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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
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
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