When a man comes to me for advice, I find out the kind of advice he wants, and I give it to him.

Henry Wheeler Shaw, a.k.a. Josh Billings

Health information on the internet

Millions of consumers are using the Internet to get health information. And thousands of web sites are offering health information. Some of those sites are reliable and up-to-date; some are not. How can you tell the good from the bad?

The medicines that sold online can be fake (counterfeit or 'copycat' medicines); can be too strong or too weak, or have dangerous ingredients, or have expired (are out-of-date), or haven't been approved or checked for safety and effectiveness, can be made using non-safe standards, or not safe to use with other medicine or products you use.

You have to talk with your doctor and have a physical exam before you get any new medicine for the first time. Use only medicine that has been prescribed by your doctor or another trusted professional.

Be sure your privacy is protected: look for privacy and security policies that are easy-to-find and easy-to-understand. Don't give any personal information such as social security number, credit card, or medical or health history, unless you are sure the website will keep your information safe and private.

Understanding the drug interactions

There are more opportunities today than ever before to learn about your health and to take better care of yourself. It is also more important than ever to know about the medicines you take.

Drug interactions may make your drug less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you.

Reading the label every time you use a nonprescription or prescription drug and taking the time to learn about drug interactions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.

Early in a drug's development, companies conduct research to detect or predict potential interactions between drugs. Experts evaluate the drug-interaction studies as part of assessing a drug's safety.

Mixing two drugs together could make one of the drugs ineffective. The combination also could increase a drug's effect, and be harmful. The result might be mild symptoms such as nausea, stomach upset, or headache, or more serious symptoms such as a dramatic drop in blood pressure, irregular heart beat, or damage to the liver-the primary way that drugs pass through the human body.

The most important enzymes in the liver that metabolize drugs are called the cytochrome P450 family of enzymes. These enzymes break down drugs when they pass through the liver or small intestine.

A drug may affect these enzymes by inhibiting them, which causes reduced activity of the enzyme and a buildup of the drug in the body. Or drugs may "induce" the enzymes, which causes increased activity of the enzyme and a reduction of the drug in the body.

This phase of research in test tubes, known as in vitro studies, allows researchers to perform drug-interaction studies in labs by testing a drug with other drugs that have the same route. This has made the research faster and more accurate. If two drugs go through the same enzyme, the presence of one drug can prevent the metabolism of the other. So this allows you to look at the worst-case scenarios and ask: 'What if we put this drug with that one, knowing that they have the same route?'"

In addition to having a good grasp of drugs and their effects, doctors take medication histories, and they consult with other members of their team to guide them in making decisions about drug interactions. They also use concise drug summaries and resources on pharmacological principles.

Health professionals also use computer systems with drug-interaction screening software, electronic prescribing, and other technology. Mark Langdorf, M.D., chair of the department of emergency medicine at the University of California, Irvine, says, "In a busy emergency room, you have to quickly find out what a patient is taking and how those drugs could interact with other treatments."

But it is good way -- consumers remind doctors of everything they take when they are prescribed a new medication. So a patient might say: "Now remember, I'm also taking birth control pills. Is there a risk of interaction with this new medicine?"

Drug interactions with other drugs includes both prescription and over-the-counter medicines. Tricyclic antidepressants such as Elavil (amitriptyline) and Pamelor (nortriptyline) can interfere with blood pressure-lowering Catapres (clonidine). Taking the antibiotic Cipro (ciprofloxacin) with antacids lowers Cipro's effectiveness.

Drug interactions with dietary supplements includes herbs and vitamins, which can interact with drug-metabolizing enzymes. St. John's wort is an herb commonly used by people with cancer to improve mood, but research has shown it interferes with the metabolism of irinotecan, a standard chemotherapy treatment. Vitamin K (in dietary supplements or food) produces blood-clotting substances that may reduce the effectiveness of blood-thinning medicines like warfarin.

Understanding your medicines

The benefits of medicines are the helpful effects you get when you use them, such as lowering blood pressure, curing infection or relieving pain. The risks of medicines are the chances that something unwanted or unexpected could happen to you when you use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage.

Before using any medicine--as with many things that you do every day--you should think through the benefits and the risks in order to make the best choice for you.

There are several types of risks from medicine use: a) The possibility of a harmful interaction between the medicine and a food, beverage, dietary supplement (including vitamins and herbals), or another medicine. Combinations of any of these products could increase the chance that there may be interactions. b) The chance that the medicine may not work as expected. c) The possibility that the medicine may cause additional problems.

The same is true before using any medicine. Every choice to take a medicine involves thinking through the helpful effects as well as the possible unwanted effects.

You need keep an up-to-date, written list of ALL of the medicines (prescription and over-the-counter) and dietary supplements, including vitamins and herbals, that you use--even those you only use occasionally.

Read and follow the directions on the label and the directions from your doctor, pharmacist, or other health care professional. If you stop the medicine or want to use the medicine differently than directed, consult with your health care professional.

Ask your doctor always if there are interactions with any other medicines or dietary supplements (including vitamins or herbal supplements), beverages, or foods. Use the same pharmacy for all of your medicine needs, whenever possible.

You always have to pay attention to how you are feeling; note any changes. Write down the changes so that you can remember to tell your doctor, pharmacist, or other health care professional.

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