Healthy Life
We asked Douglas Defty, pharmacy services executive at Mediclinic, to answer your FAQs about side effects, generics and expiry dates.
What are generics and why are they cheaper?
Let’s say a pharmaceutical company does a lot of research and development on hypertension, for example, which costs them a lot and takes many years to get that drug onto the market. They’ve also paid for patent protection on it for say 20 years. During that time no one else can market and sell the same product with the same active ingredients. After the patent expires it means the product can now be copied.
The generic companies haven’t put in the research and development costs and clinical trials, but they must register their product and it must comply with (in South Africa) the Medicines Control Council (MCC). A generic drug must contain the same active ingredient and the same dose as the original. It must also be in the same dosage form – if the original is a tablet, the generic must a tablet. Although cheaper, generics are not inferior in quality and promote cost savings within healthcare. If there are any problems your pharmacist will report it to the MCC and it will be followed up.
Is the pharmacist allowed to give me a generic substitute?
The law says the pharmacist may substitute with a generic – unless the patient says no; or if the doctor has specifically said not to substitute with a generic; or if the product you’re going to substitute it with is more expensive. Many medical aids only pay for generics and your pharmacist should explain to you the benefits of using a generic – it’s more affordable and as effective.
Is it OK to use medication that has expired?
An expiry date is decided on after thorough testing. A production company will test the stability of the drug at certain temperatures and whether it will degrade. The shelf life could be two years or four, depending on the product. With every batch manufactured a certain amount is retained and put into storage, so if there’s ever a query about the product degrading, it’s taken out of storage conditions and tests are done to see if it does the same as what’s happening on the market.
A pharmacy may not carry expired medicine, but if any medications are getting close to the expiry date they might send it on, for example to a hospital or clinic, so it can be used it up before it expires to reduce wastage. Once a medicine has expired its removed from the shelf and is destroyed.
If you have any medication at home that has expired, take it back to your pharmacy so it can be disposed of correctly. It’s illegal to dump any medication down the municipal sewer system – especially antibiotics, which results in low concentrations of antibiotics in our environment that subsequently assist the exposed bacteria to develop resistance.
Side effects of medication
Many things we ingest can be regarded as drugs – sugar, caffeine, gluten, alcohol, etc – because they’re foreign to the make-up of our bodies. Medicines are also ingested foreign substances, so each individual will react differently. In the same way that some people are allergic to gluten for whatever physiological reason, some people are allergic to some medications. Depending on the mechanism action it could be affecting the neurological, digestive or circulatory system – it all depends on where it is working and how the body handles it. When pharmaceutical companies do trials, any side effects a patient experiences are listed on the information brochure. Of course that’s not to say you’ll have all those side effects! Or even any of them but by law they must be listed.
Antihistamines block the response caused by a allergen, but many of these drugs penetrate the central nervous system as well as, which is why they might make you drowsy or give you a dry mouth. Your pharmacist will tell you what the main side effects are. With Myprodol, for example, you’ll be advised to take it after food to prevent an upset stomach because it’s an anti-inflammatory that works on the gut; also, the codeine may make you feel drowsy so you shouldn’t drive or cause severe constipation. Side effects are very much an individual response and you should take notice of the warnings. If you find, for instance, that a cough mixture makes you drowsy, don’t drive or do potentially dangerous activities such as swimming on your own.
Will the side effects subside after long-term use?
Some of them do. Say you’re taking something for cholesterol and perhaps feel a bit woozy in the morning but later feel better, you need to ask if the benefit of taking the medication outweighs the inconvenience of that early-morning drowsiness. And it does. So what can you do about it? Try to take your medication earlier in the evening. And are you perhaps taking your medication with alcohol at night, which would compound the wooziness? Your pharmacist will help you look at whether there’s something you can do to reduce whatever side effect you might be experiencing. Some people do overcome side effects and their bodies become used to the medication. With many neurological medicines it takes a while to stabilise, which is often why the dose will be increased gradually.