WebMD Ask the Pharmacist

Best Questions From Season 1: Ask the Pharmacist

Feb. 16, 2010. Pharmacist Kristen Binaso, RPh, answers the most popular questions about medicine from season one of Ask the Pharmacist.

Question:

Is it OK to cut this pill in half? I have 20 milligram pills.

Answer:

Tablet splitting or pill cutting is a practice that involves patients obtaining higher-strength tablets and breaking the tablet in half, quarter, or whatever smaller portion they can in an effort to save money. The FDA has issued a statement on this practice. Splitting tablets are risky for several reasons. 1.) You might get confused about the right dose, especially if you forget to split the tablet; 2.) Splitting a tablet does not guarantee an equal distribution of medication; 3.) Some tablets are hard to split and may even crumble when attempting to split; 4.) Not all pills are safe to split, especially capsules and those with specially formulations to control drug release. I suggest not splitting any medication unless you and your health care provider have discussed the risks and benefits.

Question:

Are brand-name drugs superior in quality to their generic equivalents?

Answer:

Great question. Many patients think that more expensive brand medications are better than their cheaper generic equivalents. The FDA requires pharmaceutical companies to prove all brand and generic drugs meeting specific requirements for not only safety and efficacy, but also related to identity, strength, quality, purity, and potency. Scientific tests and procedures are undertaken to demonstrate generic drugs can be substituted or be the therapeutic equivalent to their brand-drugs counterparts. Generic drug products must contain the identical amounts of the same active drug ingredient as the brand-name product, but can differ in shape, flavor, preservatives, and other inactive ingredients, along with how they are "released" into the body (especially for extended release products).

Question:

Can I get too many vitamins? If so, what can happen?

Answer:

Believe it or not, you can actually take too many vitamins and they can build up in your body and possibly cause toxicity. This can happen with the "fat soluble" vitamins, which are A, D, E, and K. You definitely want to be careful and make sure that your health care provider (they may run blood work periodically) and pharmacist know everything that you are taking.

Question:

Can vitamins interfere with any prescription medicines?

Answer:

Yes, they can, so it is very important that you always check with your doctor, health care provider, or pharmacist before taking them. If they approve, make sure you list them on your personal medication list. This list should be with you at all times, and you should show it to your pharmacist every time you pick up medication. If you have any questions about drug interactions, get to know your pharmacist, you will be glad you did!

Question:

Why do you take some medicines on an empty stomach and at the same time every day?

Answer:

Great question. Some medications have to be taken on an empty stomach because it helps the medication dissolve and get into your bloodstream quicker. Certain medications need to be taken around the same time every day so you have a consistent level in your bloodstream and body. A good example of this is blood pressure medications -- you should take your dose at the same time each day so you benefit from the medication. If you ever have any questions about how to take your medications, ask your pharmacist. We are happy to help.

Question:

I am taking azithromycin 250 mg and now I have diarrhea. Can I take Imodium with this?

Answer:

Good question -- mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your health care provider right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea, even with Imodium, without first checking with your doctor or health care provider.

Question:

Where can I get a blank drug sheet to list my meds to take to the doctor with me?

Answer:

I was so excited when I saw this question! We are encouraging everyone to use a personal medication record which is a list of all your medications, including over the counter, vitamins, and herbals. You should bring this to every health care provider visit and show your pharmacist. You can download a template at www.pharmacist.com/pmr and also at the FDA web site at http://www.fda.gov/Drugs/ResourcesForYou/ucm079489.htm.

Question:

Hello, I heard that if I get a flu shot then I will never be able to go without a flu shot for the rest of my life. Is that true?

Answer:

This is actually not true. You have to get your seasonal influenza vaccine each year. The virus changes "strains" or the way it is made up so each year, manufacturers make a new batch that comes close to what "strains" the CDC thinks may be present for the season.

Question:

I need a home remedy for heartburn.

Answer:

This is an interesting request. I would need to ask you a few more questions because there really isn’t any "home remedy" for heartburn. I need to know how often you have been having heartburn and what your exact symptoms are. I also recommend changing your diet. There are many "trigger" foods that can cause heartburn. For more information, including a "diary," visit the National Heartburn Alliance at www.heartburnalliance.org.

Question:

I stopped taking medications for bipolar a week and a half ago, but now I want to start them again. Can I just restart where I left off?

Answer:

I would like to know why you decided to stop taking your medications and does your doctor or health care provider know? This is very risky and it is important that you understand that with some medications, you should not just stop them abruptly because you felt like it. Nor is it wise to just "start them up" again when you feel like it. I would strongly recommend that you call your doctor and let them know what you did. They may want to see you for further evaluation and gradually ease you back onto your medications.

Question:

I am nursing my baby. Can I take an over-the-counter allergy medication like Claritin?

Answer:

Great question and something that you should always ask your pharmacist because you need to be careful with over-the-counter medications even while you are nursing. Allergy medications like Claritin, Benadryl, and Zyrtec have all been found in breast milk. Because of the higher risk of adverse reactions in infants generally, and for newborns and premature infants in particular, antihistamine therapy is not recommended in nursing mothers.

Question:

Does Preparation H help with dark circles under the eyes?

Answer:

This caught my attention because Preparation H should only be used to help treat and relieve the symptoms of hemorrhoids. You should not use over-the-counter products for other areas of the body unless the packaging states so. It is very important that you follow the directions on the package and use these products correctly to avoid serious harm.

Question:

I am allergic to penicillin. Can I take amoxicillin?

Answer:

Great question. If you are allergic to penicillin, you are also allergic to amoxicillin (they are related). You want to make sure that all of your health care providers know you are allergic to penicillin including your pharmacist. This is a very important piece of information!

Question:

I take a lot of medication but am hesitant to share all my medical information. If I tell the pharmacist everything I am on and it gets listed in their system, who does that get shared with?

Answer:

There are specific laws in place that do not allow this type of information to be shared with the "common world." You should be aware of the fact that if you don't share this information with the pharmacist, who is a health care provider, you are putting yourself at risk of drug interactions and adverse effects. We don't know all of the medications, OTCs, vitamins, and herbals you are taking and one thing that many do not know is how they may cause a dangerous drug interaction. I went through six years of school focusing on that and protecting you! Talk to your pharmacist, it may actually save your life.

Question:

Is there a safe dosage of Benadryl I can give my 5-month-old baby who is battling a very congested nose?

Answer:

This is a good question because Benadryl is not a nasal decongestant and will do nothing for the stuffy nose (not to mention this medication should not be given to a child this young.) You want to use saline drops to help thin out the mucus in the nose and then use a nasal aspirator to help clear the passageway. I also recommend running a vaporizer in the baby's bedroom -- that usually helps a lot as well for congestion. Parents need to be very careful about cough and cold medications in infants and children, so take the time to talk to your pharmacist.

Question:

Can you mix Bayer Chewable 81 milligram baby aspirin and Tylenol 80 milligram infant drops?

Answer:

I have to ask why you want to do this. If we are treating an infant for pain or fever, I would recommend the Tylenol Infant Drops only. Due to the fact that aspirin can increase the risk of Reye's syndrome, I would not consider chewable 81 milligram baby aspirin. Infants and children are not "little adults," so you need to be very careful when it comes to medication.

Question:

My little girl is 3 years old. She just took her first dose of Augmentin and about an hour later she vomited. Is vomiting a common side effect of this medication, and should it typically be taken with food or milk?

Answer:

Yes, vomiting is a side effect of the medication. It is important that you give your child this medication with some food or milk because it can be harsh on the stomach. If she continues to vomit after the second or third dose of the medication, contact your doctor or health care provider, it may be necessary to switch her to a different antibiotic.

Question:

I take hydrocodone 10/660 for pain and I don't understand the 10 mg. Is that the pain medicine or the acetaminophen or is the 660 the dosage of pain medicine?

Answer:

This is a common question. Believe it or not, the medication that you are on is a combination product that uses two medications to combat pain on two different levels. Acetaminophen (660 mg) is an effective pain reliever and is used in combination with the hydrocodone (10 mg). You want to take the medication exactly as prescribed by your doctor or health care provider.

Question:

What does the abbreviation “BID” on a prescription stand for?

Answer:

Great question, and something that you can always ask your pharmacist when you pick up your medication. The term "BID" means twice a day or every 12 hours. I recommend to patients that if they take their medication at 8 a.m., then they should take their next dose at 8 p.m. If you are ever unsure about how or when to take your medication, talk to your pharmacist.

Question:

Are there any OTC creams that will help relieve the pain and sting of shingles?

Answer:

Shingles is tough because it typically requires evaluation by a doctor or health care provider and prescription medications to help speed the recovery and for the pain. There are no over-the-counter creams that can be used for the pain and stinging.

Question:

I often take Tylenol PM to fall asleep; is that a problem or should I see my physician?

Answer:

Good question. I would ask this patient if they are aware of the principles of good sleep hygiene (believe it or not, they exist!). They include: establishing a regular sleep pattern (basically go to bed and arise about the same time daily, even on weekends), make the bedroom comfortable for sleeping (no noise, light, comfortable temperature), engage in relaxing activities before bedtime, avoiding exercise 2-4 hours before bedtime, avoid eating at least two hours before bed, and avoid using caffeine, alcohol, or nicotine for at least 4-6 hours before bed. Tylenol PM contains diphenhydramine and it should be taken only if needed. If you are using it for more than 14 days, you should see your health care provider for further evaluation.

Question:

Is it safe to give my child a prescription medicine if it is six months past the discontinue date?

Answer:

It is not safe to give your child expired medication -- even if it is prescription or over the counter. Your child may be put at risk for having an allergic reaction to the medication breaking down and the medicine may not even work. It is not worth it, especially if it costs you a trip to the hospital. You should go through all of your medications once a year. Make sure you get those vitamins and over the counters as well. The process is really easy for disposal: We do not recommend flushing anymore; instead, get a zip-top bag and place the medicines in the bag. You can then add some water to the bag to help them dissolve. Next, add kitty litter or coffee grinds, zip it up, and throw it in the trash. For more information, visit www.smarxtdisposal.net.

Question:

Is it dangerous to take Tylenol PM on a regular basis to assist with sleep?

Answer:

The general rule of thumb is that you should not take products like Tylenol PM for more than 14 days. If you have been taking this for more than that, I would advise making an appointment with your doctor or health care provider for further evaluation. With continued use you may experience "rebound insomnia," which means you get a version of insomnia that can be much worse, or you could even develop a tolerance to Tylenol PM (which means no matter how much you take, it will not work). Another important issue is that you may be experiencing side effects like dry mouth, dizziness, and constipation, which could lead you to using additional medications to treat those side effects -- which would not be necessary if you were not taking the Tylenol PM.

Question:

Can you administer oral medication rectally due to nausea?

Answer:

This is a good question. No, you cannot administer "for oral use" medications rectally because they will not work. Medications that are approved for "rectal use" (will say so right on the packaging) are specifically made in a particular way so the medication can be absorbed into your body.

Question:

Can I ever have grapefruits again if I take a statin?

Answer:

We are learning more and more each day about drug interactions with food, especially juices like grapefruit. Grapefruit juice has the ability to interact with certain enzymes in the body – the same enzymes that help break down medicines like statins so your body can use them. This can lead to high levels of the drug in the body and lead to a variety of health problems. It is best to avoid grapefruit while on this class of medications. You can also talk to your doctor or health care provider to see if you can be switched to a different class of medications for your cholesterol; we have a few other options besides statins. If you have any questions about drug/food interactions, talk to your pharmacist. We are happy to help.

Question:

What is the best OTC medicine for any skin infection?

Answer:

Good question. This really depends on what type of infection and how severe it is. Typically if you have a small cut, you can wash with soap and water and then apply a triple antibiotic ointment. If the infection on the skin appears red, warm to the touch, painful, or oozing, you will need to see your health care provider. Skin infections can be very difficult to treat and can require prescription antibiotics if not taken seriously.

Question:

I have dry sinuses. What OTC products will be the most helpful?

Answer:

Saline nasal sprays or mists can be applied to the nasal cavity. Avoid sharing spray bottles with other members of the family. There are many types of nasal sprays available in the OTC aisle; be sure to ask your pharmacist for help with product selection.

Question:

Why are some medications, like Sudafed, kept behind the counter?

Answer:

Sudafed is an over-the-counter (OTC) nasal and sinus decongestant that contains the active ingredient pseudoephedrine. Although safe and effective if used as directed, it has been placed behind the counter because of its potential for misuse and abuse. Federal regulations require states track products containing pseudoephedrine as a means to curb improper use.

Question:

I have trouble swallowing pills. Can my prescription be made into a liquid?

Answer:

Some medications are available in liquid formulations. Many other medications can be made into a liquid formulation by a compounding pharmacist. Be sure to let your health care provider know you have difficulty swallowing medications. They should be able to accommodate you.

Thank you for joining us for WebMD Ask the Pharmacist. Be sure to come back on March 16 at 1 p.m. ET when we'll be focusing on drug interactions and safety. Sign up if you'd like an email reminder the day before our next premiere event.