Ask the doctor - effective painkillers

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I find paracetamol works best for my headaches, but my friend swears by aspirin. Which one is best?
Everyone responds to drugs in different ways. When the Pain Research Unit at Oxford University analysed 45,000 patients, it found that no single drug produced high levels of pain relief in all patients. When taking either aspirin (1g) or paracetamol (600mg) on their own, only one in three people benefited, but a combination of 500mg paracetamol plus 200mg ibuprofen worked against moderate to severe pain in more than two out of three cases. So you’re both right!
Dr Sarah Brewer, Prima (May 12)

I get plenty of sleep at night, but find it hard to stay awake in the afternoon. Can you recommend any herbal supplements that may help me?
To avoid sleepiness after lunch, try not to eat lots of fatty or carbohydrate-rich foods. Instead, eat a light, healthy salad with a source of protein. Another good ploy is to exercise at lunchtime – go for a brisk walk, aerobics class, cycle ride or a swim. On the herbal front, guarana extracts can help you stay awake. Guarana contains a complex of natural stimulants, similar to caffeine, that help you stay alert for up to six hours. Korean ginseng has a more long-term, stimulating action. You may also find Coenzyme Q10 helpful.
Dr Sarah Brewer, Prima (Feb 12)

I’ve been taking St John’s Wort for a year. But I’ve noticed the appearance of moles on my face and back. Could they be related to the herbal remedy? My back has not been exposed to the sun.

St John’s Wort is as effective in treating mild to moderately severe depression as many prescription drugs and, according to one manufacturer, volunteers on high doses have shown no evidence of skin sensitivity on exposure to sunlight. Even so, those who are sun-sensitive should avoid direct exposure – especially if they are fairskinned – as theoretically, photosensitivity is a possible cause, although, as your back has not been exposed to the sun, it’s unlikely in your case. Seek medical advice about any skin blemish that gets bigger or darker, or is scaly, itches, weeps, ulcerates, crusts over or scabs.
Dr Sarah Brewer, Prima (Sept 11)

I have tried the herb valerian for insomnia, but it didn’t work for me. I’m considering using 5-HTP – is it worth trying?

A5-HTP is a natural substance found in small amounts in turkey, chicken, meat and cheese. Once absorbed into the circulation, some 5-HTP travels to the brain, where it’s converted into chemical messengers, such as serotonin and melatonin, which help regulate mood and sleep. Taking 5-HTP appears to extend the period of time spent in rapid eye movement (REM) sleep, so you wake up feeling more refreshed. However, 5-HTP should not be taken at the same time as prescription antidepressants.
Dr Sarah Brewer, Prima (Jul 11)

There's so much choice when it come to buying painkillers these days, but is there any difference between a 16p pack of budget paracetamol and a £1.49 pack with the same number of tablets when both contain 500mg of paracetamol?

According to the Royal Pharmaceutical Society of Great Britain, there is no difference between the generic and branded medicine, as long as the dose of the drug and the type of formulation are exactly the same. This means that if both tablets contain simple paracetamol at a dose of 500mg per tablet, you may just be paying for the brand name with the more expensive version. This is because the company have to recover the large costs associated with the original development and patenting of the drug, whereas the non-branded form (produced when the product is no longer protected by a patent) does not have to include these costs. However, some more expensive products may have a different form of the drug, such as those that dissolve more quickly, or which work more rapidly in the body.
Dr Sarah Brewer, Prima (Aug 10)   

Is it necessary to take multivitamin and mineral supplements in the summer? I'm getting vitamin D from the sun and I'm eating more fruit, vegetables and salads.

Although a lack of vitamins and minerals is often thought of as a winter problem, the latest Government nutritional survey shows that only 33 per cent of women and 37 per cent of men meet the five-a-day guideline for fruit and vegetables. Although you may need less vitamin D from your diet in the summer, you still need to ensure good intakes of other vitamins - such as B group vitamins - and trace elements, such as zinc and selenium. A multivitamin and mineral supplement can help to guard against the deficiencies that can lead to tiredness, lowered immunity and other health problems. Try Healthspan's Multivitamins & Minerals Gold (£4.45 for 90 tablets from www.healthspan.co.uk) or Centrum Complete (£12.79 for 100 tablets from www.boots.com).

Dr Sarah Brewer, Prima (Aug 10)  

I take around 1,000mg of vitamin C per day and a multivitamin with cod liver oil to boost my immune system, as I have a busy lifestyle and can't afford to be ill. But, recently, I had a very painful kidney stone - is this anything to do with my supplements?

About one in 20 women in the UK develops a kidney stone at some stage in their life. No one really knows why, but research suggests that certain supplements, like vitamins C and D and calcium, can increase the risk. The Food Standards Agency (FSA) warns that taking more than 500mg of vitamin C could be harmful to people prone to kidney stones - calcium and vitamin D supplements are also thought to increase your risk. I would advise that you stop having supplements, or at least cut down - the FSA says that a healthy balanced diet with plenty of fruit and vegetables should provide all the nutrients that most people need. You should also drink plenty of water - you're more likely to develop a stone if your urine is concentrated - this is particularly important if you exercise a lot. Try drinking around two to three litres a day and keep an eye on your urine - it should be pale rather than dark.

Dr Lousie Selby, SHE (Feb 10) 

Supplements with extras?
Some vitamin and mineral supplements have extras such as probiotics or ginseng. Are they worth paying more for?

It depends what you want out of your supplement. To safeguard against nutritional defi ciencies, an A-Z style combination may be all you need. Or, if you're lacking in energy, then you may benefit from a multivitamin and mineral supplement that also contains ginseng (such as Pharmaton, £21.99 for 100 capsules from Boots). To boost immunity, then probiotics may be ideal - you could try Multibionta Immune Support (£12.82 for 60 tablets from Boots) or Immunobiotic (£8.95 for 90 tablets, available from Healthspan, Visit www.healthspan.co.uk). 

Dr Sarah Brewer, Prima (Jan 10) 

Which is best for preventing hangovers over the Christmas period - milk thistle or globe artichoke extract?

In the weeks running up to a celebration, and for long-term protection of the liver, I usually suggest milk thistle extracts (Medic Herb Milk Thistle, £7.99 for 30 tablets from The Nutri Centre; 0845 602 6744). These contain an antioxidant complex known as silymarin, which boosts liver levels of glutathione, a substance that helps neutralise toxins such as alcohol. Silymarin also promotes liver cell regeneration. For prevention and treatment of hangover symptoms such as bloating and nausea, however, globe artichoke extract (Artichoke Extract, £5.95 for 120 tablets from Healthspan; (0800 731 2377) is more effective. This is because it stimulates bile production, so more toxins are flushed out of the liver and digestive symptoms improve - often within 30 minutes. It can be taken with milk thistle extracts for a synergistic action. So take milk thistle regularly, and globe artichoke before and after going out to drink. Of course, drinking sensibly is the best way of all to avoid symptoms.

Dr Sarah Brewer, Prima (Dec 09)

My husband takes the natural supplement saw palmetto to reduce urinary symptoms caused by an enlarged prostate gland. Will this affect the results of the PSA prostate cancer test?

Researchers at the University of Edinburgh have looked into this and concluded that saw palmetto fruit extracts improve prostate symptoms without affecting levels of PSA (prostate specific antigen). The PSA test screens for possible prostate cancer - the risk increases as the PSA level increases. A large study recently showed that PSA-based screening can reduce the rate of death from prostate cancer by 20 per cent. Although a national screening programme is not planned, men are entitled to have a PSA test free on the NHS as long as they have made an informed choice, based on good quality information, about the advantages and disadvantages. It involves a simple blood test, but false positives are common because a high PSA level doesn't always mean prostate cancer. A positive result is likely to cause worry and subject a man to invasive tests such as a biopsy to investigate. A website that can help him decide is www.prosdex.com.

Dr Sarah Brewer, Prima (Dec 09)

Permanently on penicillin?
I had my spleen removed after it ruptured in a recent car accident and I've been told I will need to take penicillin for life. Why?

The spleen is an important part of your lymphatic system and acts like a large lymph node. It finely filters your blood to remove unwanted
debris and old red blood cells for recycling. It also contains a large number of immune cells that are ready to pounce on any bacteria and
viruses to remove and destroy them. If your spleen is removed, bacteria can cause general infections more easily. One way to reduce your chances of developing a serious infection after a splenectomy is to take a longterm antibiotic (take a probiotic, too). You should also have an annual flu vaccination, and a pneumococcal vaccine every five years. You may be advised to have an Hib (Haemophilus influenzae Type b) jab as well. If you're going abroad at any time, get advice about immunisation, as you need to be protected against Group A meningococcus and malaria when visiting certain areas.

Dr Sarah Brewer, Prima (Oct 09) 

I suffer from regular headaches and arthritis, so I take quite a lot of painkillers, mainly ibuprofen. Are there any long-term risks in doing this?

Ibuprofen is both an anti-inflammatory drug and a painkiller, so it's particularly good at easing inflammatory problems such as arthritis. It works well as a short-term treatment for headaches and period pain, but I would be cautious about taking it if you suffer from conditions such as asthma, hypertension or kidney or liver trouble. Long-term use can lead to stomach ulcers, so it's very important to avoid ibuprofen if you get indigestion. And if you take it on a regular basis it can actually cause headaches, so beware of over-using it. Aspirin has similar side effects and properties to ibuprofen, but it can also thin your blood, so it wouldn't be suitable for people taking blood-thinning medications, or those at risk of bleeding. Paracetamol is a good general painkiller, but does not have anti-inflammatory properties. It's relatively free from side-effects at low doses, though if it's taken above the recommended dosage it can damage your liver, so people with liver problems or those who are heavy drinkers must use it with caution.

Another good painkiller is co-codamol, which is a combination of paracetamol and codeine. The codeine content provides stronger pain relief but increases the side-effects, with problems such as constipation and drowsiness. Codeine can be addictive if taken regularly at high doses, though it's only sold at low doses on counter.

Dr Louise Selby, SHE (Aug 09)

May I mix mood boosters?

I'd like to try taking 5-HTP to boost my mood, but I'm wondering if it will be safe to take it with St John's wort?

I don't advise combining these two supplements, as it may increase the risk of side effects. Although they have been used together in clinical practice, to boost each other's effects, this is not something you should do on your own. If St John'sWort alone hasn't worked for you, it's best to stop taking it before switching to 5-HTP. Always seek advice from your GP if you feel depressed.

Dr Sarah Brewer, Prima (Aug 09)

I've been taking simvastatin tablets to bring my cholesterol down. The trouble is, they made my muscles ache dreadfully so I stopped taking them. Now my doctor says my cholesterol has gone up again and I should think about taking a lower dose. But won't this cause the same symptoms?

Muscle aches are a common side effect of statin tablets and they can be very troublesome. If they're bad, your GP will often do a blood test to check they aren't caused by an extremely rare muscle complication. As long as the blood test is normal, there's no reason not to try a lower dose. Most people take 40mg a day of simvastatin. However, you can get much of the cholesterol-lowering benefit from 20mg or 10mg per day and this may get rid of side-effects entirely. If the lowest dose doesn't bring your cholesterol down enough, there are more effective statins that can lower cholesterol with smaller doses. If you really can't tolerate any statin, talk to your GP about alternatives. Raised cholesterol is one of the biggest risk factors for heart attack and stroke, and keeping it down could save your life.

Dr Sarah Jarvis, Good Housekeeping (May 09)

My GP won't give me antibiotics

I often suffer with sinusitis in the winter, and my GP has always given me antibiotics, which settle it within a few days. But when I went in with another bout yesterday, she refused to give me any. Should I see another doctor?

Acute sinusitis (the medical term for inflammation of the sinuses) is miserable. You have four sets of sinuses in your skull near the surface of your cheekbones and forehead, and they're all closely connected. If they get inflamed, you can suffer from headaches; pain or pressure behind your eyes or upper teeth; blocked nose and fever. But sinusitis is usually caused by a viral infection, so antibiotics won't help. When you get an acute sinus infection, your body's immune system usually fights it off within a week - but if you've taken antibiotics, you'll give the credit to them, not to your body! Unless you've had sinusitis for over a week, you're unlikely to get any benefit from antibiotics. Simple painkillers can help with the headache, and decongestants can relieve that blocked-up feeling - but avoid antihistamines, which can make mucus thicker and harder to clear.

Dr Sarah Jarvis, Good Housekeeping (Jan 09)

What if I need to see a doctor in the night?

In the past when I was ill, I knew I could call my doctor at any time. Now there seem to be endless choices - walk-in centres, minor injury units, and NHS Direct - but it's harder to see a GP out of normal working hours. How do I know where to get help?

The work GPs do during ‘standard working' hours (between 8am and 6.30pm) has got much more complicated in recent years, because now there's more focus on preventing, as well as treating, disease. That's made it impossible to provide quality care 24 hours a day. However, GPs still work in groups at out-of-hours centres, and you can get hold of a GP 24 hours a day by calling your surgery. But there are more alternatives, too. Lots of areas now have a minor injuries unit - mostly attached to hospitals. They can sort out minor infections, cuts and sprains, and they're usually open 12 hours every day. NHS Direct (NHS24 in Scotland) can give 24-hour-a-day advice, or pass on details of your nearest healthcare services and their opening hours. Call NHS Direct if you're in England or Wales on 0845 4647, and NHS24 on 0845 424 2424.

Dr Sarah Jarvis, Good Housekeeping (Jan 09) 

I've been taking Citalopram for depression and have heard that this drug can help the immune system and even ward off cancer. Is that right?

For some time, it has been recognised that depression influences the outcome of diseases and people taking antidepressants fare better. Scientists have found that Citalopram (a type of SSRI) may improve the immune system of people with HIV or AIDS. Tests showed that the drug improves the activity of natural killer cells, which are crucial for a strong immune system. It is thought that other SSRIs are likely to have similar effects. While we are a long way from proving the drug can ward off cancer, there is no doubt that effectively treating depression will help the immune system too. You can also boost your immune system by ensuring you get a balanced diet and taking regular exercise.
Dr Louise Selby, SHE

Should I change tablets?

I have high blood pressure and have been prescribed the drug ramipril, but it has given me a dry cough. My GP suggested I change to a tablet that he says won’t have the same problems, but I’m worried whether it will be as effective.

New drugs are often developed not because existing ones don’t work, but because they have too many side effects. Ramipril is from a ‘family’ of drugs called the ACE inhibitors – it has been found to cut blood pressure and the risk of cardiovascular disease. The drug your doctor has suggested is probably an ARB (the drugs in this group have names that end in ‘sartan’ and include telmisartan, losartan and candesartan). These are well tolerated and don’t cause the cough that can affect people taking ACE inhibitors. A study using the ARB telmisartan has shown it has all the benefits of the ACE inhibitor you’ve been taking.

Dr Sarah Jarvis, Good Housekeeping 

Problems with aspirin

I recently had some chest pain, and was told that although I hadn’t had a heart attack, the pain was related. I’ve been taking aspirin anyway for a couple of years to prevent heart attacks – but now my GP wants me to change to something called clopidogrel. What’s wrong with taking aspirin?

The answer is nothing - for most people. Aspirin is amazingly effective at cutting your risk of heart attack or stroke. We recommend it for the majority of  people who are at risk of these conditions - and since they account for one in three premature deaths in men and one in four in women, that's a lot of aspirin. However, it seems that quite a lot of people (as many as one in five) find aspirin hard to tolerate. For them, clopidogrel is an effective alternative. And now studies have also shown that if you're at particularly high risk of having a heart attack or a stroke, taking clopidogrel may be more effective, and safer, than taking aspirin.
Dr Sarah Jarvis, Good Housekeeping
 

Isotretinoin and depression

My 17-year-old son has terrible acne, which has made his life miserable. Three months ago, however, he started taking isotretinoin, and it’s worked wonders. Now I’ve heard this drug can cause depression – even suicide – so should I be concerned?

I'm afraid I can't give you a definitive answer about the side effects of this drug, better known by its brand name Roaccutane. The trouble is that although there are reports of depression and suicide among young people taking Roaccutane, it's hard to work out if it's the medicine or the acne that caused it. Severe acne, as you know, can wreck lives. Likewise, Roaccutane can control acne that's so severe nothing else can touch it. As your son has been on the drug for three months already, you may have nothing to worry about, but look out for symptoms of depression or mood changes. If you are worried, talk to his doctor at once to see if your son should stop the medicine.
Dr Sarah Jarvis, Good Housekeeping

 

Drug monitoring and warfarin

I take the blood thinning drug warfarin and have always attended the local hospital to be monitored. Now I’ve been told I’ll have to go to a local GP’s surgery instead. Is this just a way of saving money?

I can reassure you that you'll get just as good a service at your local surgery as in hospital and it should be more convenient as well. You do have to be monitored regularly if you're on warfarin - as nearly a million people in this country are - and more GPs are setting up local clinics. These are required to undergo checks to make sure that all their equipment and measurements are accurate. It means you won't have to trek to the hospital every four to six weeks. These days, many people have home machines to monitor their warfarin dose - they obtain the strips to do the tests on NHS prescription and can ring the clinic to discuss any changes in their dosage. Ask your GP if this might be an option for you.
Dr Sarah Jarvis, Good Housekeeping

My malaria dilemma

Are there any alternatives to taking malaria tablets? I’m going to Africa and am worried about side effects.

Malaria is a disease that can cause serious complications and be fatal. Prevention is vital – you must strongly consider taking recommended anti-malaria drugs, using mosquito nets, insect repellents and covering up as much flesh as possible, especially at dusk. Complementary approaches should only be used as well as, not instead of, anti-malaria drugs to reduce the risk of being bitten. Garlic powder tablets taken daily work well – mosquitoes do not like the garlic scent in your sweat that results. You can get information on medicines, vaccinations and disease prevention from the Medical Advisory Services For Travellers Abroad (www.masta.org).
Dr Sarah Brewer, Prima

My twin dilemma

I have twin eight-year-old boys who do everything together – and whenever one needs medicine, the other wants it, too. What can I do?

I also have twins, so I know what you’re up against! While you try to treat them equally, there are times when a different approach is needed. When ours were younger, we kept a bottle of sugar-free tonic as a ‘placebo’ to give when one needed paracetamol and the other felt left out. They are now seven and old enough to understand medicines must be treated with respect – if only one needs medicine, the other must go without but is made to feel special by helping to look after the poorly one. You need to be firm and give a reason they can understand.
Dr Sarah Brewer, Prima
 

Am I taking too  much aspirin?

My family has a history of heart problems so for the last year, since I turned 40, I’ve been taking aspirin regularly, which I know can help prevent heart disease. However, I read recently that too much aspirin can be dangerous so now I’m worried – is one pill a day too much?

Aspirin is an extremely useful drug – far more than just an effective painkiller. It is well known that it can help to cut your risk of a heart attack or stroke by reducing the thickness of the blood, thereby lowering the risk of a blood clot forming in the arteries. But what you may not know is that you don’t need to take a full adult painkilling dose every day to make a real difference. A recent US study has confirmed that a low daily aspirin intake of just 75mg to 81mg – the amount found in a child’s dose – is best for the long-term prevention of both cardiovascular disease and strokes, without causing serious side effects. Higher doses of aspirin don’t offer any more protection and are associated with increased risks of gastrointestinal bleeding, according to the authors of the study.
However, it is very important that you don’t self-medicate. Visit your GP who will assess your risk and advise you on the best course of action. Taking aspirin regularly is only one way of helping to keep your heart healthy – you need to lead a healthy lifestyle too. That means 30 minutes of exercise daily and a healthy low-fat diet with five portions of fruit and veg a day. It’s also best if you don’t smoke and keep your alcohol intake to no more than a couple of units a day. Make sure that you have your cholesterol checked regularly too, and aim to maintain a suitable weight for your height.
Dr Louise Selby, SHE

Are there any good alternatives to statins?

I have a high cholesterol level but had to stop the treatment my doctor prescribed because of side effects. What alternatives are there?

 Several different cholesterol-lowering drugs are available, and it’s likely that your doctor can prescribe another statin that may suit you better. Taking co-enzyme Q10 supplements helps to reduce some statin side effects such as muscle aches. Garlic tablets can reduce cholesterol levels by an average of 11 per cent. Antioxidants (such as vitamins A, C and E, and the plant extract Pycnogenol) are also beneficial. Omega-3 fish oil supplements also have a positive effect on blood fat balance and help to reduce furring up of the arteries.
Dr Sarah Brewer, Prima

Are these drugs dangerous? 

I’ve always sworn by nasal decongestants when I’ve had a cold. Now I’ve been told that they are being labelled as dangerous because addictive drugs can be manufactured from them. Should I be worried?

The MHRA (the official body that regulates medicines in this country) has looked at whether medicines containing pseudoephedrine and ephedrine – ingredients in some decongestant medicines – should be available only on prescription rather than over the counter. In fact, what the MHRA has suggested is that the size of the pack you can buy from a chemist should be limited. Large quantities of these medicines are needed to make small amounts of the highly addictive drug methylamphetamine, also known as crystal meth. The move to restrict their use is aimed at stopping illegal drug makers from buying up the huge amounts they need by shopping at lots of pharmacies. However, these decongestant medications are completely safe – as well as effective at reducing the misery of colds – in the doses recommended by your pharmacist.
Dr Sarah Jarvis, Good Housekeeping

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