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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!

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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.

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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.

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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.

Some think all medicines must be taken after meals. The correct way is to follow the directions on the medicine label. Why must some medicines be taken on empty stomach?

Empty stomach is defined as one hour before eating or 2 hours after eating. Some compositions in food might interact with the drug, affecting the absorption and lowering the effectiveness. Some might increase the amount of medicine in your blood to potentially dangerous levels.

A special example to share is the intake of bisphosphonates. Bisphosphonates is used to treat osteoporosis. It is recommended to take on am empty stomach in the early morning. After administration, the patient should not have food, drink or mediciations for at least 30 to 60 minutes, and stay upright for at least 30 minutes to prevent the drug from causing oesophageal irritation if stayed for too long.