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Altitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare

<a href="https://theconversation.com/profiles/brian-strickland-1506270">Brian Strickland</a>, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a> Equipped with the latest gear and a thirst for adventure, mountaineers embrace the perils that come with conquering the world’s highest peaks. Yet, even those who tread more cautiously at high altitude are not immune from the health hazards waiting in the thin air above. Altitude sickness, which most commonly refers to <a href="https://medlineplus.gov/ency/article/000133.htm">acute mountain sickness</a>, <a href="https://doi.org/10.1016/j.pcad.2010.02.003">presents a significant challenge</a> to those traveling to and adventuring in high-altitude destinations. Its symptoms can range from <a href="https://doi.org/10.1089/ham.2017.0164">mildly annoying to incapacitating</a> and, in some cases, may progress to more <a href="https://doi.org/10.1183/16000617.0096-2016">life-threatening illnesses</a>. While <a href="https://doi.org/10.18111/9789284424023">interest in high-altitude tourism is rapidly growing</a>, general awareness and understanding about the hazards of visiting these locations <a href="https://doi.org/10.1089/ham.2022.0083">remains low</a>. The more travelers know, the better they can prepare for and enjoy their journey. As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/36740">emergency physician specializing in high-altitude illnesses</a>, I work to improve health care in remote and mountainous locations around the world. I’m invested in finding ways to allow people from all backgrounds to experience the magic of the mountains in an enjoyable and meaningful way. <h2>The science behind altitude sickness</h2> Altitude sickness is rare in locations lower than 8,200 feet (2,500 meters); however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">it becomes very common</a> when ascending above this elevation. In fact, it affects about <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">25% of visitors to the mountains of Colorado</a>, where I conduct most of my research. The risk rapidly increases with higher ascents. Above 9,800 feet (3,000 meters), up to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">75% of travelers</a> may develop symptoms. Symptoms of altitude sickness are usually mild and consist of <a href="https://doi.org/10.1089/ham.2017.0164">headache, dizziness, nausea, fatigue and insomnia</a>. They usually <a href="https://doi.org/10.1016/j.rceng.2019.12.009">resolve after one to two days</a>, as long as travelers stop their ascent, and the symptoms quickly resolve with descent. When travelers do not properly acclimatize, they can be susceptible to life-threatening altitude illnesses, such as <a href="https://doi.org/10.1016/j.resp.2007.05.002">high-altitude pulmonary edema</a> or <a href="https://doi.org/10.1089/1527029041352054">high-altitude cerebral edema</a>. These conditions are characterized by fluid accumulation within the tissues of the lungs and brain, respectively, and are the <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">most severe forms of altitude sickness</a>. Altitude sickness symptoms are thought to be caused by <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">increased pressure surrounding the brain</a>, which results from the failure of the body to acclimatize to higher elevations. As people enter into an environment with lower air pressure and, therefore, <a href="https://doi.org/10.1001/jamanetworkopen.2023.18036">lower oxygen content</a>, their <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">breathing rate increases</a> in order to compensate. This causes an increase in the amount of <a href="https://doi.org/10.1016/s1357-2725(03)00050-5">oxygen in the blood as well as decreased CO₂ levels</a>, which then increases blood pH. As a result, the <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">kidneys compensate</a> by removing a chemical called bicarbonate from the blood into the urine. This process makes people urinate more and helps correct the acid and alkaline content of the blood to a more normal level. <figure><iframe src="https://www.youtube.com/embed/iv1vQPIdX_k?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Tips for preventing or reducing the risk of altitude sickness.</figcaption></figure> <h2>The importance of gradual ascent</h2> High-altitude medicine experts and other physicians <a href="https://doi.org/10.1016/s0140-6736(76)91677-9">have known for decades</a> that <a href="https://doi.org/10.1089/ham.2010.1006">taking time to slowly ascend is the best way</a> to prevent the development of altitude sickness. This strategy gives the body time to complete its natural physiologic responses to the changes in air pressure and oxygen content. In fact, spending just <a href="https://doi.org/10.1089/ham.2010.1006">one night at a moderate elevation</a>, such as Denver, Colorado, which is at 5,280 feet (1,600 meters), has been shown to <a href="https://doi.org/10.7326/0003-4819-118-8-199304150-00003">significantly reduce the likelihood of developing symptoms</a>. People who skip this step and travel directly to high elevations are <a href="https://doi.org/10.1093/jtm/taad011">up to four times more likely</a> to develop altitude sickness symptoms. When going to elevations greater than 11,000 feet, multiple days of acclimatization are necessary. Experts generally recommend ascending <a href="https://doi.org/10.1089/ham.2010.1006">no more than 1,500 feet per day</a> once the threshold of 8,200 feet of elevation has been crossed. Workers at high altitude, such as <a href="https://doi.org/10.1089/ham.2020.0004">porters in the Nepali Himalaya</a>, are at <a href="https://doi.org/10.1016/j.wem.2018.06.002">particular risk of altitude-related illness</a>. These workers often do not adhere to acclimatization recommendations in order to maximize earnings during tourist seasons; as a result, they are more likely to experience <a href="https://www.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">severe forms of altitude sickness</a>. <h2>Effective medications</h2> For more than 40 years, <a href="https://doi.org/10.1056/nejm196810172791601">a medicine called acetazolamide</a> has been used to <a href="https://medlineplus.gov/druginfo/meds/a682756.html">prevent the development of altitude sickness</a> and to treat its symptoms. Acetazolamide is <a href="https://www.ncbi.nlm.nih.gov/books/NBK557838/">commonly used as a diuretic</a> and for the <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma">treatment of glaucoma</a>, a condition that causes increased pressure within the eye. If started <a href="https://doi.org/10.1378/chest.09-2445">two days prior</a> to going up to a high elevation, acetazolamide can <a href="https://doi.org/10.1378/chest.09-2445">prevent symptoms of acute illness</a> by speeding up the acclimatization process. Nonetheless, it does not negate the recommendations to ascend slowly, and it is <a href="https://doi.org/10.1016/j.wem.2019.04.006">routinely recommended only</a> when people cannot slowly ascend or for people who have a history of severe altitude sickness symptoms even with slow ascent. Other medications, including ibuprofen, have <a href="https://doi.org/10.1016/j.wem.2012.08.001">shown some effectiveness</a> in treating acute mountain sickness, although <a href="https://doi.org/10.1016/j.amjmed.2018.10.021">not as well as acetazolamide</a>. A <a href="https://pubmed.ncbi.nlm.nih.gov/2028586/">steroid medication called dexamethasone</a> is effective in both treating and preventing symptoms, but it does not improve acclimatization. It is <a href="https://doi.org/10.1016/j.wem.2019.04.006">recommended only when acetazolamide is not effective</a> or cannot be taken. Additionally, it is important to <a href="https://wwwnc.cdc.gov/travel/page/travel-to-high-altitudes">avoid alcohol during the first few days at higher altitudes</a>, as it impairs the body’s ability to acclimatize. <h2>Unproven therapies and remedies are common</h2> As high-altitude tourism becomes increasingly popular, multiple commercial products and remedies have emerged. Most of them are not effective or provide no evidence to suggest they work as advertised. Other options have mixed evidence, making them difficult to recommend. Medications such as <a href="https://doi.org/10.1089/ham.2007.1037">aspirin</a>, <a href="https://doi.org/10.1183/13993003.01355-2017">inhaled steroids</a> and <a href="https://doi.org/10.1089/ham.2011.0007">sildenafil</a> have been proposed as possible preventive agents for altitude sickness, but on the whole they have not been found to be effective. <a href="https://doi.org/10.1093/qjmed/hcp026">Supplements and antioxidants have no proven benefit</a> in preventing or treating altitude sickness symptoms. Both normal and high-altitude exercise are popular ways to prepare for high elevations, especially among athletes. However, beyond <a href="https://doi.org/10.1097/jes.0b013e31825eaa33">certain pre-acclimatization strategies</a>, such as brief sojourns to high altitude, <a href="https://doi.org/10.1016/j.tmaid.2013.12.002">physical fitness and training is of little benefit</a>. <a href="https://missouripoisoncenter.org/canned-oxygen-is-it-good-for-you">Canned oxygen</a> has also exploded in popularity with travelers. While <a href="https://doi.org/10.1016/0140-6736(90)93240-p">continuously administered medical oxygen</a> in a health care setting can alleviate altitude sickness symptoms, portable oxygen cans <a href="https://doi.org/10.1016/j.wem.2019.04.006">contain very little oxygen gas</a>, casting doubt on their effectiveness. Some high-altitude adventure travelers sleep in <a href="https://doi.org/10.2165/00007256-200131040-00002">specialized tents</a> that simulate increased elevation by lowering the quantity of available oxygen in ambient air. The lower oxygen levels within the tent are thought to accelerate the acclimatization process, but the tents aren’t able to decrease barometric pressure. This is an important part of the high-altitude environment that induces acclimatization. Without modifying ambient air pressure, these <a href="https://doi.org/10.1016/j.wem.2014.04.004">tents may take multiple weeks</a> to be effective. Natural medicines, such as <a href="https://doi.org/10.1580/08-weme-br-247.1">gingko</a> and <a href="https://doi.org/10.1186/s40794-019-0095-7">coca leaves</a>, are touted as natural altitude sickness treatments, but few studies have been done on them. The modest benefits and significant side effects of these options makes their use <a href="https://doi.org/10.1016/j.wem.2019.04.006">difficult to recommend</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/8469948/">Staying hydrated</a> is very important at high altitudes due to fluid losses from increased urination, dry air and increased physical exertion. <a href="https://doi.org/10.1186%2Fs12889-018-6252-5">Dehydration symptoms</a> can also mimic those of altitude sickness. But there is <a href="https://doi.org/10.1580/1080-6032(2006)17%5B215:AMSIOF%5D2.0.CO;2">little evidence that consuming excessive amounts of water</a> can prevent or treat altitude sickness. The mountains have something for visitors of all interests and expertise and can offer truly life-changing experiences. While there are health risks associated with travel at higher elevations, these can be lessened by making basic preparations and taking time to slowly ascend.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222057/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brian-strickland-1506270">Brian Strickland</a>, Senior Instructor in Emergency Medicine, <a href="https://theconversation.com/institutions/university-of-colorado-anschutz-medical-campus-4838">University of Colorado Anschutz Medical Campus</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/altitude-sickness-is-typically-mild-but-can-sometimes-turn-very-serious-a-high-altitude-medicine-physician-explains-how-to-safely-prepare-222057">original article</a>.

Travel Trouble

Taking expensive medicines or ones unavailable in Australia? Importing may be the answer

<a href="https://theconversation.com/profiles/jacinta-l-johnson-1441348">Jacinta L. Johnson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/kirsten-staff-1494356">Kirsten Staff</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> The cost-of-living crisis may be driving some Australians to look for cheaper medicines, especially if those medicines are not subsidised or people don’t have a Medicare card. Options can include buying their medicines from overseas, in a process called “<a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/personal-importation-scheme">personal importation</a>”. Others also use this option to import medicine that is not available in Australia. Here’s what’s involved and what you need to know about the health and legal risks. <h2>Cost-of-living crisis bites</h2> Many Australians, particularly those with long-term illnesses, are finding it increasingly hard to afford health care. The <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/latest-release#barriers-to-health-service-use">Australian Bureau of Statistics</a> reports the proportion of people who delayed or did not see a GP due to cost doubled in 2022-23 (7%) compared with 2021-22 (3.5%). A <a href="https://australianhealthcareindex.com.au/wp-content/uploads/2022/11/Australian-Healthcare-Index-Report-Nov-22.pdf">survey</a> published in 2022 of over 11,000 people found more than one in five went without a prescription medicine due to the cost. For those with a Medicare card it’s usually best (and cheapest) to get medicines locally, especially if you also have a concession card. However, for some high-cost medicines, personal importation may be cheaper. That’s when an individual arranges for medicine to be sent to them directly from an overseas supplier. A 2023 study found <a href="https://www.publish.csiro.au/AH/AH23143?jid=AHv47n6&xhtml=5AA1F839-38C8-45E8-A458-79DCDB7597FB">1.8%</a> of Australians aged 45 or older had imported prescription medicines in the past 12 months. That indicates potentially hundreds of thousands of Australians are importing prescription medicines each year. Almost half of the survey respondents indicated they would consider importing medicines to save money. <h2>What’s involved?</h2> Australia’s drug regulator, the Therapeutic Goods Administration (TGA), allows individuals to import up to three months’ supply of medicines for their own personal use (or use by a close family member) under the <a href="https://www.tga.gov.au/products/unapproved-therapeutic-goods/personal-importation-scheme">personal importation scheme</a>. This often involves ordering a medicine through an overseas website. If the medicine would require a prescription in Australia, you must also have a legally valid prescription to import it. Selling or supplying these medicines to others outside your immediate family is strictly prohibited. <h2>How could this help?</h2> For some high-cost medicines, personal importation may be cheaper than having the medicine dispensed in Australia. This is most likely for medicines not subsidised by the <a href="https://www.pbs.gov.au/info/about-the-pbs">Pharmaceutical Benefits Scheme</a> (the PBS). People who do not hold a Medicare card may also find it cheaper to import certain medicines as they do not have access to PBS-subsidised medicines. For example, for people with a specific type of leukaemia, treatment with sorafenib is not covered by the PBS. For these patients it could be up to about ten times more expensive to have their treatment dispensed in Australia as it is to import. That’s because there is a cheaper generic version available overseas. Personal importation may also allow you to access medicines that are available overseas but are not marketed in Australia. <h2>What are the risks?</h2> All medicines carry risks, and medicine sold online can pose additional dangers. The TGA does not regulate medicines sold overseas, so the safety and quality of such medicines can be uncertain; they may not be produced to <a href="https://www.tga.gov.au/what-tga-regulates">Australian standards</a>. While similar regulatory agencies exist in other countries, when ordering medicines from overseas websites it can be difficult to determine if the product you are buying has been assessed to ensure it is safe and will do what it says it will do. The medicines purchased could be counterfeit or “fake”. Products bought through unverified or overseas websites may have undisclosed ingredients, contain a dose that differs from that on the label, or lack the active ingredient entirely. <a href="https://www.tga.gov.au/importing-therapeutic-goods">Not all medicines</a> can be legally imported through the personal importation scheme. Certain medicines are never allowed to be imported into Australia, and others can only be imported by a medical professional on behalf of a patient. So if you attempt to import a restricted medicine, the Australian Border Force <a href="https://www.abf.gov.au/entering-and-leaving-australia/can-you-bring-it-in/categories/medicines-and-substances">may seize it</a>. Not only would you lose your medicine, but you could also receive a fine or face <a href="https://www.tga.gov.au/news/blog/can-i-import-medicine-personal-use#:%7E:text=If%20you%20try%20to%20import,a%20fine%20or%20jail%20time.">jail time</a>. As with any purchase from an overseas business, there is also a risk you may lose your money and you might not be protected by Australian consumer laws. If you do choose to import medicines by buying them from an overseas website, you should also consider what could happen if delivery is delayed and you don’t get your medicine in time. <h2>Where can I get more advice?</h2> If you are thinking about importing medicines you should first discuss this with a health professional, such as your GP or pharmacist. They can help you determine if personal importation is permitted for the medicine you need. You can also discuss if this is the best option for you. If you are having difficulty covering the cost of your medicines your doctor or pharmacist can also explore other potential alternatives to ensure you are receiving the most cost-effective treatment available in Australia. <h2>Where do I go online?</h2> If you then decide to import, here are some reputable sites to help navigate the global online medicines market: <ul> <li> <a href="https://everyone.org/">everyone.org</a> helps people everywhere in the world access the latest medicines not available in their own countries </li> <li> <a href="https://buysaferx.pharmacy/">Alliance for Safe Online Pharmacies</a> is a not-for-profit organisation that collates information on how to find safe online pharmacies based in different regions of the world </li> <li> <a href="https://www.pharmacychecker.com/accredited-online-pharmacies/">PharmacyChecker</a> has also collated a list of trusted online pharmacies that ship medicines internationally. </li> </ul> Australian government websites about importing medicines include those from <a href="https://www.tga.gov.au/news/blog/can-i-import-medicine-personal-use">the TGA</a> and on what to consider when buying medicines online from <a href="https://www.healthdirect.gov.au/buying-medicines-online#overseas">overseas</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219394/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jacinta-l-johnson-1441348">Jacinta L. Johnson</a>, Senior Lecturer in Pharmacy Practice, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/kirsten-staff-1494356">Kirsten Staff</a>, Senior Lecturer in Pharmacy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-expensive-medicines-or-ones-unavailable-in-australia-importing-may-be-the-answer-219394">original article</a>.

Caring

Six surprising things about placebos everyone should know

<a href="https://theconversation.com/profiles/jeremy-howick-250620">Jeremy Howick</a>, <a href="https://theconversation.com/institutions/university-of-leicester-1053">University of Leicester</a> Placebos have been studied more than any treatment in the history of medicine, yet they remain mysterious. I’ve been studying placebos for 20 years and I’ve done some of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288933/">key studies</a> that have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655171/">advanced the scientific knowledge</a> in this area. Here are six facts about this strange effect that still fascinate me. <h2>1. Placebos have a dark cousin: nocebos</h2> A 29-year-old builder went to the hospital after having jumped onto a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471339/">15cm nail</a> that pierced his boot. Moving the nail was so painful he had to be sedated with powerful drugs (fentanyl and midazolam) to remove it. But when he took off his boot, the medics discovered that the nail had gone between his toes. The builder’s pain was caused by the wrong belief that the nail had penetrated his foot. The detrimental effects of negative expectations are called nocebo effects. For evolutionary reasons (survival depends on avoiding danger), nocebo effects are larger than placebo effects. Unfortunately, patients are often told more about the bad things that might happen than the good things, which can result in a self-fulfilling prophecy. For example, learning that a drug has a possible side-effect of nausea or pain can actually <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368797/">cause nausea or pain</a>. <h2>2. Placebos work even if people know they are placebos</h2> Linda Buonanno suffered so badly from irritable bowel syndrome that she often couldn’t <a href="https://www.theguardian.com/lifeandstyle/2017/may/22/knew-they-were-sugar-pills-felt-fantastic-rise-open-label-placebos">leave the house</a> for weeks. She signed up for a trial of “honest” (open-label) placebos, which is a placebo that patients know is a placebo. The Harvard doctors in the trial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008733/">told her</a> the pills were “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in [irritable bowel] symptoms through mind-body self-healing processes”. The honest placebos worked so well that she was able to resume a normal life. Honest placebos have <a href="https://pubmed.ncbi.nlm.nih.gov/28452193/">worked in other trials</a> for treating depression, back pain and attention deficit hyperactivity disorder (ADHD). Honest placebos work because of our subconscious expectations. Our past experiences of doctors and hospitals can generate subconscious expectations that activate our body’s inner pharmacy, which produces morphine (endorphins) and other beneficial drugs. <h2>3. Honest placebos are ethically acceptable</h2> It is often considered unethical for doctors to give placebos to patients because this supposedly <a href="https://link.springer.com/article/10.1007/s11724-014-0400-1">involves lying</a> (telling patients that a sugar pill is a powerful medication). But honest placebos do not involve lying, so there is no ethical barrier. In one <a href="https://pubmed.ncbi.nlm.nih.gov/34805194/#:%7E:text=Introduction%3A%20Open%2Dlabel%20placebos%20have,label%20placebos%20in%20acute%20pain.">ongoing trial</a>, doctors asked patients whether they would be willing to try a mix of real painkillers and honest placebos. Patients in this trial have the same level of pain relief following surgery, but are less likely to become dependent on painkillers. <h2>4. Placebo effects are part of most treatment effects</h2> When a doctor prescribes ibuprofen for back pain, the effects are due to the ibuprofen and the patient’s beliefs and expectations, which can be influenced by the doctor’s communication. Doctors who offer positive messages in a warm, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047264/">empathic manner</a> will increase the effect of the drugs. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2359128/">size and colour</a> of the pill can also influence the effect. A large, orange pill can reduce pain more than a small, red one. By contrast, blue pills generally have a sedative effect – except for Italian men, for whom blue pills have an <a href="https://www.amherst.edu/system/files/media/1601/moerman_explanatory%20mechanisms%20for%20placebo%20effects.pdf">excitative effect</a>), probably because their revered football team wears blue. Doctors’ ethical duty to benefit patients suggests it is an ethical duty to maximise the placebo effects of all treatments they provide. <h2>5. You don’t need placebos to have placebo effects</h2> In one trial, patients were given morphine <a href="https://pubmed.ncbi.nlm.nih.gov/15488461/">via an intravenous line</a> following surgery. However, only half of the patients were told they were receiving morphine. The patients who were told this had 50% more pain relief than those who were not told they were receiving morphine. This is an example of a placebo effect without a placebo. <h2>6. You can generate placebo (and nocebo) effects in yourself</h2> All communication can have a beneficial or harmful effect. One study found that teaching communication skills to families <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915212/">reduced anxiety and depression</a>. On the other hand, couples who dwell on problems and negative aspects of their relationships were shown in a study to have <a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453022003304?via%3Dihub">weaker immune systems</a>. Acts of altruism, focusing on a brighter future, or gratitude are proven ways to reduce the effect of negative communication. An easy way to generate positive placebo effects for yourself is by performing a <a href="https://www.mentalhealth.org.uk/explore-mental-health/kindness-and-mental-health/random-acts-kindness">random act of kindness</a>, such as making a colleague a cup of tea, or simply smiling and saying hello. You can learn more about the amazing effects of placebos and nocebos in my <a href="https://www.press.jhu.edu/books/title/12830/power-placebos">latest book</a>, The Power of Placebos: How the Science of Placebos and Nocebos can Improve Health Care.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/220829/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jeremy-howick-250620">Jeremy Howick</a>, Professor and Director of the Stoneygate Centre for Excellence in Empathic Healthcare, <a href="https://theconversation.com/institutions/university-of-leicester-1053">University of Leicester</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/six-surprising-things-about-placebos-everyone-should-know-220829">original article</a>.

Body

Drinking alcohol this Christmas and New Year? These medicines really don’t mix

<a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> A glass or two of champagne with Christmas lunch. A cool crisp beer at the beach. Some cheeky cocktails with friends to see in the New Year. There seem to be so many occasions to unwind with an alcoholic drink this summer. But if you’re taking certain medications while drinking alcohol, this can affect your body in a number of ways. Drinking alcohol with some medicines means they may not work so well. With others, you risk a life-threatening overdose. Here’s what you need to know if you’re taking medication over summer and plan to drink. <h2>Why is this a big deal?</h2> After you take a medicine, it travels to the stomach. From there, your body shuttles it to the liver where the drug is metabolised and broken down before it goes into your blood stream. Every medicine you take is provided at a dose that takes into account the amount of metabolism that occurs in the liver. When you drink alcohol, this is also broken down in the liver, and it can affect how much of the drug is metabolised. Some medicines are metabolised more, which can mean not enough reaches your blood stream to be effective. Some medicines are metabolised less. This means you get a much higher dose than intended, which could lead to an overdose. The effects of alcohol (such as sleepiness) can act in addition to similar effects of a medicine. Whether or not you will have an interaction, and what interaction you have, depends on many factors. These include the medicine you are taking, the dose, how much alcohol you drink, your age, genes, sex and overall health. Women, older people and people with liver issues are more likely to have a drug interaction with alcohol. <h2>Which medicines don’t mix well with alcohol?</h2> Many medicines interact with alcohol regardless of whether they are prescribed by your doctor or bought over the counter, such as <a href="https://www.drugs.com/article/herbal-supplements-alcohol.html">herbal medicines</a>. 1. Medicines + alcohol = drowsiness, coma, death Drinking alcohol and taking a medicine that depresses the <a href="https://adf.org.au/drug-facts/depressants/">central nervous system</a> to reduce arousal and stimulation can have additive effects. Together, these can make you extra drowsy, slow your breathing and heart rate and, in extreme cases, lead to coma and death. These effects are more likely if you use more than one of this type of medicine. Medicines to look out for include those for depression, anxiety, schizophrenia, pain (except <a href="https://www.nps.org.au/australian-prescriber/articles/alcohol-and-paracetamol">paracetamol</a>), sleep disturbances (such as insomnia), allergies, and colds and flu. It’s best not to drink alcohol with these medicines, or to keep your alcohol intake to a minimum. 2. Medicines + alcohol = more effects Mixing alcohol with some medicines increases the effect of those medicines. One example is with the sleeping tablet zolpidem, which is <a href="https://www.tga.gov.au/news/product-recalls/zolpidem-stilnox">not to be taken with alcohol</a>. Rare, but serious, side effects are strange behaviour while asleep, such as sleep-eating, sleep-driving or sleep-walking, which are more likely with alcohol. 3. Medicines + craft beer or home brew = high blood pressure Some types of medicines only interact with some types of alcohol. Examples include some medicines for depression, such as phenelzine, tranylcypromine and moclobemide, the antibiotic linezolid, the Parkinson’s drug selegiline, and the cancer drug procarbazine. These so-called <a href="https://www.mydr.com.au/medicine/monoamine-oxidase-inhibitors-maois-for-depression/">monoamine oxidase inhibitors</a> <a href="https://www.health.qld.gov.au/__data/assets/pdf_file/0020/145802/oncol_maoi.pdf">only interact with</a> some types of boutique and artisan beers, beers with visible sediment, Belgian, Korean, European and African beers, and home-made beers and wine. These types of alcohol contain high levels of tyramine, a naturally occurring substance usually broken down by your body that doesn’t ordinarily cause any harm. However, monoamine oxidase inhibitors prevent your body from breaking down tyramine. This increases levels in your body and can cause your blood pressure to rise to dangerous levels. 4. Medicines + alcohol = effects even after you stop drinking Other medicines interact because they affect the way your body breaks down alcohol. If you drink alcohol while using such medicines you may you feel nauseous, vomit, become flushed in the face and neck, feel breathless or dizzy, your heart may beat faster than usual, or your blood pressure may drop. This can occur even after you stop treatment, then drink alcohol. For example, if you are taking metronidazole you should avoid alcohol both while using the medicine and for at least 24 hours after you stop taking it. An example of where alcohol changes the amount of the medicine or related substances in the body is acitretin. This medication is used to treat skin conditions such as severe psoriasis and to prevent skin cancer in people who have had an organ transplant. When you take acitretin, it changes into another substance – <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2017-CMI-02034-1&d=20221221172310101">etretinate</a> – before it is removed from your body. Alcohol increases the amount of etretinate in your body. This is especially important as etretinate can cause birth defects. To prevent this, if you are a woman of child-bearing age you should avoid alcohol while using the medicine and for two months after you stop taking it. <h2>Myths about alcohol and medicines</h2> Alcohol and birth control One of the most common myths about medicines and alcohol is that you can’t drink while using <a href="https://youly.com.au/blog/sexual-reproductive-health/does-alcohol-make-the-pill-less-effective/">the contraceptive pill</a>. It is generally safe to use alcohol with the pill as it <a href="https://www.healthline.com/health/womens-health/birth-control-and-alcohol#:%7E:text=There's%20a%20bit%20of%20good,a%20less%20effective%20birth%20control.">doesn’t directly affect</a> how well birth control works. But the pill is most effective when taken at the same time each day. If you’re drinking heavily, you’re more likely to forget to do this the next day. Alcohol can also make some people nauseous and vomit. If you vomit within three hours of taking the pill, it will not work. This increases your risk of pregnancy. Contraceptive pills can also affect your response to alcohol as the hormones they contain can change the way your body <a href="https://americanaddictioncenters.org/alcoholism-treatment/birth-control">removes alcohol</a>. This means you can get drunk faster, and stay drunk for longer, than you normally would. Alcohol and antibiotics Then there’s the myth about not mixing alcohol with any <a href="https://theconversation.com/mondays-medical-myth-you-cant-mix-antibiotics-with-alcohol-4407">antibiotics</a>. This only applies to <a href="https://www.healthdirect.gov.au/medicines/medicinal-product/aht,21161/metronidazole">metronidazole</a> and <a href="https://www.healthdirect.gov.au/medicines/brand/amt,1011571000168100/linezolid-apo">linezolid</a>. Otherwise, it is generally safe to use alcohol with antibiotics, as alcohol does not affect how well they work. But if you can, it is best to avoid alcohol while taking antibiotics. Antibiotics and alcohol have similar side effects, such as an upset stomach, dizziness and drowsiness. Using the two together means you are more likely to have these side effects. Alcohol can also reduce your energy and increase how long it takes for you to recover. <h2>Where can I go for advice?</h2> If you plan on drinking alcohol these holidays and are concerned about any interaction with your medicines, don’t just stop taking your medicines. Your pharmacist can advise you on whether it is safe for you to drink based on the medicines you are taking, and if not, provide advice on alternatives.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/196646/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drinking-alcohol-this-christmas-and-new-year-these-medicines-really-dont-mix-196646">original article</a>.

Caring

Taking an antidepressant? Mixing it with other medicines – including some cold and flu treatments – can be dangerous

<a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> In the depths of winter we are more at risk of succumbing to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522168/">viral respiratory infections</a> – from annoying sore throat, common cold and sinusitis, to the current resurgence of respiratory syncytial virus (RSV), influenza and COVID. Symptoms of upper respiratory tract infection range in severity. They can include fever, chills, muscle or body aches, cough, sore throat, runny or stuffy nose, earache, headache, and fatigue. Most antibiotics target bacteria so are <a href="https://pubmed.ncbi.nlm.nih.gov/32495003/">not effective</a> for viral infections. Many people seek relief with over-the-counter medicines. While evidence varies, guidelines suggest medicines taken by mouth (such as cough syrups or cold and flu tablets) have a <a href="https://pubmed.ncbi.nlm.nih.gov/25420096/">limited but potentially positive</a> short-term role for managing upper respiratory infection symptoms in adults and children older than 12. These include: <ul> <li>paracetamol or ibuprofen for pain or fever</li> <li>decongestants such as phenylephrine or pseudoephedrine</li> <li>expectorants and mucolytics to thin and clear mucus from upper airways</li> <li>dry cough suppressants such as dextromethorphan</li> <li>sedating or non-sedating antihistamines for runny noses or watery eyes.</li> </ul> But what if you have been prescribed an antidepressant? What do you need to know before going to the pharmacy for respiratory relief? <h2>Avoiding harm</h2> An audit of more than 5,000 cough-and-cold consumer enquiries to an Australian national medicine call centre found questions frequently related to drug-drug interactions (29%). An 18-month analysis showed 20% of calls <a href="https://pubmed.ncbi.nlm.nih.gov/26590496/">concerned</a> potentially significant interactions, particularly with antidepressants. Australia remains in the “<a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-%20prescriptions#Prescriptionsbytype">top ten</a>” antidepressant users in the <a href="https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC">OECD</a>. More than <a href="https://www.aihw.gov.au/mental-health/topic-areas/mental-health-prescriptions">32 million</a> antidepressant prescriptions are dispensed on the Pharmaceutical Benefits Scheme each year. Antidepressants are commonly prescribed to manage symptoms of anxiety or depression but are also used in chronic pain and incontinence. They are classified primarily by how they affect chemical messengers in the nervous system. These classes are: <ul> <li>selective serotonin reuptake inhibitors (SSRI) such as fluoxetine, escitalopram, paroxetine and sertraline</li> <li>serotonin and noradrenaline reuptake inhibitors (SNRI) such as desvenlafaxine, duloxetine and venlafaxine</li> <li>tricyclic antidepressants (TCA) such as amitriptyline, doxepin and imipramine</li> <li>monoamine oxidase inhibitors (MAOI) such as tranylcypromine</li> <li>atypical medicines such as agomelatine, mianserin, mirtazapine, moclobemide, reboxetine and vortioxetine</li> <li>complementary medicines including St John’s wort, S-adenosyl methionine (SAMe) and L-tryptophan</li> </ul> Medicines within the same class of antidepressants have similar actions and side-effect profiles. But the molecular differences of individual antidepressants mean they may have different interactions with medicines taken at the same time. <h2>Types of drug interactions</h2> Drug interactions can be: <ul> <li>pharmacokinetic – what the body does to a drug as it moves into, through and out of the body. When drugs are taken together, one may affect the absorption, distribution, metabolism or elimination of the other</li> <li>pharmacodynamic – what a drug does to the body. When drugs are taken together, one may affect the action of the other. Two drugs that independently cause sedation, for example, may result in excessive drowsiness if taken together.</li> </ul> There are many <a href="https://wchh.onlinelibrary.wiley.com/doi/pdf/10.1002/pnp.429">potential interactions</a> between medications and antidepressants. These include interactions between over-the-counter medicines for upper respiratory symptoms and antidepressants, especially those taken orally. Concentrations of nasal sprays or inhaled medicines are generally lower in the blood stream. That means they are less likely to interact with other medicines. <h2>What to watch for</h2> It’s important to get advice from a pharmacist before taking any medications on top of your antidepressant. Two symptoms antidepressant users should monitor for shortly after commencing a cough or cold medicine are central nervous system effects (irritability, insomnia or drowsiness) and effects on blood pressure. For example, taking a selective SSRI antidepressant and an oral decongestant (such as pseudoephedrine or phenylephrine) can cause irritability, insomnia and affect blood pressure. Serotonin is a potent chemical compound produced naturally for brain and nerve function that can also constrict blood vessels. Medicines that affect serotonin are common and include most antidepressant classes, but also decongestants, dextromethorphan, St John’s wort, L-tryptophan, antimigraine agents, diet pills and amphetamines. <a href="https://reference.medscape.com/drug-interactionchecker">Combining drugs</a> such as antidepressants and decongestants that both elevate serotonin levels can cause irritability, headache, insomnia, diarrhoea and blood pressure effects – usually increased blood pressure. But some people experience orthostatic hypotension (low blood pressure on standing up) and dizziness. For example, taking both a serotonin and SNRI antidepressant and dextromethorphan (a cough suppressant) can add up to high serotonin levels. This can also occur with a combination of the complementary medicine St John’s Wort and an oral decongestant. Where serotonin levels are too high, <a href="https://pubmed.ncbi.nlm.nih.gov/15666281/">severe symptoms</a> such as confusion, muscle rigidity, fever, seizures and even death have been reported. Such symptoms are rare but if you notice any of these you should stop taking the cold and flu medication straight away and seek medical attention. <h2>Ways to avoid antidepressant drug interactions</h2> There are a few things we can do to prevent potentially dangerous interactions between antidepressants and cold and flu treatments. 1. Better information Firstly, there should be more targeted, consumer-friendly, <a href="https://www.webmd.com/interaction-checker/default.htm">online drug interaction information</a> available for antidepressant users. 2. Prevent the spread of viral infections as much as possible Use the non-drug strategies that have worked well for COVID: regular hand washing, good personal hygiene, social distancing, and facemasks. Ensure adults and children are up to date with immunisations. 3. Avoid potential drug interactions with strategies to safely manage symptoms Consult your pharmacist for strategies most appropriate for you and only use cold and flu medications while symptoms persist: <ul> <li>treat muscle aches, pain, or a raised temperature with analgesics such as paracetamol or ibuprofen</li> <li>relieve congestion with a nasal spray decongestant</li> <li>clear mucus from upper airways with expectorants or mucolytics</li> <li>dry up a runny nose or watery eyes with a non-sedating antihistamine.</li> </ul> Avoid over-the-counter cough suppressants for an irritating dry cough. Use a simple alternative such as honey, steam inhalation with a few drops of eucalyptus oil or a non-medicated lozenge instead. 4. Ask whether your symptoms could be more than the common cold Could it be influenza or COVID? Seek medical attention if you are concerned or your symptoms are not improving. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208662/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/treasure-mcguire-135225">Treasure McGuire</a>, Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and as Associate Professor (Clinical), <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/taking-an-antidepressant-mixing-it-with-other-medicines-including-some-cold-and-flu-treatments-can-be-dangerous-208662">original article</a>.

Body

Which medicines don’t go well with flying?

Every day, <a href="http://www.iata.org/pressroom/pr/Pages/2012-12-06-01.aspx">more than 10 million people</a> take a flight somewhere in the world. While flying is relatively safe, the unique environmental conditions can put passengers at risk if they’re taking certain medications. These include any hormone-based drugs, like the contraceptive pill and some fertility medicines, and drugs used to prevent heart attack and stroke. Antihistamines should also not be used to help passengers sleep during a flight. <h2>What makes flying different from other forms of travel?</h2> While flying is <a href="https://theconversation.com/whats-most-likely-to-kill-you-measuring-how-deadly-our-daily-activities-are-72505">one of the safest forms of travel</a>, there are specific risks that come with air travel, regardless of the length of the flight. Passenger planes are typically pressurised to the same atmospheric conditions that are found at 10,000 feet altitude. <a href="https://www.ncbi.nlm.nih.gov/pubmed/6823572">At that level</a>, <a href="https://www.higherpeak.com/altitudechart.html">the effective oxygen level is only 14.3%</a>, which is much lower than the 20.9% found at ground level. An additional risk is reduced blood flow from a lack of movement and sitting in cramped conditions, unless of course you’re fortunate enough to be in business or first class. And finally, dehydration is also a common side effect of flying due to the lack of humidity in the air. When these conditions are combined, it results in an increased risk of <a href="https://www.healthdirect.gov.au/deep-vein-thrombosis">deep vein thrombosis</a>, which is also known as DVT. This is a type of blood clot that occurs in the veins deep in the body and occurs most often in the legs. The development of a blood clot can result in blocked blood flow to the lungs, heart, or brain, which in turn can cause a heart attack or stroke. <h2>Contraceptive pill and other hormone-based medicines</h2> Given the inherent risk of a blood clot when flying, a passenger should use with caution any medication that can further increase the risk of a clot. Some brands of contraceptive for women (tablet or implant formulation) are <a href="http://www.theaustralian.com.au/national-affairs/health/new-bloodclot-alerts-added-to-diane35-eds-product-information/news-story/eaa0b596541a760e9c6cf89b37900c42">known to increase the chances of a blood clot</a>, although the overall increase in risk is small. While it’s thought the major risk comes from the hormone <a href="http://www.healthywomen.org/condition/estrogen">estrogen</a>, <a href="http://www.cochrane.org/CD010813/FERTILREG_contraceptive-pills-and-venous-thrombosis">a review of all the medical evidence in 2014</a> showed there’s a risk of blood clot from all contraceptive medicines. Likewise, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hormone-replacement-therapy-hrt-and-menopause">hormone replacement therapy</a>, particularly those that include estrogen, or some fertility medicines, such as <a href="https://www.babycenter.com/0_fertility-drug-gonadotropins_6188.bc">gonadotrophins</a>, can increase the risk of a blood clot. If you take one of these medicines, it does not mean you cannot fly, nor that you should necessarily stop taking the drug. Many millions of women fly while taking these medicines and suffer no ill effects. But the risk is also increased if you have an underlying health condition that includes type II diabetes, heart disease, and prior heart attacks or strokes. As such, passengers who also take medications to help prevent heart attacks and strokes should consult their doctor or pharmacist before flying. If you’re at increased risk of a blood clot, then an anti-platelet medication may be suitable for you. These medicines act by stopping the blood cells from sticking together and include prescription medicines such as <a href="http://www.melbournehaematology.com.au/fact-sheets/warfarin.html">warfarin</a> and <a href="https://www.nps.org.au/australian-prescriber/articles/clopidogrel">clopidogrel</a>, and over-the-counter medicines such as <a href="https://www.healthdirect.gov.au/medicines/brand/amt,34661000168102/aspirin-low-dose-pharmacy-action">low dose aspirin</a>. <h2>Antihistamines</h2> Many passengers can have trouble sleeping when flying, especially on long-haul flights. Parents flying with young children can also be concerned about them not sleeping or being unsettled and annoying other passengers. In these instances, many will turn to <a href="https://www.healthdirect.gov.au/antihistamines">sedating antihistamines</a>, like <a href="https://www.healthdirect.gov.au/medicines/brand/amt,22661000168108/phenergan">promethazine</a> to try to induce sleep. But this is a bad option. The Australian Medical Association specifically recommends <a href="http://www.smh.com.au/national/australian-medical-association-warns-against-sedating-children-on-long-journeys-20150405-1mesd0.html">parents do not do this</a>, as sometimes it can have the reverse effect and make children less sleepy and more active. These types of <a href="http://www.medsafe.govt.nz/profs/PUArticles/Mar2013ChildrenAndSedatingAntihistamines.htm">antihistamines are also known to depress breathing</a>, and in the low oxygen environment of the aircraft this can be especially dangerous. If you feel you or another family member will need sedation when flying, don’t use an antihistamine. Consult your doctor or pharmacist for a more suitable medication. Examples include prescription sleeping tablets, such as <a href="https://sleepfoundation.org/sleep-topics/melatonin-and-sleep">melatonin</a>, or natural remedies, such as <a href="https://www.webmd.com/vitamins-supplements/ingredientmono-870-valerian.aspx?activeingredientid=870">valerian</a>. <h2>What to do before and during your flight</h2> Before you fly, if you’re taking any form of medication, it’s recommended you meet with your doctor or pharmacist to discuss the suitability of your medicines. They may advise you there’s little risk for you, or if there is a risk, they may recommend a different medicine for the trip or recommend a new medicine to reduce the risk of blood clots. During your flight, don’t take antihistamines, and reduce your chance of a blood clot by drinking lots of water, stretching in your seat, and moving about the cabin as much as is appropriate. Finally, the effects of alcohol can be increased when flying – so drink in moderation, and try to avoid tea, coffee, and other caffeinated drinks as these can have dehydrating effects and make it harder to sleep. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/which-medicines-dont-go-well-with-flying-90222" target="_blank" rel="noopener">The Conversation</a>.

Travel Tips

Huge news for Alzheimer’s sufferers

An experimental new drug by Eli Lilly has demonstrated an ability to slow the progression of Alzheimer’s disease, according to new study reports. The pharmaceutical company has said that its drug, donanemab, met each goal of their 18-month trial, successfully slowing cognitive decline by 35 per cent compared to a placebo. 1,182 individuals in the early stages of Alzheimer’s participated in the study, with each patient receiving monthly infusions of donanemab. After 12 months, half of the participants showed no evidence of amyloid plaques, while 48 per cent of patients in the trial had no disease progression at 12 months, compared to 29 per cent from the placebo group. In the wake of the news, experts are optimistic, but still hold concerns about the risks moving forward. Dr Ronald Petersen, a Mayo Clinic Alzheimer research, told the ABC that “Lilly's trial is the third to show removing amyloid from the brain slows progression of the disease, which could put to rest some lingering doubts about the benefits of drugs in the class and the amyloid-lowering theory. "It's modest, but I think it's real and I think it's clinically meaningful." Washington University neurologist Dr Erik Musiek noted that mounting evidence was suggesting “that these drugs do work”. He also said that the findings were reminding them of the benefits of early treatment, explaining that “it really does suggest that you need to remove these plaques early, before the tau really gets going.” When it comes to the associated risks, Eli Lilly have said that the drug’s side effects could include brain swelling as well as bleeding, with serious swelling occurring in 1.6 per cent of patients. As Dr Eric Reiman, Banner Alzheimer’s Institute’s executive director, explained, “clearly one saw benefits here, but there is some risk that needs to be considered.” From there, Lily plan to file for US approval by the end of June, and to proceed with regulars from other countries in the time after. A spokesperson for the company is confident that a decision over approval in the US should occur by the end of 2023, or early in 2024. Experts in the field want to see the study’s full results, which are likely to be presented at an Amsterdam Alzheimer’s meeting later in the year. As for the cost, the company has not yet finalised a price point, but CEO David Ricks informed CNBC that they intend for it to be similar to other therapies in the same field. Images: Getty

Caring

Millions of Aussies to be eligible for half-price medicines

Massive changes are underway for millions of Aussies as the federal government is moving to cut the cost of prescription medicine. Health minister Mark Butler announced that patients will be able to double the number of scripts they can receive, from one month’s supply to two months. From September 1, general patients will be able to save up to $180 a year if their medicine can be prescribed for 2 months, concession card holders will save up to $43.80 per year on medicine. Under the reform, which is to be included in May’s budget, 320 different medicines treating chronic conditions such as cholesterol, heart disease and hypertension will be dispensed in 60-day doses rather than the current 30. They will still be subject to the current price caps, so instead of paying a maximum of $30 for a 30-day medicine supply, those affected will pay $40 at most for a 60-day supply. One of the ideas behind it is that Aussies won’t have to visit a doctor or pharmacist as often. The federal government said the change will bring Australia into line with other countries, including New Zealand and the UK, where patients already have access to multiple month medicines on a single prescription. "Every year, nearly a million Australians are forced to delay or go without a medicine that their doctor has told them is necessary for their health. "This cheaper medicines policy is safe, good for Australians' hip pockets and most importantly good for their health.” The overhaul of prescriptions has long been supported by the Australian Medical Association and was recommended by the indecent Pharmaceutical Benefits Advisory Committee in 2018. However, pharmacists have opposed the reform, with Pharmacy Guild saying the change would cost community chemists $3.5billion. Pharmacy Guild of Australia president Trent Twomey said the change does little to acknowledge a massive shortage in medications. “I'm all for cost-of-living relief and a cost-of-living measure but this, unfortunately, is just smoke and mirrors,' he told ABC TV. “If you don't have the medicine in stock, how do you give double nothing? Double nothing is still nothing.” Instead, the federal government needed to boost local manufacturing of pharmaceuticals to fix the medicine shortage, Twomey said. Dr Nick Coatsworth also agreed that the new policy could lead to major medication shortages for patients across Australia. “The medication shortage issue is not made up. “This policy could lead to Australians turning up to pharmacies and being turned away for medications they've been on for five-to-10 years,” he told Today. “I'm actually worried about this, it looks good at face value but I knew a lot about supply chains in Covid and Australians probably aren't quite aware of how ropey those supply chains are. “If we start giving people 60 days of medications instead of 30, people will miss out.” Opposition leader Peter Dutton has supported the Pharmacy Guild’s stance in an online video. "Many, particularly older Australians, but families as well, really rely on the relationship with their local pharmacist," he said. "The government's proposal at the moment is going to make it harder for pharmacists to do that work and have that relationship with their patients.” Nationals leader David Littleproud said regional, remote and rural Australians risked being impacted by the changes. "Thousands of Australians who need medications could suffer as a consequence, because doubling scripts for some might mean others miss out," he said. However, the reform has been supported by the Australian Medical Association, a doctor’s body, with vice president Danielle McMullen welcoming the change. “At the time we're talking about so many cost-of-living pressures, this will really ease the burden on patients across Australia,” she told Sunrise. “There are some situations of shortages in medicines at the moment but there will be a staged approach to this announcement to ease the burden on the shortages.” Health Minister Mark Butler said the changes will be launched in three states, each introducing around 100 medications. The first stage will commence on September 1 2023, with the second on March 1 2024, and the final on September 1 2024. Butler said the new prescriptions will reduce how often those living in rural areas need to travel for treatment and shed light on the issue of Aussies delaying or going without medicines they need due to high costs. “Every year, nearly a million Australians are forced to delay or go without a medicine that their doctor has told them is necessary for their health,” he said. “This cheaper medicines policy is safe, good for Australians' hip pockets and most importantly good for their health.” Butler rejected the idea that the scheme will cause widespread shortages, noting only seven medications on the list are currently scarce. From September 1, 60-day scripts will be available for the six million people prescribed the eligible medications. Image credit: Shutterstock

Money & Banking

URGENT RECALL of 44 different cough medicines

Numerous cough medicines containing pholcodine are being stripped from pharmacy shelves after a safety investigation was undertaken by the Therapeutic Goods Administration (TGA). 55 products are being cancelled from the Australian Register of Therapeutic Goods. Of the 55 products containing pholcodine that were registered in Australia, 44 products are currently stocked on shelves in pharmacies and are subject to the recall, a spokesperson from the TGA told 7News. The discovery of a new link between pholcodine-containing medicines and an increased risk of anaphylactic reactions to certain medicines used as muscle relaxants during general anaesthesia prompted the action. Pholcodine has been used in a wide range of over-the-counter medicines to treat dry coughs, particularly present in syrups and lozenges. It is also used in combination with other medicines in products that treat the symptoms of cold and flu. “It is difficult to reliably predict who may be at risk of anaphylaxis during anaesthesia and some patients may not know if they have taken pholcodine medicines recently,” TGA Head Adjunct Professor John Skerritt said. “Some patients undergoing emergency surgery may not be in a position to talk to their anaesthetist at all. In addition, while surgical facilities may ask about which prescription medicines a patient is taking, they may not ask about over-the-counter products. “Fortunately, safer alternatives to treat a dry cough are available and consumers should ask their doctor or pharmacist for advice. I urge consumers to check if any of your over-the-counter cold and flu medicines contain pholcodine and, if they do, ask your doctor or pharmacist to suggest an alternative treatment. “If you will need general anaesthesia and have taken pholcodine in the past 12 months, I advise you to tell your health professional. Health professionals should also check whether patients scheduled to undergo general anaesthesia have used pholcodine in the previous 12 months.” The European Medicines Agency (EMA) had recently recommended the withdrawal of marketing authorisations for these products in Europe, prompting the review in Australia. Supported by a Western Australia study, the European findings showed that pholcodine was a risk factor. The TGA has received 50 reports of Australian cases of suspected pholcodine-related anaphylactic reactions to neuromuscular blockers, including one fatality earlier this year. Find the full list of recalled products <a href="https://www.tga.gov.au/safety/information-about-specific-safety-alerts-and-recalls/about-pholcodine-cough-medicines-cancelled-tga-and-recalled-pharmacies-safety-reasons" target="_blank" rel="noopener">here</a>. Image credit: Getty

News

Is my medicine making me feel hotter this summer? 5 reasons why

If you’re really feeling the heat this summer, it might be down to more than the temperature outside. Some types of medicines can increase your core body temperature or make you feel hotter than you really are. Some can affect your body’s ability to cool down. Here’s what you need to know about heat intolerance and medicines. <h2>What is heat intolerance?</h2> Some people simply dislike the feeling of feeling hot, while others feel hot at temperatures most people find comfortable. Both are examples of <a href="https://www.medicalnewstoday.com/articles/325232#symptoms">heat intolerance</a>. Typical symptoms during warm weather include excessive sweating (or not sweating enough), exhaustion and fatigue, nausea, vomiting or dizziness, and changes in mood. A number of factors can cause heat intolerance. This includes the disorder <a href="https://my.clevelandclinic.org/health/diseases/6004-dysautonomia">dysautonomia</a>, which affects people’s autonomic nervous system – the part of the body that regulates the automatic functions of the body, including our response to heat. Conditions such as diabetes, alcohol misuse, <a href="https://theconversation.com/what-causes-parkinsons-disease-what-we-know-dont-know-and-suspect-57579">Parkinson’s disease</a>, the autoimmune disease <a href="https://theconversation.com/explainer-what-is-guillain-barre-syndrome-and-is-it-caused-by-the-zika-virus-53884">Guillain-Barré syndrome</a> and <a href="https://theconversation.com/explainer-what-are-mitochondria-and-how-did-we-come-to-have-them-83106">mitochondrial disease</a> can cause dysautonomia. People in old age, those with some neurological conditions, or people less physically fit may also have it. But importantly, medications can also contribute to heat intolerance. <h2>1. Your body temperature rises</h2> Some medicines directly increase your body temperature, which then increases the risk of heat intolerance. These include <a href="https://bpspubs.onlinelibrary.wiley.com/doi/epdf/10.1111/bph.15465">stimulant medications</a> to treat ADHD (attention deficit hyperactivity disorder), such as methylphenidate, dexamfetamine and lisdexamfetamine. <a href="https://www.healthdirect.gov.au/antipsychotic-medications">Antipsychotic medications</a> (such as clozapine, olanzapine and quetiapine) used to treat mental health conditions, such as schizophrenia and bipolar disorder, are other examples. These ADHD and antipsychotic medicines raise your temperature by acting on the hypothalamus, the region of the brain essential for cooling. The drug levothyroxine, used to treat an under-active thyroid, also increases your body temperature, this time by <a href="https://www.ncbi.nlm.nih.gov/books/NBK500006/">increasing your metabolism</a>. <h2>2. Your blood flow is affected</h2> Other medicines constrict (tighten) blood vessels, decreasing blood flow to the skin, and so prevent heat from escaping this way. This means your body can’t regulate its temperature as well in the heat. Examples include <a href="https://www.healthdirect.gov.au/beta-blockers">beta-blockers</a> (such as metoprolol, atenolol and propranolol). These medications are used to treat conditions such as high blood pressure, angina (a type of chest pain), tachycardia (fast heart rate), heart failure, and to prevent migraines. <a href="https://www.nhs.uk/conditions/decongestants/">Decongestants</a> for blocked noses (for example, pseudoephedrine and phenylephrine), triptans for migraines (such as sumatriptan and zolmitriptan) and the ADHD medications mentioned earlier can also act to decrease blood flow to the skin. <h2>3. You can get dehydrated</h2> Other medicines can cause dehydration, which then makes you more susceptible to heat intolerance. The best examples are <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretics/art-20048129">diuretics</a> such as furosemide, hydrochlorothiazide, acetazolamide and aldosterone. These are used to control high blood pressure and heart failure by forcing your kidneys to remove more fluid from your body. Laxatives, such as senna extract and bisacodyl, also remove water from your body and so have a similar effect. <h2>4. You can sweat less</h2> Other medicines have a drying effect. This can be needed for medicines to do their job (for instance, to dry up a runny nose). For others, it is an unwanted side effect. This drying reduces the amount you sweat, making it harder to lose heat and regulate your core temperature. A number of medicines have these effects, including: <ul> <li>some antihistamines (such as promethazine, doxylamine and diphenhydramine)</li> <li>certain antidepressants (such as amitriptyline, clomipramine and dothiepin)</li> <li>medicines used to treat <a href="https://www.healthdirect.gov.au/urinary-incontinence#:%7E:text=Urinary%20incontinence%2C%20or%20poor%20bladder%20control%2C%20is%20very%20common%20in,to%20cure%20or%20improve%20it.">urinary incontinence</a> (for example, oxybutynin and solifenacin) </li> <li>nausea medicine (prochlorperazine)</li> <li>medicines for stomach cramps and spasms (for instance, hyoscine) </li> <li>the antipsychoptics chlorpromazine, olanzapine, quetiapine and clozapine.</li> </ul> <h2>5. You don’t feel thirsty</h2> Finally, some medicines, such as the antipsychotics haloperidol and droperidol, can aggravate heat intolerance by reducing your ability to feel thirsty. If you don’t feel thirsty, you drink less and are therefore at risk of dehydration and feeling hot. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/is-my-medicine-making-me-feel-hotter-this-summer-5-reasons-why-199085" target="_blank" rel="noopener">The Conversation</a>.

Body

Support is the best medicine

Sharing your experience and talking with others when ill can be very good for your wellbeing. Here’s why support groups are great. Good friends may help your life last longer as they’ll boost your self-esteem, offer companionship and provide support when you need it. A study by the Centre for Ageing Studies at Flinders University backed this up by following 1500 older Aussies for 10 years and found that those who had a large network of friends outlived those with fewer friends by 22 per cent. When you know you can count on someone to help or provide support when you most need it, it can make the world of difference. However, sometimes people may not live near close friends or have found it difficult to develop a strong community group around them. When a person becomes ill, a good network can be the best medicine for helping to keep a person’s spirits up, so joining a support group could be the perfect solution. Another study, completed in 2005 and published in health journal Cancer, found that out of the 61 women who had advanced ovarian cancer those with support networks had much lower levels of a protein linked with more aggressive types of cancer. Women who didn’t have as much social support around them had levels of the protein that were a whopping 70 per cent higher! Support groups can bring people together who are facing similar issues, ranging from major life changes to illness. Many people join support groups because sharing experiences with people who are going through the same battles can be incredibly helpful and make a person feel like they’re not alone. Well-known Australian cancer survivor, Dr Ian Gawler, who was diagnosed with bone cancer, had his right leg amputated and then had to battle the disease again later that same year, believes having a positive and practical attitude can help in many ways when battling disease. According to a 2005 study by The Cancer Council, there are health benefits associated with being part of a health support group. These include: improvements in coping and adaptation, reductions in psychological stress, enhanced self-esteem and even positive effects on immunological response. Just ask Terri-Ann Carter, a Queenslander who underwent surgery and chemotherapy for a lump on her neck. She started an online support group called Gladstone Cancer Friends as a way to cope with the isolation and stress of going through cancer treatment. For cancer sufferers, two big fears are one of relapse and social isolation. Whether online or in person, a support group can help a person cope with these two alienating factors. When it comes to your health, nothing should be taken for granted. Together with surrounding yourself with the love and support of family, friends or new acquaintances from a support group, it’s always worth getting good health insurance. How to find a support group: Ask your doctor or health care provider. They may be able to point you in the right direction of a support group near you. Go online. There are many over-60s who live in rural or regional areas, so more people are turning to the internet to connect with others for support and advice. Social media sites, such as Facebook, have become very popular for people to comfortably share their stories and experience in an open and supportive forum. Get in touch with local centres. Look to your local community halls, libraries and even supermarket notice boards for possible support groups in your area. Look to state or national bodies. Organisations for a particular illness or issue usually have a directory of the support groups in various local communities for people to be redirected to. Take a look and find one that’s close to you. Can’t find one? Start your own. If there’s no support group near you, why not start your own? Look to start an online group via Facebook or post announcements on a board in your local medical centre or hospital to spread the word. Image: Getty

Caring

Drugs – 4 essential reads on how they’re made, how they work and how context can make poison a medicine

Pandemics and disease outbreaks put a spotlight on the hurdles researchers face to get a drug on the shelves. From finding prospective drug candidates to balancing time and financial pressures with ensuring safety and efficacy, there are many aspects of drug development that determine whether a treatment ever makes it out of the lab. Broadening the definition of “medicine” and where it can be found, however, could help expand the therapeutic options available for both researchers and patients. Here are four facets of how drugs are developed and how they work in the body, drawn from stories in The Conversation’s archive. <h2>1. Matching drug to target</h2> The most effective drugs are, in a sense, the product of good matchmaking – they bind to a specific disease-causing receptor in the body, elicit a desired effect and ideally ignore healthy parts of the body. Drugs <a href="https://theconversation.com/how-do-drugs-know-where-to-go-in-the-body-a-pharmaceutical-scientist-explains-why-some-medications-are-swallowed-while-others-are-injected-182488" target="_blank" rel="noopener">travel through the bloodstream</a> to reach their targets. Because of this, most drugs circulate throughout the body and can bind to unintended sites, potentially causing undesired side effects. Researchers can increase the precision and effectiveness of a drug by designing different ways to take it. An inhaler, for example, delivers a drug directly to the lungs without its having to travel through the rest of the body to get there. Whether patients take drugs as prescribed is also essential to ensuring the right dose gets to where it needs to be often enough to have a desired effect. “Even with all the science that goes into understanding a disease well enough to develop an effective drug, it is often up to the patient to make it all work as designed,” writes pharmaceutical scientist <a href="https://www.researchgate.net/profile/Thomas-Anchordoquy" target="_blank" rel="noopener">Tom Anchordoquy</a> of the University of Colorado Anschutz. <h2>2. Searching for drug candidates</h2> Researchers have discovered a number of drugs by chance, including <a href="https://www.pbs.org/newshour/health/the-real-story-behind-the-worlds-first-antibiotic" target="_blank" rel="noopener">penicillin</a> for bacterial infections, <a href="https://www.bbc.com/future/article/20200928-how-the-first-vaccine-was-born" target="_blank" rel="noopener">vaccines for smallpox</a> and <a href="https://doi.org/10.1038/nrcardio.2017.172" target="_blank" rel="noopener">warfarin</a> for blood clots. While serendipity still plays a role in modern drug discovery, most drug developers take a systematic approach. Scientists typically start by identifying a particular molecular target, usually receptors that trigger a specific response in the body. Then, they look for chemical compounds that react with that target. Technology called <a href="https://theconversation.com/discovering-new-drugs-is-a-long-and-expensive-process-chemical-compounds-that-dupe-screening-tools-make-it-even-harder-175972" target="_blank" rel="noopener">high-throughput screening</a> allows researchers to quickly test thousands of potential drug candidates at once. Compounds that match screening criteria advance to further development and refinement. Once optimized for their intended use, compounds go on to safety and efficacy testing in animals and people. One way to ease the search for optimal drug candidates is to work with compounds that are already optimized to work in living beings. <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963" target="_blank" rel="noopener">Natural products</a>, derived from organisms like microbes, fungi, plants and animals, share similar structures and functions across species. Though not without their own development challenges, they could aid the search for related compounds that work in people. “There are thousands of microorganisms in the ocean left to explore as potential sources of drug candidates, not to mention all the ones on land,” writes medical chemist <a href="https://scholar.google.com/citations?user=8_T1ueYAAAAJ&hl=en" target="_blank" rel="noopener">Ashu Tripathi</a> of the University of Michigan. “In the search for new drugs to combat antibiotic resistance, natural products may still be the way to go.” <h2>3. A drug by any other name may be just as effective</h2> Existing drugs can find a second (or third, fourth and fifth) life through repurposing. Most drugs <a href="https://theconversation.com/many-medications-affect-more-than-one-target-in-the-body-some-drug-designers-are-embracing-the-side-effects-that-had-been-seen-as-a-drawback-184922" target="_blank" rel="noopener">have many functions</a> beyond what researchers originally designed them to do. While this multifunctionality is often the cause of unwanted side effects, sometimes these results are exactly what’s needed to treat a completely unrelated condition. Sildenafil, for example, failed to treat severe chest pain from coronary artery disease, but proved to be potent at inducing erections as Viagra. Similarly, thalidomide, a compound that caused birth defects in thousands of infants around the world as a morning sickness drug, found redemption as a cancer treatment. Because drugs inherently have more than one function in the body, <a href="https://theconversation.com/repurposing-generic-drugs-can-reduce-time-and-cost-to-develop-new-treatments-but-low-profitability-remains-a-barrier-174874" target="_blank" rel="noopener">repurposing existing drugs</a> can help fill a gap where pharmaceutical companies and other developers cannot or will not. <a href="https://scholar.google.com/citations?user=iDKZaA4AAAAJ&hl=en" target="_blank" rel="noopener">Gregory Way</a>, a researcher at the University of Colorado Anschutz, uses artificial intelligence to predict the various effects a drug can have and believes that this lack of specificity is something to explore rather than eliminate. Instead of trying to home in on one specific target, he suggests that scientists “embrace the complexity of biology and try to leverage the multifaceted effects drugs can offer.” <h2>4. Poison as medicine</h2> If so many drugs can have toxic effects in the body, be it through side effects or taking the wrong dose or for the wrong condition, what determines whether a drug is a “medicine” or a “poison”? Biomedical scientists evaluate drugs based on their active ingredient, or a specific compound that has a specific effect in the body. But reducing medicines to just a single molecule ignores another important factor that determines whether a drug is therapeutic – the context in which it is used. Opioids treat intractable pain but can lead to debilitating and lethal addiction when improperly administered. Chemotherapy kills tumors but causes collateral damage to healthy tissues in the process. Another pharmaceutical paradigm, <a href="https://theconversation.com/poison-or-cure-traditional-chinese-medicine-shows-that-context-can-make-all-the-difference-163337" target="_blank" rel="noopener">traditional Chinese medicine</a>, has historically acknowledged the malleability of drugs through the use of poisons as therapeutics. <a href="https://scholar.google.com/citations?user=4q0hYSwAAAAJ&hl=en" target="_blank" rel="noopener">Yan Liu</a>, a medical historian at University of Buffalo who studies this practice, notes that ancient texts did not distinguish between poisons and nonpoisons – rather, Chinese doctors examined drugs based on a continuum of potency, or ability to harm and heal. They used different processing and administration techniques to adjust the potency of poisons. They also took a personalized approach to treatment, aware that each drug works differently based on a number of different individual factors. “The paradox of healing with poisons in traditional Chinese medicine reveals a key message: There is no essential, absolute or unchanging core that characterizes a medicine,” Liu writes. “Instead, the effect of any given drug is always relational – it is contingent on how the drug is used, how it interacts with a particular body and its intended effects.” This article originally appeared on <a href="https://theconversation.com/drugs-4-essential-reads-on-how-theyre-made-how-they-work-and-how-context-can-make-poison-a-medicine-192590" target="_blank" rel="noopener">The Conversation</a> and is a roundup of of articles from The Conversation’s archives. Image: Shutterstock

Books

Big study shows that lowering blood pressure lowers risk of dementia

A study across 20 countries has strengthened a link between lowering blood pressure, and reducing the risk of dementia. The meta-analysis, published in the European Heart Journal, draws on clinical trial data from 28,008 participants, to show the strongest link to date between medication that lowers blood pressure, and reduced dementia risk. “We know that high blood pressure is a risk factor for dementia – especially high blood pressure in midlife, so say 40 to 65 years of age,” says lead author Dr Ruth Peters, an associate professor at the University of New South Wales and program lead for dementia in the George Institute’s Global Brain Health Initiative. “But there has been some uncertainty about whether lowering blood pressure, especially in older adults, would reduce risk of dementia. “What we’ve done is take five really high-quality clinical trials and combine them into one dataset, which gave us the ability to really look at this question and look at the relationship between blood pressure-lowering tablets – antihypertensives – and dementia.” The five studies were all double-blind, randomised clinical trials – the ‘gold standard’ in medical research – with participants hailing from 20 different countries. The average age of the participants was 69, and participants were followed up an average of four years after doing the trial. Participants who took antihypertensives had a significantly lower chance of being diagnosed with dementia than those who took placebos. Dementia affects 50 million people worldwide: a number projected to triple by 2050. According to The Lancet’s 2020 Commission on dementia, treatment for hypertension (high blood pressure) is “the only known effective preventive medication for dementia,” all other methods of reducing your risk come from lifestyle and environment. “The strength of this study is the use of individual patient data in a meta-analysis of data drawn from randomised controlled trials of blood pressure medication. This is the first time such data has been meta-analysed,” says Professor Kaarin Anstey, a senior principal research scientist at Neuroscience Research Australia and the UNSW. “This is important for informing clinical practice,” adds Anstey, who was not involved with the study. Professor Nicolas Cherbuin, head of the Australian National University’s Centre for Research on Ageing, Health and Wellbeing, says that the study is “well-designed”, and reflects research by his team showing that higher blood pressure is linked to lower brain volumes and poorer brain health. “The diagnostic procedure and criteria used are well-established, the sample size is large, those with dementia at baseline were excluded,” says Cherbuin. But he points out that the study didn’t find an effect of blood pressure medication on cognitive decline, and nor did it include participants with mild cognitive impairment, who would be “more likely to convert”. Anstey points out that “inevitably” the participants in the cohort are now quite old, and thus may be different to populations developing dementia now. “Clinical trials involve highly selected samples and often exclude diverse ethnic groups,” she adds. “I hope that this reinforces the importance of blood pressure control for brain health,” says Peters. But she emphasises that, while this is useful news for preventing dementia in mid-life, people of all ages can improve their brain health by other means. “It’s not just blood pressure lowering – it has to be taken in the context of a healthy lifestyle.” This article originally appeared on <a href="https://cosmosmagazine.com/health/dementia-blood-pressure-meta/" target="_blank" rel="noopener">cosmosmagazine.com</a> and was written by Ellen Phiddian. Image: Shutterstock

Body

14 medicinal herbs you can grow in your backyard

Basil This medicinal herb can help with flatulence, lack of appetite, cuts and scrapes. Harvest the young leaves of this annual plant as needed. Chamomile Use the flower heads of this medicinal herb for infusions and salves to relieve conditions such as indigestion and colic, anxiety and tension, and skin inflammations and irritations. Echinacea If you suffer from a cold or the flu, try this medicinal herb to ease the severity of your symptoms. It also helps provide relief to your immune system. Feverfew Use the leaves and flowers of this medicinal herb for teas; chew leaves to ease headache pain (including migraines). It’s also been shown to be one of the most effective natural remedies for arthritis, as well as a treatment for various skin conditions. Wild pansy With anti-inflammatory properties, this medicinal herb is a good home remedy for eczema and skin blemishes, as well as to help loosen phlegm. Lavender Is there anything lavender can’t do? Even smelling this medicinal herb has been shown to calm and relax. It also eases pain, and when applied to cuts and bruises functions as an antiseptic. Lemon balm A relative of mint, lemon balm is a versatile medicinal herb that helps relieve anxiety, insomnia, wounds, herpes, insect bites, flatulence and an upset stomach. Marigold Good for easing sunburn, acne, and blemishes, this medicinal herb also soothes ulcers and digestive problems. Parsley Don’t think of it as decorative on your plate; this medicinal herb is loaded with nutrients as well as healing powers to help with flatulence and bad breath. Peppermint If you have digestion issues or gas, sipping tea made of this medicinal herb might provide relief. It’s also been shown to help soothe headaches. Rosemary This medicinal herb helps memory and concentration, improves mood – and sweetens breath. Sage Sage’s genus name, Salvia, means “to heal,” reflecting its early use as a medicinal, not culinary, herb. It can help provide relief for mouth and throat inflammations. Thyme The active principle in thyme, thymol, is a strong antiseptic. If you suffer from coughs, congestion, indigestion or gas, consider using this medicinal herb. St. John's wort Talk to your doctor if you suffer from mild to moderate depression; she may suggest St. John’s wort. The glossy leaves and yellow flowers are this medicinal herb’s active parts. Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.com.au/food-home-garden/14-medicinal-herbs-you-can-grow-in-your-backyard?pages=1" target="_blank" rel="noopener">Reader's Digest</a>.

Home & Garden

Patch me up, Scotty! Remote surgery robot destined for ISS

Strap yourself in so you don’t float away, select the required procedure, lie back and relax as your autonomous surgery robot patches you up from whatever space ailment bothers you. Sound far-fetched? Not according to Professor Shane Farritor, from the University of Nebraska-Lincoln, who <a href="https://news.unl.edu/newsrooms/today/article/husker-developed-surgery-robot-to-be-tested-aboard-international-space/" target="_blank" rel="noreferrer noopener">has just received funding from NASA</a> to prepare his miniature surgical robot for a voyage to the International Space Station (ISS) in 2024. MIRA, which stands for “miniaturised in vivo robotic assistant” is comparatively little for a surgery-performing machine – small enough to fit inside a microwave-sized experimental locker within the ISS. The brainchild of Farritor and colleagues at the start-up company Virtual Incision, MIRA has been under development for almost 20 years. The ultimate aim for MIRA is to be able to perform surgery autonomously and remotely, which has far-reaching ramifications for urgent surgery in the field – whether that’s in the depths of space, a remote location or even <a href="http://bionics.seas.ucla.edu/publications/JP_11.pdf" target="_blank" rel="noreferrer noopener">in a war-torn region</a>. Initially MIRA won’t go near anyone’s body. Once on the ISS, it will autonomously perform tasks designed to mimic the movements required for surgery, such as cutting stretched rubber bands and pushing metal rings along a wire. <div class="newsletter-box"> <div id="wpcf7-f6-p200559-o1" class="wpcf7" dir="ltr" lang="en-US" role="form"> <form class="wpcf7-form mailchimp-ext-0.5.62 spai-bg-prepared init" action="/health/remote-surgery-robot-destined-for-iss/#wpcf7-f6-p200559-o1" method="post" novalidate="novalidate" data-status="init"> <input class="wpcf7-form-control wpcf7-text referer-page spai-bg-prepared" name="referer-page" type="hidden" value="https://cosmosmagazine.com/technology/" data-value="https://cosmosmagazine.com/technology/" aria-invalid="false" /> </form> </div> </div> Being autonomous is important as it won’t need to access bandwidth to communicate back to Earth. MIRA has already successfully completed surgery-like tasks via remote operation including a colon resection. Space is the next frontier. Farritor says, as people go further and deeper into space, they might need surgery. “We’re working toward that goal.” The stint on the ISS will not only mark the most autonomous operation so far, but it will also provide insight into how such devices might function in zero gravity. The dream goal is for MIRA to function entirely on its own, says Farritor. Just imagine: “the astronaut flips a switch, the process starts, and the robot does its work by itself. Two hours later, the astronaut switches it off and it’s done”. As anyone who has seen the scene in the movie, <a href="https://www.youtube.com/watch?v=Ue4PCI0NamI" target="_blank" rel="noreferrer noopener">The Martian</a>, can attest, it would certainly make pulling a wayward antenna spike out of yourself from within a deserted Martian habitat station far more comfortable.  <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=200559&title=Patch+me+up%2C+Scotty%21+Remote+surgery+robot+destined+for+ISS" width="1" height="1" />  <div id="contributors"> <a href="https://cosmosmagazine.com/health/remote-surgery-robot-destined-for-iss/" target="_blank" rel="noopener">This article</a> was originally published on <a href="https://cosmosmagazine.com" target="_blank" rel="noopener">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/clare-kenyon" target="_blank" rel="noopener">Clare Kenyon</a>. Clare Kenyon is a science writer for Cosmos. She is currently wrangling the death throes of her PhD in astrophysics, has a Masters in astronomy and another in education, and has classroom experience teaching high school science, maths and physics. Clare also has diplomas in music and criminology and a graduate certificate of leadership and learning. Image: Getty Images </div>

Technology

How nurses are changing the conversation around medicinal cannabis

For many years, those with chronic conditions and ailments have had limited options for pain-relieving treatments, with varying opioids and anti-inflammatories the usual go-to for relief. However, in recent years the use of medicinal cannabis in Australia has <a href="https://www1.racgp.org.au/newsgp/clinical/research-shows-medicinal-cannabis-boom-in-australi">increased</a> exponentially, giving patients a new lease on life. While more people are turning to this natural source of treatment, accessing medicinal cannabis is still not easy. This accessibility issue has prompted the Australian Nursing and Midwifery Federation (ANMF), which has more than 310,000 members, and NSW and QLD nurse associations to lobby for medicinal cannabis education to be introduced into the curriculum for all schools of nursing and midwifery in Australia, so they can administer in hospitals. For former Queensland nurse Lucy Haslam, the accessibility and affordability is a cause close to her heart, as she saw first-hand how medicinal cannabis helped her son, Dan, during his battle with stage 4 bowel cancer. For me personally, medicinal cannabis is a topic I have been interested in for years. As a patient with a chronic condition with very limited treatment options, the accessibility hurdle is one I have long been fighting to jump over. However, to long-term pain patients like myself, this new initiative by the ANMF is bringing newfound hope that accessibility and affordability is at the forefront of the medicinal cannabis conversation. Australian Natural Therapeutic Group (ANTG) Chief Scientific Officer Justin Sinclair said this will be a game-changer for patients, as nurses are on the frontline of care with close relationships with patients. This comes as new <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/australias-attitudes-and-perceptions-towards-drugs/contents/about">data</a> from the Australian Institute of Health and Welfare shows almost half the population support legalising cannabis, given its recent boom in success for treating patients with both physical and mental conditions. According to Justin Sinclair, medicinal cannabis is being used to treat a variety of conditions with outstanding results. He told OverSixty, “According to data from the Therapeutic Goods Administration, the main clinical indication that medicinal cannabis is being used for in Australia is chronic pain, with over 115,000 prescriptions being issued to date.” “That being said, there are a wide range of other clinical indications that Australian patients are also using medicinal cannabis for, and includes examples such as anxiety, sleep disorders, migraine, fibromyalgia, epilepsy, palliative care, multiple sclerosis and cancer pain and symptom management.” For many patients with a chronic condition, overuse of traditional pain-relievers can lead to more complex health issues, which can, in some circumstances, make medicinal cannabis a safer long-term solution. When it comes to the difference between medicinal cannabis and traditional pain-relievers, Dr Joel Wren, who is the President of the Society of Cannabis Clinicians Australian Chapter (SCCAC), believes medicinal cannabis is a superior option. He told OverSixty, “The significant differences of medicinal cannabis compared to other treatments is twofold; firstly it can be a multi-target medicine helping not only with pain, but possibly also sleep and anxiety all at the same time.” “The second difference is the variability; cannabis contains hundreds of botanical compounds which may contribute to the therapeutic benefits in different ways. Another huge difference is safety - there have been NO lethal overdoses on record that have ever been attributed 100% to cannabis.” As the ANMF and the Australian Medicinal Cannabis Association (AMCA) continue to campaign for wider distribution of medicinal cannabis, along with making the drug more affordable for those in need, Dr Joel Wren told OverSixty that patients should talk to their doctor about trialling medicinal cannabis through the current pathways. He said, “Australian patients need to speak with their doctor about possibly getting a prescription for medicinal cannabis. There has to be a clear medical reason, and conventional therapies and medications must be trialled first. If the doctor is confident, they can prescribe or alternatively they may refer to another doctor who can.” Image credits: Getty Images

Body

This Aussie discovery could save lives and beat antibiotic resistance

Many if not all of us have been sick because of bacteria, with a trip to the GP seeing us walk away with a script for some kind of antibiotic. With bacterial infections having the potential to be quite deadly and causing people to deteriorate within hours while identifying the specific kind of bacteria (and which antibiotic is the best to treat with) can take days, doctors are often forced to use a best guess, “one-size-fits-all” antibiotic to treat patients. But, patients could soon be treated with a more targeted option, thanks to a new testing method that could identify bacteria within hours. A team of researchers from the Harry Perkins Institute of Medical Research, the University of Western Australia, and PathWest Laboratory Medicine WA have developed a process that first confirms that bacteria is causing a patient’s illness, before then determining which antibiotic will be the most effective. Dr Kieran Mulroney, a UWA Prospect Fellow involved in the research, says this new method not only helps doctors find the best treatments for their patients, but also combats the growing problem of antibiotic resistance. “The established method involves growing bacteria from a patient sample then applying different antibiotics to see which are effective. Patients with serious infections cannot wait the several days it can take to return antibiotic test results. Consequently, the patient's doctor has to rely on a best guess, 'one-size-fits-all', antibiotic choice to treat patients,” he <a href="https://www.scimex.org/newsfeed/lifesaving-australian-discovery-helps-combat-antibiotic-resistance-in-the-lancet-ebiomedicine">explains</a>. “The biggest problem with prescribing broad-spectrum antibiotics is that it encourages some bacteria to become resistant to the antibiotics. This is a growing and serious problem world-wide, because antibiotic resistant bacteria can spread from person to person and reduce treatment options. He says that using broad spectrum antibiotics is one of the “key drivers” in antibiotic resistance spreading. “New tests are urgently needed that give doctors evidence they can rely on to select the right antibiotic” he says. The new method consists of two stages, with the first involving a 30-minute test, rather than taking one to two days, to determine whether a person is ill as a result of a bacterial infection. “Once a patient has a confirmed bacterial infection, we then expose the bacteria to different types of antibiotics in the laboratory. Using a device that measures hundreds of thousands of individual bacteria in just a few seconds, the research team can detect the damage antibiotics cause to bacteria, and then use this information to confirm which antibiotic will be an effective treatment. We can predict which antibiotics will be effective to treat that infection with 96.9% accuracy,” Dr Mulroney said. Dr Aron Chakera, a renal physician at Sir Charles Gairdner Hospital who was also involved in the research, says it could be potentially life-saving for patients with chronic illnesses. “As a renal physician I treat patients with end-stage kidney disease who need to be in hospitals or clinics for several hours a week connected to dialysis machines. Many could manage their own dialysis using a surgically implanted catheter, which actually has better outcomes, is far less costly and is more satisfying for patients, but the ever-present fear of infection from the catheter deters many from choosing it,” Dr Charkera explains. “This new test would give confidence to patients and their treating doctors.” WA Country Health Service Translation Fellow Dr Tim Inglis, who was also involved in the research, notes that the need for rapid test results has been made all the more apparent since the start of the COVID-19 pandemic, and that the challenge of antibiotic resistance will still remain once Covid has tailed off. “Even in the most advanced health systems, hospital patients risk bacterial infection through trauma wounds, surgery sites, breathing machines and indwelling catheters,” he explains. “This can lead to pneumonia, urinary tract, abdominal and bloodstream infections. Applying the research team's new technology to these infections is expected to transform how quickly and effectively we treat patients in Western Australia and further afield.” Their work was published in the international medical journal <a href="https://doi.org/10.1016/j.ebiom.2022.104145" target="_blank" rel="noopener">The Lancet eBiomedicine</a>. Image: Dr Kieran Mulroney (Scimex)

Body

Why the "just one drink a day" excuse no longer cuts it

According to a new study, those who have one standard drink a day are putting themselves at risk of permanent brain damage. The study of almost 21,000 people, published in the PLOS Medicine journal, found that consumption of seven or more units of alcohol per week is associated with higher iron levels in the brain. More iron in the brain is also linked to Alzheimer's and Parkinson's disease and is a potential mechanism for alcohol-related cognitive decline. The participants reported their own alcohol consumption, and their brains were scanned using magnetic resonance imaging (MRI). Of those participants, 7,000 of them also had MRIs on their livers imaged to see the levels of systemic iron. They were also required to complete a few tasks to assess their cognitive and motor function. The participants' average age was 55 years old and 48.6 per cent were female. Anya Topiwala of the University of Oxford, United Kingdom, and her colleagues found that alcohol consumption above seven units per week led to higher iron levels in basal ganglia - the part of the brain that helps with movement. “Markers of higher basal ganglia iron associated with slower executive function, lower fluid intelligence, and slower reaction times,” the study reported. “Iron accumulation in some brain regions was associated with worse cognitive function.” They concluded that moderate alcohol consumption is associated with higher iron levels in the brain. Image: Shutterstock

Caring

New type of gel helps the medicine go down

Swallowing tablets can be a challenge for most children and some adults, but scientists have come to the rescue with a new drug-delivering oleogel that can make it easier to consume a variety of medicines. According to a <a class="spai-bg-prepared" href="https://www.science.org/doi/10.1126/sciadv.abm8478" target="_blank" rel="noreferrer noopener">new study</a>, the gels are made from plant-based oils and can be prepared in a variety of textures – from a thickened drink to a gel with yogurt-like consistency. This could help adults who have difficulty swallowing pills, such as older people or those who have suffered a stroke. The gels have also been designed to remain stable at 40°C for two weeks, and even up to 60°C for one week. This could make them especially helpful for children in developing nations, where the gels might be transported in vehicles without refrigeration. “Given the simplicity of the system and its low cost, it could have a tremendous impact on making it easier for patients to take medications,” says senior author Giovanni Traverso, assistant professor of mechanical engineering at Massachusetts Institute of Technology (MIT) and a gastroenterologist at Brigham and Women’s Hospital, US. Existing strategies for people unable to swallow pills have relied on dissolving drugs in water, but this requires a water-soluble medicine, as well as access to clean water and refrigeration. It can also be difficult to achieve the right dosage for children if the pills used are meant for adults. To avoid these issues, the interdisciplinary research team focused on the potential of oil-based gels, also known as oleogels, for drug delivery. The researchers explored several different types of plant-derived oils, including sesame, cottonseed and flaxseed oil. By combining these oils with edible gelling ingredients – such as beeswax and rice bran wax – they found they could control the texture depending on the type of oil and gelling agent, and their concentrations. <div class="newsletter-box spai-bg-prepared"> <div id="wpcf7-f6-p193139-o1" class="wpcf7 spai-bg-prepared" dir="ltr" lang="en-US" role="form"> <form class="wpcf7-form mailchimp-ext-0.5.61 spai-bg-prepared init" action="/health/oleogels-alternative-medicine-delivery/#wpcf7-f6-p193139-o1" method="post" novalidate="novalidate" data-status="init"> <input class="wpcf7-form-control wpcf7-text referer-page spai-bg-prepared" name="referer-page" type="hidden" value="https://cosmosmagazine.com/health/" data-value="https://cosmosmagazine.com/health/" aria-invalid="false" /> </form> </div> </div> To identify the most palatable oleogels, the researchers worked with a consulting firm specialising in consumer sensory experiences to narrow down the oleogels to those made from oils with a neutral or slightly nutty flavour. “That approach gave us the capacity to deliver very hydrophobic drugs that cannot be delivered through water-based systems,” says lead author Ameya Kirtane, former MIT postdoctoral researcher and current instructor in medicine at Brigham and Women’s Hospital. “It also allowed us to make these formulations with a really wide range of textures.” They then tested delivering three oil-soluble (hydrophobic) drugs from the World Health Organization’s (<a class="spai-bg-prepared" href="https://www.who.int/" target="_blank" rel="noreferrer noopener">WHO</a>) list of <a class="spai-bg-prepared" href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.03" target="_blank" rel="noreferrer noopener">essential medicines for children</a>: praziquantel, used to treat parasitic infections; lumefantrine, used to treat malaria; and azithromycin, used to treat bacterial infections. The tests showed that in pigs the oleogels were able to deliver doses of these medicines equal to or greater than the amounts absorbed from tablets, and that a water-soluble <a class="spai-bg-prepared" href="https://cosmosmagazine.com/health/medicine/antibiotic-resistance-millions-years/" target="_blank" rel="noreferrer noopener">antibiotic</a> (moxifloxacin hydrochloride) could also be successfully delivered. “Based on that list, infectious diseases really stood out in terms of what a country needs to protect its children,” Kirtane says. “A lot of the work that we did in this study was focused on infectious-disease medications, but from a formulation standpoint, it doesn’t matter what drug we put into these systems.” A phase I clinical trial of the oleogel formulation of azithromycin should be underway within the next few months.  <img id="cosmos-post-tracker" class="spai-bg-prepared" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=193139&title=New+type+of+gel+helps+the+medicine+go+down" width="1" height="1" />  <div id="contributors"> <a href="https://cosmosmagazine.com/health/oleogels-alternative-medicine-delivery/" target="_blank" rel="noopener">This article</a> was originally published on <a href="https://cosmosmagazine.com" target="_blank" rel="noopener">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/imma-perfetto" target="_blank" rel="noopener">Imma Perfetto</a>. Imma Perfetto is a science writer at Cosmos. She has a Bachelor of Science with Honours in Science Communication from the University of Adelaide. Image: Getty Images </div>

Body

The medicines to pack for your overseas holiday

When travelling overseas, we all want a comfortable and pleasurable stay. This involves packing the right clothes for the right conditions and bringing a good book or music playlist. But what medicines should you take? The medicines you need will depend on what your expected needs are and what is available in the country being visited. Common medicines you may need to take include those for sleep, diarrhoea, malaria, pain and anxiety. When deciding what to take, it’s also important to remember that even if a medicine is available at home, its supply may be restricted or even prohibited in the country you are visiting. So, you should check beforehand. <h2>Medicines for sleep</h2> Sleeping on an aeroplane, while wedged in a tiny chair listening to a crying baby in the distance, can be very difficult for many people. As such, prescription sleeping medicines may be recommended by a doctor for short-term use. Alternatively, over-the-counter sleeping medicines, like the sedating antihistamine <a href="https://www.nps.org.au/medical-info/medicine-finder/restavit-tablets">doxylamine</a> are available from a pharmacy. But sedating antihistamines should not be used for <a href="http://www.smh.com.au/national/australian-medical-association-warns-against-sedating-children-on-long-journeys-20150405-1mesd0.html">children</a> when flying. You should also consider whether you actually need to sleep. If the flight is too long, then being asleep or sedated may prevent you from moving around while flying. Leg movement and stretching is <a href="https://www.cdc.gov/ncbddd/dvt/travel.html">recommended</a> when flying to improve blood flow and protect against blood clots. <h2>Medicines for diarrhoea</h2> Diarrhoea poses the <a href="https://www.racgp.org.au/afp/2012/october/parasitic-causes-of-prolonged-diarrhoea-in-travellers/">highest infectious risk</a> for travellers overseas, depending on where you are going. Diarrhoea is associated with <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/travellers-diarrhoea">symptoms</a> of stomach cramps, runny poo and nausea. <a href="https://www.nps.org.au/medical-info/medicine-finder/buscopan-tablets">Hyoscine</a> is a medicine that may help relieve cramps by relaxing the stomach muscles. <a href="https://www.tga.gov.au/otc-medicine-monograph-loperamide-hydrochloride">Loperamide</a> is useful in helping to stop diarrhoea, altogether. This may be particularly important if you’re stuck on a ten-hour flight, or have just set off on that once-in-a-lifetime jungle safari. Otherwise, medical advice often recommends not stopping the diarrhoea. Why? Because this stops your body from flushing out the pathogen that is causing the problem, and keeps the runny poo in, neither of which is a good thing. It’s best to let the diarrhoea pass and remain hydrated, which may include drinking more than just plain water; <a href="https://travel.gc.ca/travelling/health-safety/rehydration">oral rehydration</a> products may also be needed. These work by replacing all the lost sugars and salts in your body due to diarrhoea. They are available in sachets or effervescent tablets which can be mixed with water, making them easy to carry and use. Sometimes, treatment of diarrhoea will require additional medicines such as antibiotics. Either way you should consult a doctor or pharmacist before using medicines for diarrhoea, especially if it is persistent, if you experience fever, or if you see pus or blood in your wee or poo. <h2>Medicines for malaria</h2> For particular countries, there are medicines you may need to take before your journey to prevent you from getting sick while on vacation. If you are going to <a href="https://www.cdc.gov/malaria/travelers/country_table/a.html">certain areas</a> in Africa, India and Central America, for example, you may need to take an antimalarial medicine, such as the antibiotic <a href="https://www.nps.org.au/medical-info/medicine-finder/doxylin-tablets">doxycycline</a>. To be effective, these types of drugs need to be taken before, during, and after your travels, so it’s advisable to plan in advance with your doctor when travelling to areas with malaria. <h2>Medicines for pain</h2> Many of us use <a href="https://www.tga.gov.au/otc-medicine-monograph-paracetamol-oral-use">paracetamol</a> and <a href="https://www.tga.gov.au/otc-medicine-monograph-ibuprofen-oral-use">ibuprofen</a> for short-term pain relief. Even though they may be available from a pharmacy in some countries, like Australia, they can sometimes be hard to obtain overseas due to language barriers or different rules about how they can be supplied. <a href="https://www.healthdirect.gov.au/codeine">Codeine</a> is also often found in pain relief preparations. Some countries have restrictions placed on the supply of codeine. For example, in Australia, codeine-based medicines can only be obtained with a <a href="https://www.nps.org.au/medical-info/clinical-topics/over-the-counter-codeine-changes-to-supply">prescription</a> <h2>Medicines for anxiety</h2> Some people experience anxiety when flying. A doctor may recommend prescription medicines like <a href="https://www.nps.org.au/medical-info/medicine-finder/valium-tablets">diazepam</a>, along with psychological therapy for those who experience anxiety when flying. A side effect of diazepam is sedation, but this may be welcomed by travellers trying to sleep on a flight. <h2>Restrictions on medicines when travelling</h2> Some countries require documentation if travelling with certain medicines. For example, in <a href="http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Consumer_Information/Personal_Import_Regulations/bringing_personal_medication_into_Singapore.html">Singapore</a>, a license is needed for larger quantities or doses of codeine. If travelling to Indonesia with codeine, you may need to apply for a <a href="https://www.kbri-canberra.go.id/menu-customs/taking-prescribed-medicine-to-indonesia#requirements">letter</a> from the embassy or high commission to bring such medicines into the country. Restrictions placed on medicines are not limited to those that require a prescription. In Singapore, nicotine chewing gum that is not <a href="http://www.hsa.gov.sg/pub/faq/faq/faqcategory/bringing-personal-medication-into-singapore.aspx">Singapore-registered</a>is a <a href="http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Consumer_Information/Personal_Import_Regulations/bringing_personal_medication_into_Singapore.html">prohibited</a> substance. <h2>What to remember</h2> It’s important to check with your doctor or pharmacist if a medicine is suitable for your needs. Each person is different and not all medicines are safe, especially among children, pregnant or breastfeeding women, and the elderly. It is also a good idea to ask your pharmacist about the storage requirements for any medicines you’re taking with you. And remember, regardless of how you purchase the medicine back home, it’s important to check the requirements in your destination. As a general rule, it’s advisable to check with the relevant embassy or high commission and to take your doctor’s prescription or letter, as well as the labelled medicine box with you when travelling. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/the-medicines-to-pack-for-your-overseas-holiday-90930" target="_blank" rel="noopener">The Conversation</a>.

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