in a child resistant containers. This can make it difficult for people with arthritis or other conditions if they do not have the strength to open bottles.
If this is a problem for you, or someone you care for there are a number of things you can do:
- request non-childproof tops from your pharmacist when collecting the medicine
- ask for wing tops, although these are not always available
- ask for blister packs rather than bottles
If you are a carer or family member, you may think about leaving the lids loose or putting the tablets out on trays or special dispensing boxes.
Some other good practice in keeping and disposing of medicines
Storage of medicines
Many people store their medicines in the bathroom or kitchen. This may not always be the best idea as these areas are generally warm and moist. Medicines should be stored at room temperature and away from sunlight.
In general:
- keep medicines safe, and out of reach of children
- keep them cool and dry, and away from direct sunlight
- keep medicines in the original containers if you can
- only store in the fridge if the label says so. (Some people think that all eye drops go in the fridge, but this is not the case)
- keep liquid medicine that you put in your mouth in a different place from liquid medicine that you put on your skin so that you don’t muddle them up!
Disposing of medicines
Medicines contain ingredients that may be harmful to the environment, so they need to be disposed of in a safe manner. Take any medicine that you no longer need back to a pharmacy, it is a normal part of their job to receive waste medicine and dispose of it safely. You do not have to return it to the pharmacy that provided it.
Remember:
- don’t keep used or out of date medicines in the home
- never throw them into the bin
- never put medicines down the sink or down the toilet