AC, DC, Or PC?

Should medicines be taken before, during, or after meals?

Tidak ada jawaban sederhana untuk pertanyaan ini.

Namun, secara umum, aturan minum obat sebaiknya dilakukan pada waktu perut kosong (satu jam sebelum makan atau 2 jam setelahnya.

Hal ini karena banyak obat dapat terpengaruh absorbsinya dan berinteraksi dengan makanan 

Ada sejumlah alasan mengapa minum obat dilakukan sebelum makan atau saat perut kosong, hal ini disebabkan:

•  Beberapa makanan bisa menghalangi dan menghentikan obat sehingga  tidak terabsorbsi dengan benar

•  Terkadang, makanan bisa meningkatkan jumlah obat yang terabsorbsi ke tubuh, sehingga kemungkinan terjadinya efek samping lebih besar

•  Beberapa obat perlu bekerja langsung di lambung, sehingga membutuhkan kondisi lambung benar benar kosong

secara garis besar, ada empat cara dan waktu kapan sebaiknya minum obat berdasarkan jeda dengan waktu makan, yaitu:

1. Obat yang sebaiknya diminum pada kondisi perut kosong (1 jam sebelum makan atau 2 jam setelah makan)
2. obat yang sebaiknya diminum sebelum makan
3. obat yang sebaiknya diminum pada saat makan
4. obat yang dianjurkan diminum setelah makan

 mari kita telaah satu per satu ya...

•   Obat yang diminum saat PERUT KOSONG

Pada beberapa jenis obat ini, kehadiran makanan akan mengganggu terserapnya obat tersebut dari saluran cerna. Contoh obat yang sebaiknya diminum saat perut kosong adalah obat antasida untuk meredakan maag, rifampisin dan isoniazid (obat tuberculosis), sirup yang mengandung sukralfat (biasanya berwarna pink, digunakan untuk dispepsia). 

  

• Obat yang diminum SEBELUM makan

Ada beberapa alasan mengapa suatu obat disarankan diminum sebelum makan (biasanya kurang lebih 30 menit sebelum makan),hal ini dikarenakan keberadaan makanan akan menghambat keterserapan obat dari saluran cerna. Beberapa contoh obat yang diminum sebelum makan adalah golongan proton pump inhibitor seperti omeprazole, pantoprazole, esomeprazole, dan lansoprazole. untuk obat-obat ini, penelitian membuktikan bahwa kerja obat akan lebih baik jika tidak ada makanan di saluran cerna dikarenakan keberadaan makananan akan merangsang asam lambung. Sedangkan untuk obat domperidone dan metoklopramid yang biasanya diresepkan dokter untuk mengatasi gejala mual dan muntah, Anda sebaiknya mengonsumsinya 30 menit sebelum makan,hal ini dikarenakan obat akan lebih mudah terabsorbsi

• Obat yang diminum PADA SAAT makan

Yang dimaksud dengan meminum obat pada saat makan adalah, pasien mengkonsumsi dahulu beberapa suap makanan, kemudian baru meminum obat, dan lanjutkan kembali makan hingga selesai. Salah satu contoh obat yang sebaiknya diminum dengan cara seperti ini adalah suplemen yang mengandung kalsium (Ca). Makanan akan merangsang produksi asam lambung, dimana asam lambung ini akan membantu penyerapan kalsium dari saluran cerna. Oleh karena itu, kalsium disarankan diminum saat ada makanan. Contoh lain adalah suplemen yang mengandung vitamin D. Vitamin D adalah vitamin yang bersifat larut lemak, sehingga ia akan terserap lebih baik jika ada kehadiran makanan, terutama large meal.

• Obat yang diminum SETELAH makan

Obat-obat yang dianjurkan untuk diminum setelah makan biasanya memiliki sifat dapat mengiritasi lapisan mukosa di saluran cerna. Kehadiran makanan akan berperan sebagai ‘bantalan’ sehingga iritasi obat terhadap saluran cerna bisa lebih minimal. Contohnya, obat-obat antiinflamasi non steroid (NSAID) seperti asam mefenamat, metformin,natrium dan kalium diklofenak, ketoprofen dan deksketoprofen, ibuprofen, dan antalgin. Contoh lain adalah obat yang biasanya diresepkan dokter jika terjadi keluhan di daerah prostat, yakni tamsulosin dan dutasteride.

Bagaimana mengetahui obat harus dikonsumsisebelum makanan atau perut kosong.

Untuk mengetahui tentang aturan minum obat, informasi dapat diperoleh dari:

• Brosur atau selebaran informasi yang disertakan dengan obat Anda

• kemasan produk atau

• label yang diberikan oleh apoteker saat pemberian obat

Jika Anda merasa sulit untuk minum obat seperti yang diinstruksikan, bicarakan dengan dokter atau apoteker Anda.

Jika Anda memiliki pertanyaan tentang obat yang diminum, do Not hesitate, ask to your pharmacist

Because..

Medicines can help you feel better, but if medicines you 

are taken incorrectly, they can actually make you feel worse.
 

Paracetamol, Analgesic or Antipyretic?

Paracetamol, also known as acetaminophen or APAP, is a medication used to treat pain and fever. It is typically used for mild to moderate pain.There is poor evidence for fever relief in children It is often sold in combination with other ingredients such as in many cold medications. In combination with opioid pain medication, paracetamol is used for more severe pain such as cancer pain and after surgery. It is typically used either by mouth or rectally but is also available intravenously. Effects last between two and four hours.

Paracetamol is generally safe at recommended doses.Serious skin rashes may rarely occur, and too high a dose can result in liver failure. It appears to be safe during pregnancy and when breastfeeding. In those with liver disease, it may still be used, but lower doses should be taken. Paracetamol is classified as a mild analgesic. It does not have significant anti-inflammatory activity and how it works is not entirely clear.

Medical uses

Fever

Paracetamol is used for reducing fever in people of all ages The World Health Organization (WHO) recommends that paracetamol be used to treat fever in children only if their temperature is greater than 38.5 °C (101.3 °F). The efficacy of paracetamol by itself in children with fevers has been questioned and a meta-analysis showed that it is less effective than ibuprofen

Pain

Paracetamol is used for the relief of mild to moderate pain. The use of the intravenous form for pain of sudden onset in people in the emergency department is supported by limited evidence.

Osteoarthritis

The American College of Rheumatology recommends paracetamol as one of several treatment options for people with arthritis pain of the hip, hand, or knee that does not improve with exercise and weight loss.A 2015 review, however, found it provided only a small benefit in osteoarthritis.

Paracetamol has relatively little anti-inflammatory activity, unlike other common analgesics such as the NSAIDs aspirin and ibuprofen, but ibuprofen and paracetamol have similar effects in the treatment of headache. Paracetamol can relieve pain in mild arthritis, but has no effect on the underlying inflammation, redness, and swelling of the joint. It has analgesic properties comparable to those of aspirin, while its anti-inflammatory effects are weaker. It is better tolerated than aspirin due to concerns about bleeding with aspirin.

Low back pain

Based on a systematic review, paracetamol is recommended by the American College of Physicians and the American Pain Society as a first-line treatment for low back pain. However, other systematic reviews concluded that evidence for its efficacy is lacking

Headaches

A joint statement of the German, Austrian, and Swiss headache societies and the German Society of Neurology recommends the use of paracetamol in combination with caffeine as one of several first line therapies for treatment of tension or migraine headach. In the treatment of acute migraine, it is superior to placebo, with 39% of people experiencing pain relief at 1 hour compared to 20% in the control group.

Uses
Symptomatic relief of mild to moderate pain.

Dosage and administration
Adults: 0.5-1 g repeated, as necessary, every 4-6 hours to a maximum of 4 g daily.
Children: 20-30 mg/kg daily in divided doses.
Dosage should be reduced in patients with renal failure.
Suppositories are available for patients unable to take the drug orally.
Treatment should not be continued for more than 5 days except on medical advice.

Contraindications

• Hypersensitivity to paracetamol.
• Repeated administration is contraindicated in patients with hepatic insufficiency.

Adverse effects
At doses within the therapeutic range paracetamol is usually well tolerated.
Hypersensitivity, dermatological reactions, neutropenia and thrombocytopenic purpura have rarely been reported.

Overdosage

In overdosage paracetamol is dangerously hepatotoxic; potentially fatal hepatic necrosis can occur after ingestion of as little as a single dose of 10-15 g. Signs of mild gastrointestinal irritation are commonly followed 2 days later by anorexia, nausea, malaise, abdominal pain, progressive evidence of liver failure and, ultimately, hepatic coma.

Gastric lavage should be performed or emesis induced whenever there is a possibility that paracetamol remains in the stomach. When feasible, plasma paracetamol concentrations should be determined to assess the risk of liver failure. This is likely when the plasma concentration is greater than 200 micrograms/ml at 4 hours after ingestion, 100 micrograms/ml at 8 hours, 50 micrograms/ml at 12 hours, 25 micrograms/ml at 16 hours and 6 micrograms/ml at 24 hours.

Either methionine or acetylcysteine may be used as a specific antidote. To be effective the antidote must be administered within 16 hours and before signs of hepatic damage become evident. A loading dose of 140 mg/kg administered orally or through a nasogastric tube is supplemented by 70 mg/kg every 4 hours until the results of liver function tests have returned to normal. If this has not occurred within 3 days, no further improvement can be expected.

Fluid and electrolyte balance must be maintained and ventilation must be assisted when respiration is depressed.

Storage
Paracetamol tablets and syrup should be stored in tightly closed containers protected from light, below 25°C. Suppositories should be stored below 15°C.

^REFERENCE
 "International Listings for Paracetamol". Retrieved 11 January 2016.

 ^{https://en.wikipedia.org/wiki/Paracetamol}

Flu Treatment: should you use antibiotics?

Antibiotics are strong medicines that can kill bacteria. But we have overused antibiotics for many years. As a result, we now have bacteria that resist antibiotics. Resistant bacteria cause infections that are harder to cure and more costly to treat.

Antibiotics are medications that fight infections caused by bacteria, but the flu is cause by a virus.

Taking antibiotics when you have a virus may do more harm than good. Taking antibiotics when they are not needed increases your risk of getting an infection later that may resist antibiotic treatment.

Antivirals are medications that reduce the ability of flu viruses to multiply. When taken at the onset of flu, these drugs help decrease the severity and duration of flu symptoms. They can also be used in cases to help prevent the flu, but they are not a replacement for getting the flu vaccine

 Antibiotics can be lifesavers, but misuse has increased the number of drug-resistant germs.

What is antibiotic resistance?
Antibiotic resistance is the ability of bacteria or other microbes to resist the effects of an antibiotic. Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.

What kinds of infections are caused by viruses and should not be treated with antibiotics?
Viral infections that should not be treated with antibiotics include:

• Colds
• Flu
• Most coughs and bronchitis
• Sore throats (except for those resulting from strep throat)
• Some ear infections; the illness can lead to serious disability or even death.

How can I prevent antibiotic-resistant infections?
It is important to understand that, although they are very useful drugs, antibiotics designed for bacterial infections are not useful for viral infections such

1. Talk with your healthcare provider about antibiotic resistance:
   • Ask whether an antibiotic is likely to be beneficial for your illness
   • Ask what else you can do to feel better sooner
2. Do not take an antibiotic for a viral infection like a cold or the flu.
3. Do not save some of your antibiotic for the next time you get sick. Discard any leftover medication once you have completed your prescribed course of treatment.
4. Take an antibiotic exactly as the healthcare provider tells you. Do not skip doses. Complete the prescribed course of treatment even if you are feeling better. If treatment stops too soon, some bacteria may survive and re-infect.
5. Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.
6. If your healthcare provider determines that you do not have a bacterial infection, ask about ways to help relieve your symptoms. Do not pressure your provider to prescribe an antibiotic.

Why should I be concerned about antibiotic resistance?
Antibiotic resistance has been called one of the world's most pressing public health problems. Almost every type of bacteria has become stronger and less responsive to antibiotic treatment when it is really needed. These antibiotic-resistant bacteria can quickly spread to family members, schoolmates, and co-workers - threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.

Antibiotic resistance can cause significant danger and suffering for children and adults who have common infections, once easily treatable with antibiotics. Microbes can develop resistance to specific medicines. A common misconception is that a person's body becomes resistant to specific drugs. However, it is microbes, not people that become resistant to the drugs.
If a microbe is resistant to many drugs, treating the infections it causes can become difficult or even impossible. Someone with an infection that is resistant to a certain medicine can pass that resistant infection to another person. In this way, a hard-to-treat illness can be spread from person to person. In some cases, the illness can lead to serious disability or even death.

What else can I do to reduce the risk of antibiotic resistance?
Wash your hands with soap and water before you eat and after you use the bathroom. Regular hand washing will help keep you healthy and reduce the need for antibiotics.

 For more information, see the Centers for Disease Control and Prevention www.cdc.gov/getsmart/community

Drug Interactions: What You Should Know

Drug interactions overview

Whenever two or more drugs are being taken, there is a chance that there will be an interaction among the drugs. The interaction may increase or decrease the effectiveness of the drugs or the side effects of the drugs. The likelihood of drug interactions increases as the number of drugs being taken increases. Therefore, people who take several drugs are at the greatest risk for interactions. Drug interactions contribute to the cost of healthcare because of the costs of medical care that are required to treat problems caused by changes in effectiveness or side effects. Interactions also can lead to psychological suffering that can be avoided. This review discusses the issue of drug interactions and several ways to avoid them.

What are drug interactions?

A drug interaction can be defined as an interaction between a drug and another substance that prevents the drug from performing as expected. This definition applies to interactions of drugs with other drugs (drug-drug interactions), as well as drugs with food (drug-food interactions) and other substances.

How do drug interactions occur?

There are several mechanisms by which drugs interact with other drugs, food, and other substances. An interaction can result when there is an increase or decrease in:

1. the absorption of a drug into the body;
2. distribution of the drug within the body;
3. alterations made to the drug by the body (metabolism); and
4. elimination of the drug from the body.

Most of the important drug interactions result from a change in the absorption, metabolism, or elimination of a drug. Drug interactions also may occur when two drugs that have similar (additive) effects or opposite (canceling) effects on the body are administered together. For example, there may be major sedation when two drugs that have sedation as side effects are given, for example, narcotics and antihistamines. Another source of drug interactions occurs when one drug alters the concentration of a substance that is normally present in the body. The alteration of this substance reduces or enhances the effect of another drug that is being taken. The drug interaction between warfarin (Coumadin) and vitamin K-containing products is a good example of this type of interaction. Warfarin acts by reducing the concentration of the active form of vitamin K in the body. Therefore, when vitamin K is taken, it reduces the effect of warfarin.

Change in absorption

Most drugs are absorbed into the blood and then travel to their site of action. Most drug interactions that are due to altered absorption occur in the intestine. There are various potential mechanisms through which the absorption of drugs can be reduced. These mechanisms include:

1. an alteration in blood flow to the intestine;
2. change in drug metabolism (breakdown) by the intestine;
3. increased or decreased intestinal motility (movement);
4. alterations in stomach acidity, and
5. a change in the bacteria that reside in the intestine.

Drug absorption also can be affected if the drug's ability to dissolve (solubility) is changed by another drug or if a substance (for example, food) binds to the drug and prevents its absorption.

Change in drug metabolism and elimination

Most drugs are eliminated through the kidney in either an unchanged form or as a by-product that results from the alteration (metabolism) of the drug by the liver. Therefore, the kidney and the liver are very important sites of potential drug interactions. Some drugs are able to reduce or increase the metabolism of other drugs by the liver or their elimination by the kidney.
Metabolism of drugs is the process through which the body converts (alters or modifies) drugs into forms that are more or less active (for example, by converting drugs that are given in inactive forms into their active forms that actually produce the desired effect) or that are easier for the body to eliminate through the kidneys. Most drug metabolism takes place in the liver, but other organs also may play a role (for example, the kidneys, intestine, etc.). The cytochrome P450 enzymes are a group of enzymes in the liver that are responsible for the metabolism of most drugs. They are, therefore, often involved in drug interactions. Drugs and certain types of food may increase or decrease the activity of these enzymes and therefore affect the concentration of drugs that are metabolized by these enzymes. An increase in the activity of these enzymes leads to a decrease in the concentration and effect of an administered drug. Conversely, a decrease in enzyme activity leads to an increase in drug concentration and effect.

What are the consequences of drug interactions?

Drug interactions may lead to an increase or decrease in the beneficial or the adverse effects of the given drugs. When a drug interaction increases the benefit of the administered drugs without increasing side effects, both drugs may be combined to increase the control of the condition that is being treated. For example, drugs that reduce blood pressure by different mechanisms may be combined because the blood pressure lowering effect achieved by both drugs may be better than with either drug alone.
The absorption of some drugs is increased by food. Therefore, these drugs are taken with food in order to increase their concentration in the body and, ultimately, their effect. Conversely, when a drug's absorption is reduced by food, the drug is taken on an empty stomach.
Drug interactions that are of greatest concern are those that reduce the desired effects or increase the adverse effects of the drugs. Drugs that reduce the absorption or increase the metabolism or elimination of other drugs tend to reduce the effects of the other drugs. This may lead to failure of therapy or warrant an increase in the dose of the affected drug. Conversely, drugs that increase absorption or reduce the elimination or metabolism of other drugs - increase the concentration of the other drugs in the body - and lead to increased amounts of drug in the body and more side effects. Sometimes, drugs interact because they produce similar side effects. Thus, when two drugs that produce similar side effects are combined, the frequency and severity of the side effect are increased.

How often do drug interactions occur?

The prescribing information for most drugs contains a list of potential drug interactions. Many of the listed interactions may be rare, minor, or only occur under specific conditions and may not be important. Drug interactions that cause important changes in the action of a drug are of greatest concern.
Drug interactions are complex and chiefly unpredictable. A known interaction may not occur in every individual. This can be explained because there are several factors that affect the likelihood that a known interaction will occur. These factors include differences among individuals in their:

• genes,
• physiology,
• age,
• lifestyle (diet, exercise),
• underlying diseases,
• drug doses,
• the duration of combined therapy, and
• the relative time of administration of the two substances. (Sometimes, interactions can be avoided if two drugs are taken at different times.)

Nevertheless, important drug interactions occur frequently and they add millions of dollars to the cost of health care. Moreover, many drugs have been withdrawn from the market because of their potential to interact with other drugs and cause serious health care problems.

How can drug interactions be avoided?

1. Give health care practitioners a complete list of all of the drugs that you are using or have used within the last few weeks. This should include over-the-counter medications, vitamins, food supplements, and herbal remedies.
2. Inform health care practitioners when medications are added or discontinued.
3. Inform health care practitioners about changes in lifestyle (for example, exercise, diet, alcohol
4. intake).
5. Ask your health care practitioners about the most serious or frequent drug interactions with the medications that you are taking.
6. Since the frequency of drug interactions increases with the number of medications, work with your health care practitioners to eliminate unnecessary medications. 

Reference
 http://www.rxlist.com/drug-interaction-checker.htm