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When we were young, we were often educated by our parents that an injection is better than oral medication as it is more effective in curing the illness. The younger we could only suffer the pain of injection. Why doesn’t the doctor give us injection as often as before after we grow up?

Oral medication and injection are two different methods of administration. They have their own pros and cons. Oral medications are the most economical and convenient way of administration. Taking the medicine orally is convenient and patients can simply take it at home. Injection usually acts faster on bodies and has a shorter induction period. For people who have trouble swallowing pills, injection is the only option. Medicines like insulin is a protein which will be digested in our stomach so it cannot be orally administered. It is usually administered by subcutaneous injection.  The injectable antipsychotic drugs have long-lasting effects and the patients only need to take them once in a few weeks. It is ideal for patients who have difficulties in following the dosing schedule and they can still keep up with the treatment.

Is injection or oral medication better? There is no absolute answer to this question. It depends on the drug and also the conditions of the patient. Follow the instructions of the doctor and choose the safest way will do.

Hong Kong is a city where the cultures of east and west meet. A lot of people will combine both traditional Chinese and western treatments when they are ill. Is this synergistic or antagonistic?

Although Chinese medicine might seem milder, the fact is all of them have their active ingredients and they might react with the chemicals in the western medicine. Some said they should be taken at least two hours apart. However, if the effect is long-lasting, two hours might not be sufficient to avoid the drug interactions.

The best way is to consult your doctor before deciding on combining the two kinds of treatment. No matter such method is strengthening or weakening the efficacy, they will both increase the burden of your body especially the liver. Never make the decision on your own but seek professional advice first.

Doctors always ask if the patient has drug allergies during medical consultation. Such information will be clearly written on the medical history. Drug allergy is not uncommon and its consequences can be disastrous so do not neglect its importance.

Drug allergy is an immune response when your immune system reacts to a certain type of medicine. The drug type and symptoms vary from person to person. Hence, all medications are capable of inducing an allergy. You may not experience allergic symptoms the first time you take a drug but it might happen the next time. Common symptoms include skin rash, swollen lips, wheezing, etc. Stop the medication immediately and seek doctor’s advice if any of allergic reactions appear.

Some will mix up drug allergy with side effect. Drug allergy is related to the health conditions of individuals. It is unpreventable and unpredictable. What we can do is to avoid it from happening again after we discover it. Side effect is an undesirable effect occurs in addition to the desired therapeutic effect of a drug. It is usually related to the dosage and can be found out by pharmacology and clinical research.

Why do the doctor always advise us not to crush the tablets or open the capsules? Let me explain to you the reason behind!

Some medications are specially designed and should never be crushed or cut, such as controlled-release and sustained-release pills. They are designed to release slowly over time into the body. Crushing them will lose such function and result in a sudden surge of drug concentration and hence an overdose. Most capsules should be swallowed whole and never take out the powder inside. The coating of the tablets and capsules protects our stomach wall as well as protects the drug from erosion by gastric acid. It can also mask the bitterness of drugs so we can swallow them easily.

If you or your children have difficulties in swallowing the tablets or capsules, tell your doctor or pharmacist. They will suggest alternatives with different methods of administration, such as syrup or water-soluble drugs.

Many people will purchase medicines aboard as they think those products are more effective with better quality. Some might even put the medicines up for sale over the internet. Medicines are not ordinary products. The import and sale of pharmaceutical products in Hong Kong are regulated by legislations. Sale of these products online might have infringed the law too!

In Hong Kong, medicines must be registered before sale. The safety, efficacy and quality of the pharmaceutical product will be assessed before getting an approval for registration. Other than that, the local legislation in regulating the pharmaceutical products might be more stringent than that in other countries. One has to obtain specific licenses before importation and sale to protect the public safety. Unregistered pharmaceutical products of doubtful composition purchased overseas might not be able to cure the diseases and their safety and quality cannot be guaranteed.

You are advised to visit registered pharmacies with a “Rx” logo displayed outside the shop. The registered pharmacists will recommend the most appropriate medicine for you and it is the safest way to go!

There is no doubt that people are paying more attention to their appearance. Apart from the makeup, teeth whiteness is also their concern. To maintain the brightened and white teeth, a lot of them will avoid consuming food or drinks which can stain the teeth, such as coffee, tea, red wine and curry. What they do not know is that other than diet, medication can also stain the teeth.There is no doubt that people are paying more attention to their appearance. Apart from the makeup, teeth whiteness is also their concern. To maintain the brightened and white teeth, a lot of them will avoid consuming food or drinks which can stain the teeth, such as coffee, tea, red wine and curry. What they do not know is that other than diet, medication can also stain the teeth.

If discolouration is caused by diet or smoking, we can still treat it with the usual teeth whitening methods. But staining caused by medication can be difficult to reverse. The antibiotics tetracycline, which is used for fighting bacterial infections and severe aches, is proved to be one of the culprit of teeth discolouration. If pregnant women or children under the age of 12 use tetracycline, it will bind to and settle into the calcium in the teeth. After exposure to light, the affected teeth will gradually turn into a darker colour permanently.

In recent year, the researchers have developed a new generation tetracycline antibiotics. U.S. Food and Drug Administration has approved the use of this medicine for acne treatment. It has proved to have a lower binding affinity with calcium, hence a lower chance of teeth staining caused by mediciation.

When children fall ill and the symptoms are mild, most parents will purchase over-the-counter medicines to ease the symptoms. One major problem is the paediatric medicines on the market are limited in variety. Some might instead give their children smaller doses of adult medicine. This poses risks to their health so it is not recommended.

The kids are constantly growing and developing. Their nervous, digestive and metabolic systems are immature so the adult medicines might work very differently on them. The doses must be precisely calculated. Children are not just small adults. We cannot simply reduce the amount of a drug to a child based on a proportion of the child’s body weight to an adult. This is because these medicines are clinically tested on adults only and the safety on children is unknown.

Also, there are medicines that children should never take:

• Aspirin
  Aspirin is used to reduce inflammation, pain and fever. Reye's syndrome may occur when adolescents are given aspirin. This illness can cause severe damage to liver and the brain. Children who are under 16 years of age should not take aspirin, unless it is on the advice of a doctor.
   
• Codeine
  Codeine is commonly used to treat coughing. There are over 300 registered pharmaceutical products containing codeine in Hong Kong. It acts on the central nervous system to have an analgesic effect. Although it is effective in cough suppression, the risk of respiratory depression in children is present. Hence, Hong Kong Department of Health has restricted on its use in children aged below 12. For adolescents aged 12-18 years who have health conditions that may increase the risk of breathing problems, unless the benefits outweigh any risks, or codeine use is not recommended. The health conditions include obesity and severe lung diseases, which will induce hypoventilation. Medicines causing respiratory depression should not be used together with codeine either.

As a prudent measure, you should consult a doctor or pharmacist to choose the best treatment for your children. Keep all medicines out of children’s reach to avoid the danger of mistaken consumption or poisoning.

(Available in Chinese only)

HKU Clinical Trials Centre is committed to the advancement of human healthcare and the focus of work is new treatment development. Even if there are new treatments to cure the illnesses, using or storing the medication in a wrong way may bring adverse effects. How do you handle the leftover medicines? I guess 9 out of the 10 Hong Kong people will answer: keeping it in a fridge. They think those leftover medicines can be used for critical needs which might arise, while putting them in a fridge can extend its expiration date. Is it true?

Proper storage of medicines is critical to its effectiveness and safety. Drugs are sensitive to moisture, sunlight and heat so most of them should be stored in a cool, dry place and away from direct sunlight. Unless specified on the pharmacy label, medicines should be stored at room temperature. If the medicine is not stored at the correct temperature, the effectiveness may be unfavorably affected. It will damage the medicine because of the water moisture formed in it when taking out from the fridge. On the other hand, eye drops require refrigeration but should not be used longer than one month after the bottle is opened.

In the modern days, people usually live a busy life. It is not uncommon for them to miss a dose of medication. What should they do? Take the missed dose immediately, or double up the amount at the next dose?

Generally speaking, for oral drugs, if it is only 2 hours since your missed dose, you can still make up for it. If it is over 2 hours, you should decide depending on the dosing frequencies.

• If the medicine is only taken once or twice daily and there is a few hours until the next dose, go ahead and take the missed dose then take the later doses as usual.
• If the medicine is taken three times or more a day, it is recommended to take your next dose at the normal schedule.

Bear in mind that never doubling up on the medication even you miss a dose. It might cause a sudden surge in drug concentration and increase the chance of getting unwanted adverse effects.

This is a general recommendation. For the differences in drug effects and health conditions of individuals, consult your doctor or pharmacist when questions arise.