Untitled
Painkillers can bring relief to people who are suffering from pain when taken as directed.
However, the dangers of misuse must also be highlighted.
Many painkillers are available over-the-
effects such as drowsiness. This is why it
counter (OTC) from pharmacies and
is so important to read the information
A huge market exists for painkillers and it
shops without the need for a
leaflet and heed the advice provided.
is a very profitable business. There are so
prescription. This enables consumers to
A further point to note is that
many different boxes of painkillers on
AT A GLANCE
make their own decisions about what to
products often contain more than one
the shelves that it can be hard to choose
take to deal with pain. Non-prescription
active ingredient and are therefore
the right one. You have to decide whether
medicines generally provide temporary
intended to relieve a number of
you want capsules, gel caps or soluble
relief from minor symptoms such as
different symptoms. It does not make
tablets and then you must choose from a
headache or backache. Many people also
sense to buy a combination product
number of pack sizes.
reach for them at Christmas-time for
unless each ingredient is necessary.
When we looked at Nurofen, for
relief from the dreaded festive hangover.
Consumers should be given more of a
example, we found there was a wide
UK health
Although some products may provide
choice in selecting the appropriate
range of products for customers to
temporary relief, they can also have side-
choose from, including Nurofen Coated
consumer choice DECEMBER 2009/JANUARY 2010 HEALTH
Tablets, Nurofen Liquid Capsules,
available for sale without a prescription
Nurofen Gel, Nurofen Cold and Flu
are only authorised for short-term use,"
Film-Coated Tablets, Nurofen for
• Always read and follow dosage and
the IMB said. "There are explicit warnings
Children Meltlets, Nurofen For Children
storage instructions.
regarding the potential risk of addiction
Orange and Nurofen Plus.
• Store all medicines out of the reach
on the information leaflet that is supplied
Drugs and Alcohol
GlaxoSmithKline also manufactures a
of children.
with all low dose codeine-containing
whole range of products deriving from
• When painkillers are mixed with alcohol,
medicines available in pharmacies
the Solpadeine brand, including
the result can often be harmful.
without prescription. There is advice on
Solpadeine Capsules, Solpadeine Cold &
• Prolonged use of painkillers without
not exceeding the stated dose and
Flu Capsules, Solpadeine Soluble Tablets,
medical advice may be harmful - if
warning that the medicine should only be
and Solpadeine Tablets.
symptoms persist for more than 3 days
used for short-term use unless under the
There are different options available,
consult your doctor.
advice of a doctor."
depending on whether you have back
• If you accidently take too much
Earlier this year, Dr John O'Connor,
pain, neck pain, migraine and so on.
medicine, the information leaflet will tell
medical director of the Drug Treatment
Does this mean that you have to buy one
you what to do, but also check with
Centre Board (DTCB, see Useful contacts)
type of painkiller when you have a
your doctor or pharmacist immediately.
said about the problem of rising
headache and another when you get a
addiction to codeine-based medication: "I
pain in your back? In a bid to stand out
would strongly suggest, speaking in a
from other brands, it seems that
pharmacies. Solpadeine is widely
personal capacity, that codeine and some
uk/overcount/index.htm
manufacturers are competing for more
available and marketed by the
co-codamol medicines should be
shelf space by creating different packets
manufacturer GlaxoSmithKline in the UK
prescription-only." There are no official
with different claims. In reality, they are
and Ireland. According to Over-Count, an
figures for the number of people who are
Society of Ireland
basically selling the same medicine in
online support group for people addicted
addicted to codeine in Ireland because it
each packet. If a consumer has a specific
to painkillers, this is the number one
is legally sold over-the-counter. However,
pain they are more likely to choose a
over the counter product currently being
the Irish Pharmaceutical Union (IPU, see
packet with a claim to relieve their
misused by almost 72% of all Over-
Useful contacts) has recently reminded
particular symptoms printed on the
Count's female clients in the 21 to 71
consumers that codeine, which is
label. If a manufacturer has covered all
year old age group. Over-Count has over
available without a prescription, is an
angles, this makes its brand more likely
6,000 female clients alone on its register
opium-based drug and therefore has the
of current ‘active' clients. Dependency on
same active ingredient as heroin and
Solpadeine has been reported to Over-
morphine. IPU chairman Darragh
Count by clients taking as few as four
O'Loughlin has said: "These medicines are
Until 2001, painkillers containing
tablets per day over a three month
very effective in relieving symptoms of
paracetamol could be bought in any
period. Solpadeine's active constituents
headaches and other forms of pain and
amount without prescription. However,
include paracetamol, codeine phosphate
Irish pharmacists often recommend them.
there are now a number of restrictions
But prolonged use, except under medical
on the sale of medicinal products
Codeine is from the same medication
supervision, may lead to physical and
containing paracetamol. The sale of
family as heroin and contains the same
psychological dependence and result in
multiple packs of paracetamol in a single
active ingredient as morphine. If taken
withdrawal symptoms." The Irish Times
transaction is prohibited, and the sale of
regularly users can become physically and
recently reported that the Pharmaceutical
paracetamol products which include a
psychologically dependent on the
Society of Ireland (see Useful contacts) has
second analgesic (painkiller) is
substance. It can cause dizziness,
said it is currently examining the issues
prohibited in non-pharmacy outlets. A
confusion and drowsiness. Long term
around the supply of medicines
warning statement must be printed on
abuse can result in liver dysfunction,
containing codeine with a view to issuing
the outside of all packs, as well as on the
gastrointestinal disorders, gallstones,
more specific guidance in the coming
information leaflet included inside
depression, headaches and chronic
UK health warnings
Norway has a higher consumption of
Evidence is emerging that medicines
From next year in the UK, painkillers
codeine-based medication than other
which contain codeine are increasingly
such as Solpadeine Plus and Nurofen
European countries. A recent study from
being misused. Codeine is available in
Plus will display warnings on the label
the Norwegian Institute of Public Health
various formulations because when used
stating the dangers of addiction to the
compared the risk of being involved in a
alone it has only moderate painkilling
products. It has been suggested that
traffic accident with personal injury
properties. It is combined with
manufacturers will need to display on the
between codeine users and non-users.
paracetamol in Solpadeine tablets or
front of the pack the specific warning:
During the 33 month long study, 181
with ibuprofen in Nurofen Plus. Last
‘Can cause addiction. For three days' use
road traffic accidents were registered with
year, Irish consumers spent over €20
only.' A spokesperson for the Irish
personal injury where the driver had been
million on Solpadeine alone. Solpadeine
Medicines Board (IMB, see Useful
exposed to codeine and 20 after exposure
is commonly recognised as an effective
contacts) has said that the same measures
to tramadol, a medicine which contains
way to beat a hangover and it is the best-
will not be introduced in Ireland.
codeine. ‘Exposure' was defined as the
seller in terms of painkillers in Irish
"Codeine-containing products which are
first seven days after the dispensing of a
HEALTH DECEMBER 2009/JANUARY 2010 consumer choice
and to alleviate pains, but it can irritate
the stomach and intestines and cause
Analgesics, also known as painkillers,
use in children, or in patients with
major bleeding. There have also been
belong to the group of non-steroidal anti-
bleeding disorders.
many reports in recent years to link it
inflammatory drugs that help reduce
• Ibuprofen is an anti-inflammatory and
with decreasing the risk of heart
swelling. Medicines often have more than
can be used when inflammation is the
problems. However, a recent study has
clear cause of pain such as arthritis or
shown that healthy people who regularly
• Generic name e.g. Paracetamol. This is
an injury. If used for a long time there
take aspirin to prevent heart attacks could
the medical name for the active
can be side-effects to the stomach,
be doing themselves more harm than
ingredient of the medicine.
kidneys and heart.
good. UK professors from the Aspirin for
• Brand name e.g. Panadol. This is the
• Paracetamol is a mild painkiller for use
Asymptomatic Atherosclerosis have said
trade name a manufacturer gives to a
in the short-term management of
that the use of aspirin to try to prevent
headaches including migraine and
future vascular problems cannot be
Most painkillers are based on the active
tension headaches, backache,
supported because of an increased risk of
ingredients of aspirin, ibuprofen or
rheumatic, muscle pain, period pains,
internal bleeding. Professor Peter
nerve pains, toothache and for relieving
Weissberg, of the British Heart
• Aspirin is one of a class of drugs known
fever, aches and pains of colds and flu.
Foundation (BHF, see Useful contacts)
as non-steroidal anti-inflammatory
Taking more than the recommended
which part-funded the research, said: "We
drugs (NSAIDs). It is ideal for the
dose can have serious side-effects.
know that patients with symptoms of
treatment of pain associated with
Products containing paracetamol should
artery disease, such as angina, heart
inflammation. It is not recommended for
not be taken in combination.
attack or stroke, can reduce their risk of
further problems by taking a small dose
of aspirin each day. The findings of this
prescription for a codeine or tramadol
study agree with our current advice that
preparation. The study showed that the
Pharmacists have warned in the past
people who do not have symptomatic or
risk of being involved in a road traffic
about the potential of painkillers to
diagnosed artery or heart disease should
accident with personal injury was twice
cause headache rather than to relieve the
not take aspirin, because the risks of
as high in the period after having a
symptoms. If pain relievers are used
bleeding may outweigh the benefits."
prescription for codeine dispensed. For
regularly over a prolonged period the
However for patients who have already
those who had used more than
user can experience what is known as
had a heart attack, the risk of a second
approximately 400 tablets per year, the
‘rebound' headaches. Your body becomes
heart attack is so much higher that the
risk of being involved in a traffic accident
used to the drug, so when you stop
balance is in favour of taking aspirin. It
was three times as great. When the use of
taking it, a withdrawal or rebound
should only be taken as directed, so
other potential impairing medicines was
headache is experienced. You take
consult with your doctor in advance.
excluded, the risk of accident sank
another painkiller to relieve this and a
significantly. For sporadic codeine users
vicious circle begins. So the headache
there was no increased risk of accident.
may actually get better when you stop
Painkillers can be bought at a lower cost
"One can conclude that sporadic or
taking painkillers. If somebody has been
than many consumers have been led to
moderate use of codeine alone to a small
misusing painkillers over a prolonged
believe. A huge market exists for
degree increases the chance of being
period they may need medical
painkillers, and aspirin, paracetamol and
involved in accidents with personal
supervision when coming off the
ibuprofen can be manufactured and sold,
injury. Simultaneous use of
painkillers. Contact your GP for advice.
very cheaply. Many people still choose
benzodiazepines or carisoprodol gives a
branded versions because they are
Report by
clear increase in the risk of accidents,"
unaware of the availability of generics,
Sinéad Mc Mahon cc
said the research authors.
Aspirin is commonly taken for fever relief
which are newer versions of an existing
brand. Look for generic versions of
medicines in pharmacies, or ask the
pharmacist if there is a less expensive
version of the product that might be
suitable for your needs.
Although the majority of people who take painkillers use them appropriately and as directed,
In one pharmacy we compared the price
there is clearly a minority who are not using them as safely. Keeping track of sales is impossible
of 24 500mg paracetamol tablets and
without a centralised system. People can simply buy what they want from several different
found that while the Panadol brand cost
pharmacies. It is difficult to achieve a balance on this issue to protect consumers, while also
€3.36, a lesser known brand called
allowing consumers to access medicines so they can take more control over their health.
Paratabs cost over one euro less at €2.32.
It really does not make sense to have a warning on the outer label of paracetamol-based
Similarly a box of 24 Solpadeine cost
tablets but not on codeine-based products. It is time for restrictions on the sale of these
€6.96 while Maxilief, which contains the
products to be implemented. Greater public awareness of the potential harm they can cause
same components, cost €5.28 for 24, a
must be generated by the Government and new legislation on labelling is warranted. All
difference of €1.68. Generics are cheaper
painkillers can have serious side-effects and it is important for consumers to weigh up the
and offer the same amount of active
positives and negatives of using them. We are only beginning to realise the harm they do, the
ingredients so why pay over the odds for
addictions they can result in, and the potential health risks.
consumer choice DECEMBER 2009/JANUARY 2010 HEALTH
Source: http://thecai.ie/wp-content/uploads/2011/10/PAINKILLERSDec09.pdf
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UNIVERSITÀ DEGLI STUDI DI UDINE DIPARTIMENTO DI SCIENZE MEDICHE E BIOLOGICHE Corso di Studi in Infermieristica IMPATTO DELLA TERAPIA DIURETICA DOMICILIARE SULLA QUALITÀ DI VITA DEI PAZIENTI CON SCOMPENSO CARDIACO Relatore Laureanda Dott. Stefano Fabris Angelica Moro Anno Accademico 2012 - 2013
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Lessons from Private Equity How to increase the value of private companies in B.C. Vancouver Private Company Services2011 Edition "Someone's sitting in the shade today because someone planted a tree a long time ago." Private Equity background Lessons from BC's top private equity firms Concluding remarks Appendix A – Participant companies Despite a slow economic recovery over the last couple