Buying drugs via 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?
First, it's important to carefully consider the source of information and then to discuss the information you find with your health care professional. These questions and answers can help you determine whether the health information you find on the Internet or receive by e-mail from a Web site is likely to be reliable.
Some websites that sell medicine can be not state-licensed pharmacies or aren't pharmacies at all; or may give a diagnosis that is not correct and sell medicine that is not right for you or your condition; or won't protect your personal information.
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or 'copycat' medicines); can be too strong or too weak, or have dangerous ingredients, or have expired (are out-of-date), or haven't been approved or checked for safety and effectiveness, can be made using non-safe standards, or not safe to use with other medicine or products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.
Weighing the risks, making the choice
Although medicines can make you feel better and help you get well, it's important to know that all medicines, both prescription and over-the-counter, have risks as well as benefits.
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.
For example, every time you get into a car, there are risks---the possibility that unwanted or unexpected things could happen. You could have an accident, causing costly damage to your car, or injury to yourself or a loved one. But there are also benefits to riding in a car: you can travel farther and faster than walking, bring home more groceries from the store, and travel in cold or wet weather in greater comfort.
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.
To lower the risks and obtain the full benefits of medicines you need a)talk with your doctor, pharmacist, or other health care professionals; b)know your medicines--prescription and over-the-counter; c)read the label and follow directions; d)avoid interactions; e)monitor your medicines' effects--and the effects of other products that you use
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.
Important things is tell to your doctor about any allergies or sensitivities that you may have. Tell about anything that could affect your ability to take medicines, such as difficulty swallowing or remembering to take them.
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.
You have to know what to do if you experience side effects and when to notify your doctor, and know when you should notice an improvement and when to report back.
Predicting potential problems
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.
When a drug is taken orally, it usually travels from the stomach to the liver, where it can be metabolized-the process of breaking down and removing chemicals from the body. Enzymes are complex proteins that act as catalysts in starting or speeding up chemical reactions. They cause a specific chemical change in other substances without being changed themselves.
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?'"
Researchers say there are several important variables that affect individual differences in how drugs are metabolized, including race, gender, age, and health conditions. For example, people with kidney or liver disease don't eliminate drugs from their system as well as people who are healthy. Very young children and older people have slower drug metabolism than others, and women may metabolize drugs differently than men in some cases.
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."
So rather than asking patients what medications they take, doctors should make the questions specific: "Are you taking any over-the-counter medication? Are you taking any herbal treatments or vitamins?"
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.