Health Tips

Beauty , health , and nutrition are all integrated. If you eat a balanced diet you will be able to maintain your physique and glowing beauty externally and good health internally. A balanced diet is one that provides all the nutrients you need, the right amount of proteins, carbohydrates, and fat.
To achieve goals you need to ensure a good balance in your diet, introduce variety into your meals, and practice moderation. The basis of nutrition lies in your height, weight, dimensions, and your daily energy needs. Once you know this, you can compute what your daily calorific needs are and set goals for weight maintenance, gain, or loss. By regulating your diet you can be active as well as happy.
You must:

1. Eat sensibly. Include a variety of foods in your diet such that all nutrients that are required by your body are present. Make use of a food pyramid and calorie chart to prepare tasty and nutritious meals.

2. Eat plenty of whole grains, fruits, and vegetables. They will supply you with essential vitamins, minerals, and protection from several diseases.

3. Maintain your weight at a healthy level. Successful weight management is one of the golden keys to good health. By doing this you will considerably reduce the risk of many diseases like hypertension, diabetes, heart diseases, cancer, and osteoporosis.

4. Learn self control, eat moderate portions. The secret lies in eating everything but in small portions.

5. Make a time-table for your meals and how many calories you will be taking in each meal. Never fast, starve yourself, or skip a meal. Eat when your body demands sustenance but not huge quantities.

6. Practice moderation. Good health does not lie in eliminating carbohydrates or fats. Include all your favorite foods but balance them with the rest of your diet.

7. Be sure your meals each day include all the food groups.

8. Plan to exercise every day. Either walk or take up aerobics, dance, or join a gym. Exercise will not just burn calories but put a glow into your skin, tone your muscles, and strengthen your bones. Exercise also removes accumulated toxins from your body.

9. Maintain a dairy in which you record your goals, and what you eat each day. Review your week objectively and create a table that shows at a glance what you did right and what you did wrong. This will help keep you on the right track.

10. Celebrate each victory. Give yourself a present or take yourself out every time you achieve a goal.

By eating healthy, one can live a complete and rounded life without diseases, reduce stress greatly, look and feel great, be happy from within , age well, produce healthy progeny, and live life to the fullest.

Just like brushing your teeth, healthy habits should be cultivated on a daily basis. The following is a guide to daily tasks:

1. Activity should be a daily occurrence. Walk, run or jump for a minimum total of 20 minutes a day.

2. Protect your skin. Sun block should be applied on face, neck, arms and hands even in the dead of winter. It protects against climatic toxins too. Moisturize skin daily.

3. Eat fruits, vegetables, grains, low-fat dairy products and small amounts of protein. Avoid sweets and other processed foods.

4. Meditate or spend a minimum of five minutes daily in quiet time.

5. Find your spiritual self. Discover what inspires you, raises your level of consciousness, motivates you, and satisfies your soul.

6. Exercise your brain. Read, study, solve problems, and learn new skills. As does the body, the brain atrophies with lack of use.

7. Hug somebody.

1. Move More
Make it a daily challenge to find ways to move your body. Climb stairs if given a choice between that and escalators or elevators. Walk your dog; chase your kids; toss balls with friends, mow the lawn. Anything that moves your limbs is not only a fitness tool, it's a stress buster. Think 'move' in small increments of time. It doesn't have to be an hour in the gym or a 45-minute aerobic dance class or tai chi or kickboxing. But that's great when you're up to it. Meanwhile, move more. Thought for the day: Cha, Cha, Cha…. Then do it!

2. Cut Fat
Avoid the obvious such as fried foods, burgers and other fatty meats (i.e. pork, bacon, ham, salami, ribs and sausage). Dairy products such as cheese, cottage cheese, milk and cream should be eaten in low fat versions. Nuts and sandwich meats, mayonnaise, margarine, butter and sauces should be eaten in limited amounts. Most are available in lower fat versions such as substitute butter, fat free cheeses and mayonnaise. Thought for the day: Lean, mean, fat-burning machine…. Then be one!

3. Quit Smoking
The jury is definitely in on this verdict. Ever since 1960 when the Surgeon General announced that smoking was harmful to your health, Americans have been reducing their use of tobacco products that kill. Just recently, we've seen a surge in smoking in adolescents and teens. Could it be the Hollywood influence? It seems the stars in every movie of late smoke cigarettes. Beware. Warn your children of the false romance or 'tough guy' stance of Hollywood smokers. Thought for the day: Give up just one cigarette…. the next one.

4. Reduce Stress
Easier said than done, stress busters come in many forms. Some techniques recommended by experts are to think positive thoughts. Spend 30 minutes a day doing something you like. (i.e.,Soak in a hot tub; walk on the beach or in a park; read a good book; visit a friend; play with your dog; listen to soothing music; watch a funny movie. Get a massage, a facial or a haircut. Meditate. Count to ten before losing your temper or getting aggravated. Avoid difficult people when possible. Thought for the day: When seeing red, think pink clouds….then float on them.

5. Protect Yourself from Pollution
If you can't live in a smog-free environment, at least avoid smoke-filled rooms, high traffic areas, breathing in highway fumes and exercising near busy thoroughfares. Exercise outside when the smog rating is low. Exercise indoors in air conditioning when air quality is good. Plant lots of shrubbery in your yard. It's a good pollution and dirt from the street deterrent. Thought for the day: 'Smoke gets in your eyes'…and your mouth, and your nose and your lungs as do pollutants….hum the tune daily.

6. Wear Your Seat Belt
Statistics show that seat belts add to longevity and help alleviate potential injuries in car crashes. Thought for the day: Buckle down and buckle up.

7. Floss Your Teeth
Recent studies make a direct connection between longevity and teeth flossing. Nobody knows exactly why. Perhaps it's because people who floss tend to be more health conscious than people who don't? Thought for the day: Floss and be your body's boss.

8. Avoid Excessive Drinking
While recent studies show a glass of wine or one drink a day (two for men) can help protect against heart disease, more than that can cause other health problems such as liver and kidney disease and cancer. Thought for the day: A jug of wine should last a long time.

9. Keep a Positive Mental Outlook
There's a definitive connection between living well and healthfully and having a cheerful outlook on life. Thought for the day: You can't be unhappy when you're smiling or singing.

10. Choose Your Parents Well
The link between genetics and health is a powerful one. But just because one or both of your parents died young in ill health doesn't mean you cannot counteract the genetic pool handed you. Thought for the day: Follow these basic tips for healthy living and you can better control your own destiny

Quality of life is what we all want. Good health helps us achieve a high quality of life. Fitness makes us want to live it every day. If you agree with these three premises, keep reading.

The Purpose of Health and Fitness Tips
To inform you of new developments in the health and fitness fields is our aim. We'll do the research; we have the resources. You get the results. The name of the game is 'current' and 'relevant' for today. Forget all the excess baggage of the so-called fitness gurus.

Become Healthier and Fitter Faster
While we know you are interested in becoming healthier and fitter or maintaining the health and fitness you have, we also know you have limited time to devote to it. We therefore pledge to you a fast, simple method to hop aboard the fitness fast train. Get on track with the facts.

Health Professionals, Medical Doctors and Health and Fitness Writers and Editors Make Up Our Staff
Our staff experience in the booming Health and Fitness field adds up to more than 100 years. Not that anyone is age 100 or even close, but we all plan to live that long. We want to make sure we have company. So we invite you along for the ride. We'll spur you on and help you over the rough spots to your own fitness destination.

Diet and Exercise are Keys to Healthy Living
But you know all this. So our aim is to give you the shortcuts, the little-known tricks and proven methods to help prevent boredom and hopelessness in your quest for good health. Our high tech world has advanced in the fitness field also. In fact, so fast that we want to get the information out to you yesterday. That's what the Health and Fitness Tips Site is all about…the latest up-to-the-minute-in-the-zone information for your health and fitness.

The Health and Fitness Tips Newsletter
Is a free weekly newsletter that is delivered straight to your email box. It's short, to the point, and it's absolutely free. This newsletter contains one weekly health and fitness tip that will get you on the right track. Click here and become one step closer to your health and fitness goals for the year 2008!

Those nine is the very sensitive and caring period of a women life. The nine months in which she doesn’t have to care about her as well as about new life coming to life inside her. It’s every women dream. But after delivery it’s not over yet, yes then you tied in a new relationship. There are many things that you have to care and have knowledge about after having your baby like how to feed her/him, how to give a bath and many small things here makes difference. If you are thinking what in this it’s too easy then you are wrong every baby needs special treatment in his/her in every first step he/she taking towards their new life. You should always be beware about small things that you never thing about, every thing should be in place foremost those which are dangerous or harmful to your baby. Baby may create some problems in your married life but remember that’s not his/her fault, to avoid this of problems update a time table about which time who (dad or mom) going to look after baby and if their if any such time that both of you are ignoring and want to take that by your partner so do it like two day you will do it and two days your partner will.

Here we talk about baby shower. Baby shower is most important for baby. Every mother’s like to arrange baby shower for her baby. Every likes to care his baby and also she knows what is good think for his baby. Every mother can try to always try can do best care for his baby. Mother can also arrange different gifts foe his baby for the time of pregnancy celebration is also an essential feature of such parties. After when the time of baby ‘s birth it is more important for mother that shall need many small items baby oils bottles diapers, bibs, lotions, baby powder, feeding toys and so on to suitably appear after her baby.

If we give such items to the hopeful mother in the appearance of baby shower gifts, it obtains significant Pressure off her wits is concerning to impending fiscal tasks. So it is necessary for every mother to care her baby .

When you became first time a mother many problems comes around you and one of them is what to do when your newborn baby crying. How you know the reason why is baby crying. Firstly you should know that baby communicate by crying. Because they have only the way of crying to attract there parents or any one who cares them. If they feel you ignore them or they want some thing the only way is crying to attract you. Some times baby have some physical & mental problems and then they cry.

Mostly when baby feel hungry they cry, when you feed them they may feel relax and be quiet immediately. You must help baby to pass the gas after feeding by hold him in your lap in upright position because some times baby feel very uneasy with gas problem. If baby feel very hot or very cold they must cry, so you must careful about the temperature which is appropriate for baby. Babies cry when they are wet when you change her diaper hey feel happy. If hey feel you ignore them they must cry only to attract you. Some times massage helps hem o feel relaxed when hey are sleepy.

Newborns can scratch themselves with their tiny — but very sharp — nails. Prevent these mishaps by trimming your baby's nails. You can get the job done in three easy steps.

Your baby's nails are soft — but their ability to scratch may surprise you. If wielding a scissors or other sharp object anywhere near your baby runs counter to your parental instincts, don't worry. With the right tools and a little practice, you can trim your baby's nails quickly and safely.

What you need

Nail clippers or manicure scissors designed for infants are best. The tips are rounded for safety. Look for these products where you buy other baby supplies.

Resist the temptation to trim your baby's fingernails with your teeth. The nails may tear easily, but not evenly. And the germs in your mouth may cause an infection if there's a break in your baby's skin.

What to do

You can get the job done in three easy steps.

• Get a grip. Use one hand to hold your baby's finger or toe. To reduce the likelihood of a pinch or cut, press the skin under the nail down and out of the way.
• Trim the nail. Use the other hand to trim the nail and round off any sharp edges. For fingernails, follow the nail's natural shape. For toenails, trim straight across.
• Check your work. When you've trimmed all the nails, smooth any rough edges with a soft emery board.

At first, your baby's fingernails may grow more quickly — and need more attention — than his or her toenails. But even if your baby's toenails don't need to be trimmed, check them for sharp or rough edges that may get caught on blankets or clothing.

When baby won't hold still

A squirming baby can take the challenge of trimming tiny nails to a new level. It may help to trim your baby's nails after a bath, when the nails are softer. You might ask another person to hold or distract the baby while you trim his or her nails — or simply wait until your baby is asleep.

If you cut too close

If you accidentally cut one of your baby's nails too short or nick a finger or toe, apply gentle pressure with a clean tissue or sterile gauze pad. Once the bleeding stops, there's no need to cover the area with a bandage. It may only pose a choking hazard.

The balance between calorie intake and energy expenditure determines a person's weight. If a person eats more calories than he or she burns, the person gains weight (the body will store the excess energy as fat). If a person eats fewer calories than he or she burns, he or she will lose weight. Therefore the most common causes of obesity are overeating and physical inactivity. At present, we know that there are many factors that contribute to obesity, some of which have a genetic component:

• Genetics. A person is more likely to develop obesity if one or both parents are obese. Genetics also affect hormones involved in fat regulation. For example, one genetic cause of obesity is leptin deficiency. Leptin is a hormone produced in fat cells, and also in the placenta. Leptin controls weight by signaling the brain to eat less when body fat stores are too high. If, for some reason the body cannot produce enough leptin, or leptin cannot signal the brain to eat less, this control is lost, and obesity occurs. The role of leptin replacement as a treatment for obesity is currently being explored.

• Overeating. Overeating leads to weight gain, especially if the diet is high in fat. Foods high in fat or sugar (e.g., fast food, fried food and sweets,) have high energy density (foods that have a lot of calories in small amount of food). Epidemiology studies have shown that diets high in fat contribute to weight gain.

• A diet high in simple carbohydrates. The role of carbohydrates in weight gain is not clear. Carbohydrates increase blood glucose levels, which in turn stimulate insulin release by the pancreas, and insulin promotes the growth of fat tissue and can cause weight gain. Some scientists believe that simple carbohydrates (sugars, fructose, desserts, soft drinks, beer, wine, etc.) contribute to weight gain because they are more rapidly absorbed into the blood stream than complex carbohydrates (pasta, brown rice, grains, vegetables, raw fruits, etc.) and thus cause a more pronounced insulin release after meals than complex carbohydrates. This higher insulin release, some scientists believe, contribute to weight gain.

• Frequency of eating. The relationship between frequency of eating (how often you eat) and weight is somewhat controversial. There are many reports of overweight people eating less often than people with normal weight. Scientists have observed that people who eat small meals four or five times daily, have lower cholesterol levels and lower and/or more stable blood sugar levels than people who eat less frequently (two or three) large meals daily. One possible explanation is that small frequent meals produce stable insulin levels, whereas large meals cause large spikes of insulin after meals.

• Slow metabolism. Women have less muscle than men. Muscle burns more calories than other tissue (which includes fat). As a result, women have a slower metabolism than men, and hence, have a tendency to put on more weight than men, and weight loss is more difficult for women. As we age, we tend to lose muscle and our metabolism slows, therefore, we tend to gain weight as we get older particularly if we do not reduce our daily caloric intake.

• Physical inactivity. Sedentary people burn fewer calories than people who are active. The National Health and Examination Survey (NHANES) showed that physical inactivity was strongly correlated with weight gain in both sexes.

• Medications. Medications associated with weight gain include certain antidepressants (medications used in treating depression), anti-convulsants (medications used in controlling seizures such as carbamazepine and valproate), diabetes medications (medications used in lowering blood sugar such as insulin, sulfonylureas and thiazolidinediones), certain hormones such as oral contraceptives and most corticosteroids such as Prednisone. Weight gain may also be seen with some high blood pressure medications and antihistamines.

• Psychological factors. For some people, emotions influence eating habits. Many people eat excessively in response to emotions such as boredom, sadness, stress or anger. While most overweight people have no more psychological disturbances than normal weight people, about 30 percent of the people who seek treatment for serious weight problems have difficulties with binge eating.

• Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome and Cushing's syndrome are also contributors to obesity.

The definition of obesity varies depending on what one reads, but in general, it is a chronic condition defined by an excess amount body fat. A certain amount of body fat is necessary for storing energy, heat insulation, shock absorption, and other functions. The normal amount of body fat (expressed as percentage of body fat) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.

How common is obesity?

Obesity has reached epidemic proportions in the United States. One in three Americans is obese. Obesity is also increasing rapidly throughout the world, and the incidence of obesity has nearly doubled form 1991 to 1998.

What are the health risks associated with obesity?

Obesity is not just a cosmetic consideration; it is a dire health dilemma directly harmful to one's health. In the United States, roughly 300,000 deaths per year are directly related to obesity, and more than 80% of these deaths are in patients with a BMI (body mass index, which will be discussed later in this article) over 30. Obesity also increases the risk of developing a number of chronic diseases including:

• Insulin Resistance. Insulin is necessary for the transport of blood glucose (sugar) into the cells of muscle and fat (which is then used for energy). By transporting glucose into cells, insulin keeps the blood glucose levels in the normal range. Insulin resistance (IR) is the condition whereby the effectiveness of insulin in transporting glucose (sugar) into cells is diminished. Fat cells are more insulin resistant than muscle cells; therefore, one important cause of IR is obesity. The pancreas initially responds to IR by producing more insulin. As long as the pancreas can produce enough insulin to overcome this resistance, blood glucose levels remain normal. This IR state (characterized by normal blood glucose levels and high insulin levels) can last years. Once the pancreas can no longer keep up with producing high levels of insulin, blood glucose levels begin to rise, resulting in type 2 diabetes, thus IR is a pre-diabetes condition. In fact scientists now believe that the atherosclerosis (hardening of the arteries) associated with diabetes likely develops during this IR period.

• Type 2 (adult-onset) diabetes. The risk of type 2 diabetes increases with the degree and duration of obesity. Type 2 diabetes is associated with central obesity; a person with central obesity has excess fat around his/her waist, so that the body is shaped like an apple.

• High blood pressure (hypertension). Hypertension is common among obese adults. A Norwegian study showed that weight gain tended to increase blood pressure in women more significantly than in men. The risk of developing high blood pressure is also higher in obese people who are apple shaped (central obesity) than in people who are pear shaped (fat distribution mainly in hips and thighs).

• High cholesterol (hypercholesterolemia)

• Stroke (cerebrovascular accident or CVA)

• Heart attack. The Nurses Health Study found that the risk of developing coronary artery disease increased 3 to 4 times in women who had a BMI greater than 29. A Finnish study showed that for every one kilogram (2.2 pounds) increase in body weight, the risk of death from coronary artery disease increased by one percent. In patients who have already had a heart attack, obesity is associated with an increased likelihood of a second heart attack.

• Congestive heart failure

• Cancer. While not conclusively proven, some observational studies have linked obesity to cancer of the colon in men and women, cancer of the rectum and prostate in men, and cancer of the gallbladder and uterus in women. Obesity may also be associated with breast cancer, particularly in postmenopausal women. Fat tissue is important in the production of estrogen, and prolonged exposure to high levels of estrogen increases the risk of breast cancer.

• Gallstones

• Gout and gouty arthritis

• Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back

• Sleep apnea

• Pickwickian syndrome (obesity, red face, underventilation, and drowsiness)

The Carbohydrates Addict's diet is a low-carbohydrate eating plan. The diet recommends eating low-carbohydrate meals and one "reward meal" daily. The reward meal combines carbohydrates, protein and vegetables. It must be eaten within an hour from start to finish. The Hellers' diet is based on the theory that many overweight people are carbohydrate addicts; they suffer from a biological condition caused by a hormonal imbalance. Excess insulin is produced after eating carbohydrates, resulting in all-day food cravings and a willingness in the body to store fat. The plan holds that converting to this low-carbohydrate plan reverses such biological conditions, reducing appetite and body fat storage. The body will convert to burning fat for energy versus burning glucose from carbohydrate digestion. In general, although the finer points may differ, this can be viewed as a modified Atkins plan.

Disadvantages:

There are no long-term randomized studies to support the theory of carbohydrate addiction. Enjoying carbohydrate foods is not enough for an addiction diagnosis. Also, there are no long-term randomized studies to support the safety of this diet. Eating a low-carbohydrate diet leads to consuming larger amounts of fat and protein. Although debated by the medical community, long-term low-carbohydrate diets are believed to increase risk for colon cancer and osteoporosis. High-fat and high-protein diets could cause kidney function loss, elevate cholesterol levels and increase risk of heart disease. Following this diet long term will be a challenge for many.

Advantages:

Weight loss may occur with this diet. It provides a comprehensive list of foods to consume. It encourages drinking plenty of water daily. It is less restrictive than the Atkins' diet.

The Atkins diet is a high-protein, high-fat, low-carbohydrate plan. The diet allows for unrestricted amounts of meat, cheese and eggs while severely restricting carbohydrates, including sugar, bread, pasta, milk, fruits and vegetables. Atkins' diet is based on the theory that eating carbohydrates creates a production of insulin, a hormone secreted from the pancreas, leading to increased weight gain and hunger, which is a true physiologic response. When converting to this approach, the plan holds that dieters will experience reduced appetite and their bodies will use stored fat for energy versus burning glucose from carbohydrate digestion. Burning fat for energy will supposedly lead to weight loss.

Disadvantages:

The medical community continues to debate the potential damaging effects of long-term, high-protein diets on kidney function, cholesterol levels, and possible increased risk of heart disease, osteoporosis and cancer. The Atkins diet restricts carbohydrates and limits the amounts of fruits, vegetables, milk and other high-fiber foods. These foods naturally provide essential vitamin and minerals to maintain health. Atkins diet followers may have difficulty maintaining this diet long term. The problem is taste. The only way to really satisfy taste without carbohydrate is by increasing fat. And this is another concern with the Atkins plan. Weight loss occurs predominately through a process called ketosis, and a majority of it (at least initially) is fluid loss. There have been no long-term randomized studies to support the safety of this diet.

Advantages:

People like eating high amounts of protein foods that are often restricted on other diets. Those who have been unsuccessful on other low-fat, high-carbohydrate diets will often lose weight with this plan. The diet is easy to follow; no point system, calorie counting or complicated meal plans are involved.

calorie is a calorie. Eat too many... gain weight. Eat fewer calories... lose weight. Not so complicated, right? Wrong, for those who believe weight loss is more than a calorie equation. Everywhere you turn there are so-called new-and-improved ways to lose weight. Americans spend $33 billion annually on weight loss foods, products and services, according to the American Dietetic Association. With that amount of spending, it's no surprise there are an overwhelming number of "fad" diets and other weight-loss products on the market.

When considering a weight-loss plan, start with this proven formula: Successful weight-loss programs incorporate changes to achieve long-term healthy lifestyle behaviors, including eating practices and daily physical activity. Consult your physician and registered dietitian. They will help design a plan that is safe and meets your needs. In general, be wary of diets that offer the following:

• Fast weight loss
• A quick fix
• Claims that sound too good to be true
• Foods defined as "good" and "bad"
• Less than 1,000 calories daily
• A required vitamin/mineral supplement or food product
• Elimination of a major food group (carbohydrates, fats, proteins)
• Lack of long-term randomized scientific studies proving the diet works and is safe. A randomized study distributes participants in a deliberately random way into either the non-tested diet group or the special diet group.

The following review examines the advantages and disadvantages of several popular diet plans. Most of the diets are based on low-carbohydrate approaches. These hotly debated low-carbohydrate diets were subject of a recent study in the "Journal of the American Medical Association" that found more research is needed on the safety and efficacy of such plans. The article analyzed hundreds of published studies about low-carbohydrate plans and found a lack of scientific evidence for or against the diets. "It is also important to note that in most of the studies contained in the analysis, weight loss occurred when study participants were on diets for longer periods, and when they ate fewer calories," according to a statement by Robert H. Eckel, a physician and chair of the American Heart Association's Nutrition, Physical Activity and Metabolism Council.

Keeping that in mind, let's look at a few popular diets, and go through some of the pros and cons, and the theory behind their potential effects.

New drugs: From idea to marketplace

To be sold legitimately in the United States, new drugs must pass through a rigorous system of approval specified in the Food, Drug, and Cosmetic Act and supervised by the Food and Drug Administration (FDA). Except for certain drugs subject to other regulatory provisions, no new drug for human use may be marketed in this country unless FDA has approved a "New Drug Application" (NDA) for it.

The idea
The creation of a new drug usually starts with an idea. Most likely that idea results from the study of a disease or group of symptoms. Ideas can also come from observations of clinical research. This may involve many years of study, or the idea may occur from an accidental discovery in a research laboratory. Some may be coincidental discoveries, as in the case of penicillin.

Idea development takes place most often in the laboratory of a pharmaceutical company, but may also happen in laboratories at research institutions like the National Institutes of Health, at medical centers and universities, or in the laboratory of a chemical company.

Animal testing
A new drug is first tested on animals to help determine how toxic the substance may be. Most drugs interfere in some way with normal body functions. These animal studies are designed to discover the degree of that interference and the extent of the toxic effects.

After successful animal testing, perhaps over several years, the sponsors of the new drug apply to the FDA for an Investigational New Drug (IND) application. This status allows the drug to be tested in humans. As part of their request, the sponsoring manufacturer must submit the results of the animal studies, plus a detailed outline of the proposed human testing and information about the researchers that will be involved.

Human testing
Drug testing in humans usually consists of three consecutive phases. "Informed consent" must be secured from all volunteers participating in this testing.

Phase I testing is most often done on young, healthy adults. This testing is done on a relatively small number of subjects, generally between 20 and 80. Its purpose is to learn more about the biochemistry of the drug: how it acts on the body and how the body reacts to it. The procedure differs for some drugs, however. For example, Phase I testing of cancer drugs involves actual cancer patients from the beginning of testing.

During Phase II, small controlled clinical studies are designed to test the effectiveness and relative safety of the drug. These are done on closely monitored patients who have the disease for which the drug is being tested. Their numbers seldom go beyond 100 to 200 patients. Some volunteers for Phase II testing who have severely complicated conditions may be excluded.

A "control" group of people of comparable physical and disease types is used in double-blind, controlled experiments for most drugs. These experiments are conducted by medical investigators thoroughly familiar with the disease and this type of research. In a double-blind experiment, the patient, the health professional, and other personnel do not know whether the patient is receiving the drug being tested, another active drug, or no medicine at all (a placebo or "sugar pill"). This helps eliminate bias and assures the accuracy of results. The findings of these tests are statistically analyzed to determine whether they are "significant" or due to chance alone.

Phase III consists of larger studies. This testing is performed after effectiveness of the drug has been established and is intended to gather additional evidence of effectiveness for specific uses of the drug. These studies also help discover adverse drug reactions that may occur with the drug. Phase III studies involve a few hundred to several thousand patients who have the disease the drug is intended to treat.

Patients with additional diseases or those receiving other therapy may be included in later Phase II and Phase III studies. They would be expected to be representative of certain segments of the population who would receive the drug following approval for marketing.

Final approval
When a sponsor believes the investigational studies on a drug have shown it to be safe and effective in treating specific conditions, a New Drug Application (NDA) is submitted to FDA. This application is accompanied by all the documentation from the company's research, including complete records of all the animal and human testing. This documentation can run to many thousands of pages.

The NDA and its documentation must then be reviewed by FDA physicians, pharmacologists, chemists, statisticians, and other professionals experienced in evaluating new drugs. Proposed labeling information for the physician and pharmacist is also screened for accuracy, completeness, and conformity to FDA-approved wording.

Regulations call for the FDA to review an NDA within 180 days. This period may be extended if additional data is required and, in some cases, may take several years. When all research phases are considered, the actual time it takes from idea to marketplace may be 8 to 10 years or even longer. However, for drugs representing major therapeutic advances, FDA may "fast-track" the approval process to try to get those drugs to patients who need them as soon as possible.

After approval
After a drug is marketed, the manufacturer must inform the FDA of any unexpected side effects or toxicity that comes to its attention. Consumers and health care professionals have an important role in helping to identify any previously unreported effects. If new evidence indicates that the drug may present an "imminent hazard," the FDA can withdraw approval for marketing or add new information to the drug's labeling at any time.

Generic drugs
After a new drug is approved for marketing, a patent will generally protect the financial interests of the drug's developer for a number of years. The traditional protection period is for 17 years. In reality, however, the period is much less due to the extended period of time needed to gain approval before marketing can begin. Recognizing that a considerable part of a drug's patent life may be tied up in the approval process, in 1984 the U.S. Congress passed a law providing patent extension for drugs whose commercial sale may have been unduly delayed by the approval process.

Any manufacturer can apply for permission to produce and market a drug after the patent for the drug has expired. Following a procedure called an Abbreviated New Drug Application (ANDA), the applicant must show that its product has a comparable potency and effect to the original product. Although the extensive clinical testing completed by the originator during the drug's development does not have to be repeated, comparative testing between the products must be done.

Drug names

Every drug must have a nonproprietary name, a name that is available for each manufacturer to use. These names are commonly called generic names.

The FDA requires the generic name of a drug product to be placed on its labeling. However, manufacturers often use brand names in promoting their products. In general, brand names are shorter and easier to use than the corresponding generic name. The manufacturer then emphasizes its brand name (which cannot be used by anyone else) in advertising and other promotions. Often, the consumer may not realize that a brand name drug is also available under other brand names or by generic name. Ask your pharmacist if you have any questions about the names of your medicines.

Drug quality

After an NDA or an ANDA has been approved for a product, the manufacturer must then meet all requirements relating to production. These include the FDA's current Good Manufacturing Practice regulations and any applicable standards relating to strength, quality, purity, packaging, and labeling that are established by the United States Pharmacopeia (USP).

Routine product testing by the manufacturer is required by the Good Manufacturing Practice regulations of the FDA (the FDA itself does not routinely test all products, except in cases where there is a suspicion that something may be wrong). In addition to governmental requirements, drug products must meet public standards of strength, quality, and purity that are developed by USP. In order to market their products, all manufacturers in the United States must meet USP-established standards unless they specifically choose not to meet the standards for a particular product. In this case, that product's label must state that it is "not USP" and how it differs from USP standards (this occurs very rarely).

Differences in drug products

Although standards to ensure strength, quality, purity, and bioequivalence (comparable potency and effect) exist, the standards allow for variations in certain factors that may produce other differences from product to product. These product variations may be important to some patients, since not all patients are "equivalent." For example, the size, shape, and coating may vary and, therefore, be harder or easier for some patients to swallow; an oral liquid will taste good to some patients and bad to others; one manufacturer may use lactose as an inactive ingredient in its product, while another product may contain a different inactive ingredient; one product may contain sugar or alcohol while another product does not.

In deciding to use one therapeutically equivalent product over another, consumers should keep the following in mind:

• Consider convenience factors of drug products (for example, ease of taking a particular dosage form).
• Don't overlook the convenience of the package. The package must protect the drug in accordance with USP requirements, but packages can be quite different in their ease of carrying, storing, opening, and measuring.
• If you have an allergy or any type of dietary restriction, you need to be aware of the "inactive" ingredients that may be present in different medicines. These inactive ingredients may vary from product to product.
• Price is always a consideration. The price difference between products (e.g., different brands, or brands versus generics) may be a major factor in the overall price of a prescription. Talk to your pharmacist about price considerations. Some states require that the pharmacist dispense exactly what is prescribed. However, other states allow the pharmacist to dispense less expensive medicines when appropriate.

Aside from differences in the drug product, there are many other factors that may influence the effectiveness of a medicine. For example, your diet, body chemistry, medical conditions, or other drugs you are taking may affect how much of a dose of a particular medicine gets into the body.

For the majority of drugs, slight differences in the amount of drug made available to the body will not make any therapeutic difference. For other drugs, the precise amount that gets into the body is more critical. For example, some heart or epilepsy medicines may create problems for the patient if the dose delivered to the body varies for some reason.

For those drugs in the critical category, it is a good idea to stay on the specific product you started on. Changes should only be made after a consultation with the health care professional who prescribed the medicine. If you feel that a certain batch of your medicine is more potent or does not work as well as other batches, or if you have other questions, check with your health care professional.

Communicating with your health care provider

Communication between you and your health care professional is central to good medical care. Your health care professional needs to know about you, your medical history, and your current problems. In turn, you need to understand the recommendations he or she is making and what you will need to do to follow the treatment. You will have to ask questions — and answer some too. Communication is a two-way process.

Giving information
Your health care professional needs to know some details about your past and present medical history. In discussing these details, you should always be completely open and honest. Your health professional's diagnosis and treatment will be based in part on the information that you provide. A complete list of the details that should be included in a full medical history is provided below.

A "medical history" checklist covers the following information:

• All the serious illnesses you have ever had and the approximate dates.
• Your current symptoms, if any.
• All the medicines and dietary supplements you are taking or have taken in the recent past. This includes prescription and nonprescription medicines (such as pain relievers, antacids, laxatives, and cold medicines, etc.) and herbal medicines and home remedies. This is especially important if you are seeing more than one health care professional; if you are having surgery, including dental or emergency treatment; or if you get your medicines from more than one source.
• Any allergies or sensitivities to medicines, foods, or other substances.
• Your smoking, drinking, and exercise habits.
• Any recent changes in your lifestyle or personal habits. New job? Retired? Change of residence? Death in family? Married? Divorced? Other?
• Any special diet you are on — low-sugar, low-sodium, low-fat, or a diet to lose or gain weight.
• If you are pregnant, plan to become pregnant, or if you are breast-feeding.
• All the vaccinations and vaccination boosters you have had, with dates if possible.
• Any operations you have had, including dental and those performed on an outpatient basis, and any accidents that have required hospitalization.
• Illnesses or conditions that run in your family.
• Cause of death of closest relatives.

Remember, be sure to tell your health care professional at each visit if there have been any changes since your last visit.

Medical history forms
Many health care professionals have a standard "medical history" form they will ask you to fill out when they see you for the first time. Some may ask the questions and write down the answers for you. If you will be visiting a health care professional for the first time, prepare yourself before you go by thinking about the questions that might be asked and jotting down the answers — including dates — so that you will not forget an important detail. Once your "medical history" is in the files, subsequent visits will take less time.

You will have to supply each health care provider you see — every time you see one — with complete information about what happened since your last visit. It is important that your records are updated so he or she can make sound recommendations for your continued treatment, or treatment of any new problems.

Medical history file
It will simplify things if you develop a "medical history" file at home for yourself and each family member for whom you are responsible. Setting up the file will take time. However, once it is established, you need only to keep it up-to-date and remember to take it with you when you see a health care professional. This will be easier than having to repeat the information each time and running the risk of confusing or forgetting details.

It is also a good idea to carry in your wallet a card that summarizes your chronic medical conditions, the medicines you are taking, and your allergies and drug sensitivities. You should keep this card as up-to-date as possible. Many pharmacists provide these cards as a service.

Getting information
In order to benefit from your health care professional's advice you must understand completely everything that he or she tells you. Do not be embarrassed to ask questions, or to ask him or her to explain again any instruction or detail that you do not understand. Then it is up to you to carry out those instructions precisely. If there is a failure in any part of this system, you will pay an even higher price — physically and financially — for your health care.

Your health care professional may provide instructions to you in written form. If he or she does not, you may want to write them down or ask the health care professional to write them down for you. If you do not have time to jot down everything while you are still with your health care professional, sit down in the waiting room before you leave and write down the information while it is still fresh in your mind and you can still ask questions. If you have been given a prescription, ask for written information about the drug and how to take it. Your pharmacist can also answer questions when you have your prescription filled.

What you need to know about your medicines
There are a number of things that you should know about each medicine you are taking. These include:

• The medicine's generic and brand name.
• How the medicine will help you and the expected results. How it makes you feel. How long it takes to begin working.
• How much to take at one time.
• How often to take the medicine.
• How long it will be necessary to take the medicine.
• When to take it. Before, during, after meals? At bedtime? At any other special times?
• How to take it. With water? With fruit juice? With food?
• What to do if you forget to take it (miss a dose).
• Foods, drinks, or other medicines that you should not take while taking the medicine.
• Restrictions on activities while taking the medicine, such as driving a car or operating other motor vehicles.
• Possible side effects. What to do if they appear. How to minimize the side effects. How soon they will go away.
• When to seek help if there are problems.
• How long to wait before reporting no change in your symptoms.
• How to store the medicine.
• The expiration date.
• The cost of the medicine.
• How to have your prescription refilled, if necessary.

Other information
Following are some other issues and information that you may want to consider:

• Ask your health care professional about the ingredients in the medicines — both prescription and over-the counter (OTC) — you are taking and whether there may be a conflict with other medicines. Your health care professional can help you avoid dangerous combinations or drug products that contain ingredients to which you are allergic or sensitive.
• Ask your health care professional for help in developing a system for taking your medicines properly, particularly if you are taking a number of them on a daily basis. When you are a patient in a hospital, ask for instructions before you are discharged. Do not hesitate or be embarrassed to ask questions or ask for help.
• If you are over 60 years of age, ask your health care professional if the dose of the medicine is right for you. Some medicines should be given in lower doses to certain older individuals.
• If you are taking several different medicines, ask your health care professional if all of them are necessary for you. You should take only those medicines that you need.
• Medicines should be kept in the container they came in. If this is not possible when you are at work or away from home, ask your pharmacist to provide or recommend a container to transport your medicines safely. The use of "pill boxes" can also cause some problems, such as broken or chipped tablets, mistaking one medicine for another, and even interactions between the medicine and the metal of these boxes.
• Some people have trouble taking tablets or capsules. Your health care professional will know if another dosage form is available, and if tablet or capsule contents can be taken in a liquid. If this is an ongoing problem, ask your prescriber to write the prescription for the dosage form you can take most comfortably.
• To protect children from accidental poisoning, child-resistant caps are required by law on most oral prescription medicines. These containers are designed so children will have difficulty opening them. Since many adults also find these containers hard to open, the law allows consumers to request traditional, easy-to-open packaging for their drugs. If you do not use child-resistant packaging, make sure that your medicines are stored where small children cannot see or reach them. If you use child-resistant containers, ask your pharmacist to show you how to open them.

Consumer education is one of your health care professional's most important responsibilities. To supplement what you learn during your visit, ask if there is any written information about your medicines that you can take home with you. Your health care professional may also have available various reference books or computerized drug information that you can consult for details about precautions, side effects, and proper use of your medicines.

Your health care team

Your health care team will be made up of several different health care professionals. Each of these individuals will play an important part in the overall provision of your health care. It is important that you understand the roles of each of these providers and what you should be able to expect from each of them.

Your dentist
In addition to providing care and maintenance of your mouth, teeth, and gums, your dentist is also an essential member of your overall health care team since your oral health and general health often affect one another.

In providing dental treatment, your dentist should base his or her decisions upon an extensive knowledge of your current condition and past medical and dental history. Because the dentist is a prescriber of medications, it is very important that he or she is aware of your full medical and dental history. A complete medical and dental history should include the information that is listed in the "Medical history checklist" section above. Even if you do not consider this information important, you should inform your dentist as fully as possible.

In the treatment of any dental/oral problem your dentist should make every effort to inform you as fully as possible about the nature of the problem. He or she should explain why this problem has occurred, the advantages and disadvantages of available treatments (including no treatment), and what types of preventive measures can be employed to avoid future problems. These measures may include periodic visits to the dentist, and a general awareness of the manner in which dental and overall health may affect one another. In any type of treatment, your dentist should always allow you to ask questions, and should be willing to answer them to your satisfaction.

In selecting a dentist, it is important to keep in mind the role of the dentist as a member of the health care team, and the extent of the information that he or she should be asking for and providing. There are also several practical issues that you should consider, such as:

• Is the dentist a specialist or general practitioner?
• What are the office hours?
• Is the dentist or his/her associates available after office hours by phone? In emergencies, will you be able to contact a dentist?
• What is the office policy on cancellations?
• What types of payment are accepted at the office?
• What is the office policy on x-ray procedures?
• Is the dentist willing to work with other medical and/or dental specialists that you may be seeing?

Your dentist should be an integral part of your health care team. In treating problems and providing general maintenance of your oral health, your dentist should base decisions upon a full dental and medical history. He or she should also be willing to answer any questions that you have regarding your oral health, any medications prescribed, and preventive measures to avoid future problems.

Your nurse
Depending upon the setting, type of therapy being administered, and state regulations, the role of the nurse in your health care team may vary. Registered nurses practice in diverse health care settings, such as hospitals, outpatient clinics or physicians' offices, schools, workplaces, homes, and long-term care facilities like nursing homes and retirement centers. Some nurses, including certified nurse practitioners and midwives, hold a master's degree in nursing and may assume the role of primary health care professional, either in practice by themselves or in joint practices with physicians. In most states, nurse practitioners may prescribe selected medications. Clinical nurse specialists also have a master's degree in nursing and specialize in a particular area of health care. In some hospitals, long-term care facilities, and out-patient care settings, licensed practical nurses (LPNs) have certain responsibilities in administering medication to patients. LPNs usually work under the supervision of a RN or physician. Nursing aides assist RNs and LPNs with different kinds of patient care activities. In most places where people receive health care, RNs may be the primary source of information for drug therapies and other medical treatments. It is important that you be aware of the roles and responsibilities of the nurses participating in your health care.

Professional nurses participate with other health professionals to ensure that your medication therapy is safe and effective and to monitor any effects (both desired and negative) from the medication. You may be admitted to the hospital so that nurses can administer medications and monitor your response to therapy. In hospitals or long-term care facilities, nurses are responsible for administering your medications in their proper dosage form and dose, and at correct time intervals, as well as monitoring your response to these medications. At home or in outpatient settings, nurses should ensure that you have the proper information and support of others, if needed, to get the medication and take it as prescribed. When nurses administer medication, they should explain why you are receiving this medication, how it works, any possible side effects, special precautions or actions that you must take while using the medication, and any potential interactions with other medications.

If you experience any side effects or symptoms from a medication, you should always tell your health care provider. It is important that these reactions be detected before they become serious or permanent. You can seek advice about possible ways to minimize these side effects from your nurse. Your health care professional should also be made aware of any additional medical problems or conditions (such as pregnancy) that you may have, since these can also affect the safety and effectiveness of a medication.

The professional nurse is someone who can help to clarify drug information. In most health care settings, nurses are accessible and can answer your questions or direct you to others who can assist you. Professional nurses are skilled in the process of patient teaching. To make sure that patients learn important information about their health problem and its treatment, RNs often use a combination of teaching methods, such as verbal instruction, written materials, demonstration, and audio-visual instructions. Above all, professional nurses should teach at a pace and level that are appropriate for you. RNs can also help you design a medication schedule that fits your lifestyle and may be less likely to cause unwanted side effects.

Your pharmacist
Your pharmacist is an important member of your health care team. In addition to performing traditional services, such as dispensing medications, your pharmacist can help you understand your medications and how to take them safely and effectively. By keeping accurate and up-to-date records and monitoring your use of medications, your pharmacist can help to protect you from improper medication therapy, unwanted side effects, and dangerous drug interactions. Because your pharmacist can play a vital role in protecting and improving your health, you should seek a pharmacist who will provide these services.

To provide you with the best possible care, your pharmacist should be informed about your current condition and medication history. Your personal medication history should include the information that is listed in the "Medical history checklist" section above. Your pharmacist should also be aware of any special packaging needs that you may have (such as child-resistant or easy-to-open containers). Your pharmacist should keep accurate and up-to-date records that contain this information. If you visit a new pharmacy that does not have access to your medication records, it is important that you inform that pharmacist as fully as possible about your medical history or provide him or her with a copy of your medication records from your previous pharmacy. In general, in order to get the most out of your pharmacy services, it is best to get all of your medications (including OTCs) from the same pharmacy.

Your pharmacist should be a knowledgeable and approachable source of information about your medications. Some of the information that your pharmacist should explain is listed in the "What you need to know about your medicines" section above. Ideally, this information should also be provided in written form, so that you may refer to it later if you have any questions or problems. The pharmacist should always be willing to answer any questions that you have regarding your medications, and should also be willing to contact your physician or other health care professionals (dentist, nurses, etc.) on your behalf if necessary.

Your pharmacist can also help you with information on the costs of your medicines. Many medicines are available from more than one company. They may have equal effects but different costs. Your insurance company, HMO, or other third-party payment group may reimburse you for only some of these medications or only for part of their costs. Your pharmacist will be able to tell you which of these medications are covered by your payment plan or which cost less.

In selecting a pharmacist, it is important that you understand the role of the pharmacist as a member of your health care team and the extent of information that he or she should be asking for and providing. Because pharmacies can offer different types of services and have different policies regarding patient information, some of the issues that you should consider in selecting a pharmacist also relate to the pharmacy where that person practices. There are several issues regarding the pharmacist and pharmacy that you should consider, such as:

• Does the pharmacy offer written information that you can take home? Home delivery?
• Are you able to talk to your pharmacist without other people hearing you?
• Can the pharmacist be reached easily by phone? In an emergency, is a pharmacist available twenty four hours (including weekends and holidays) by phone?
• What types of payment are accepted in the pharmacy?
• Does the pharmacy accept your HMO or third-party payment plan?
• Does the pharmacy offer any specialized services, such as diabetes education?

You should select your pharmacist and pharmacy as carefully as you select your physician, and stay with the same pharmacy so that all of your medication records are in the same place. This will help to ensure that your records are accurate and up-to-date and will allow you to develop a beneficial relationship with your pharmacist.

Your physician
One of the most important health care decisions that you will make is your choice of a personal physician. The physician is central to your health care team, and is responsible for helping you maintain your overall health. In addition to detecting and treating ailments or adverse conditions, your physician and his or her coworkers should also serve as primary sources of health care information. Because the physician plays such an important role in your overall health care, it is important that you understand the full range of the physician's role as health care and information provider.

In providing any type of treatment or counseling, your physician should base his or her decisions upon an extensive knowledge of your current condition and past medical history. A complete medical history should include the information that is listed in the "Medical history checklist" section above. Your physician should keep accurate and comprehensive medical records containing this information. Because your treatment (and your health) is dependent upon a full disclosure of your medical history, as well as any factors that may currently be affecting your health (i.e., stress, smoking, drug use, etc.), it is important that you inform your physician as fully as possible, even if you might not consider this information important.

It is important that you inform your personal physician of any other physicians (such as specialists or subspecialists), dentists, or other health care professionals that you are seeing. You should also inform your physician of the pharmacy that you use or intend to use, so that he or she can contact the pharmacist if necessary.

In treating any health problem, your physician should make every effort to help you understand completely the nature of the problem and its treatment. He or she should take the time to explain the problem, why it may have occurred, and what preventive measures (if any) can be taken to avoid it in the future. Your physician should explain fully the reasons for any prescribed treatment. He or she should also be willing to discuss alternative therapies, especially if you are uncomfortable with the one that has been prescribed. Your physician should always be willing to answer all of your questions to your satisfaction.

In selecting a physician, you should look for one who will provide a full range of services. You may also want to consider your physician's medical credentials. Your local medical society should be able to provide specific facts about your physician's training, experience, and membership in professional societies.

Cost and payment are two of the most important issues in contemporary health care. Your physician should be sensitive to the costs of your treatment and the manner in which you intend to pay for this and related medications. If you belong to an HMO or third-party payment plan, be sure that your physician is aware of your involvement in the plan. You should also be aware of the different types of payment that are accepted at the physician's office.

In prescribing medications, your physician should take into account the manner in which you intend to pay for your drugs, and should be aware of any specific concerns regarding the costs of your treatment and medication. He or she should also explain why brand or generic medication may be preferable in certain situations.

In selecting a physician, there are also several practical issues and matters of convenience that you should consider, such as:

• Is the office convenient to your home or work?
• What are the office hours?
• Is your physician or his/her associates or partners available (twenty-four hours) by phone? In emergencies, will you be able to contact a physician?
• Are you able to arrange appointments to fit your schedule? What is the office policy on cancellations?
• Is the physician well regarded in the community? Does he or she have a reputation for listening to patients and answering questions?
• Does the physician have admitting privileges at a hospital of your preference?
• Does he/she participate in your health plan?

In addition to the considerations already mentioned, your physician should be sensitive to the special concerns of treating the elderly. Older patients can present disease processes differently from younger adults, can react differently to certain drugs and dosages, and may have preexisting conditions that require special treatments to be prescribed.

There are also several special issues to consider in your selection of a pediatrician or family physician. If your child is not old enough to understand all instructions and information, it is important that your child's physician explain to you any information about a problem and all instructions for treatment. When your child is of school age, the physician should speak directly to the child as well, asking and answering questions, and providing information about cause and prevention of medical problems and the use of medications. He or she should choose a dosage form and dose that is appropriate for your child's age and explain what to do if the child has certain symptoms, such as fever, vomiting, etc. (including the amount and type of medicine to give, if any, and when to call him or her for advice).

Your physician should be a primary source of information about your health and any medications that you are taking. In providing treatment for medical problems or conditions, the physician should base decisions on a full medical history and be willing to answer any questions that you have regarding your health, treatment, and medications.

Managing your medicines

To get the full benefit and reduce risks in taking your medicines, it is important to follow instructions exactly. This means taking the right medicine and dose, at correct time intervals, for the length of time prescribed. Bad effects can result from taking too much or too little of a medicine, or taking it too often or not often enough.

Establishing a system
Whether you are taking one or several medicines, you should develop a system for taking them. It can be just as difficult to remember whether you took your once-a-day medicine as it can be to keep track of a number of medicines that need to be taken several times a day. Many medicines also have special instructions that can further complicate proper use.

Establish a way of knowing whether you took your medicines properly, then make that a part of your daily routine. If you take one or two medicines a day, you may only need to take them at the same time that you perform some other regular task, such as brushing your teeth or getting dressed.

For most people, a check-off record can also be a handy way of managing multiple medicines. Keep your medicine record in a handy, visible place next to where you take your medicines. Check off each dose as you take it. If you miss a dose, make a note about what happened and what you did on the back of the record or the bottom of the sheet.

Be sure to note any unwanted effects or anything unusual that you think may be connected with your medicines. Also note if a medicine does not do what you expect, but remember that some medicines take a while before having a noticeable effect.

If you keep a check-off record faithfully, you will know for sure whether or not you took your medicine. You will also have a complete record for your health care professionals to review when you visit them again. This information can help them determine if the medicine is working properly or causing unwanted side effects, or whether adjustments should be made in your medicines and/or doses.

If your medicines or the instructions for taking them are changed, correct your record or make a new one. Keep the old record until you are sure this information is no longer needed.

You might want to color code your medicine containers to help tell them apart. If you are having trouble reading labels or if you are color-blind, codes that can be recognized by touch (rubber bands, a cotton ball, or a piece of emery board, for instance) can be attached to the container. If you code your medicines, be sure these identifications are included on any medicine record you use. If necessary, ask your pharmacist to type medicine labels in large letters for easier reading.

A check-off list is not the only method for recording medicine use. If this system does not work for you, ask your health care professional for help in developing an alternative. Be sure he or she knows all the medicines prescribed for you and any nonprescription medicines you take regularly, the hours you usually eat your meals, and any special diet you are following.

Informed management
Your medicines have been prescribed for you and your condition. Ask your health care professional what benefits to expect, what side effects may occur, and when to report any side effects. If your symptoms go away, do not decide you are well and stop taking your medicine. If you stop too soon, the symptoms may come back. Finish all of the medicine if you have been told to do so. However, if you develop diarrhea or other unpleasant side effects, do not continue with the medicine; call your health care professional and report these effects. A change in dose or in the kind of medicine you are taking may be necessary.

When you are given a prescription for a medicine, ask the person who wrote it to explain it to you. For example, does "four times a day" mean one in the morning, one at noon, one in the evening, and one at bedtime; or does it mean every six hours around the clock? When a prescription says "take as needed," ask how close together the doses can be taken and what the maximum number of doses you can take in one day should be. Does "take with liquids" mean with water, milk, or something else? Are there some liquids that should be avoided? What does "take with food" mean? At every mealtime (some people must eat six meals a day), or with a snack? Do not trust your memory — have the instructions written down. You must understand exactly what the prescriber wants you to do in order to "take as directed."

When the pharmacist dispenses your medicine, you have another opportunity to clarify information or to ask other questions. Before you leave, check the label on your medicine to be sure it matches the prescription and your understanding of what you are to do. If it does not, ask more questions.

The key to getting the most from your prescribed treatments is following instructions accurately and intelligently. If you have questions or doubts about the prescribed treatment, do not decide to stop taking the medicine or fail to follow the prescribed regimen. Discuss your questions and doubts with your health care professional.

The time and effort put into setting up a system to manage your medicines and establishing a routine for taking them will pay off by relieving anxiety and helping you get the most from your prescribed treatment.

Taking your medicine

To take medicines safely and get the greatest benefit from them, it is important to establish regular habits so you are less likely to make mistakes.

Before taking any medicine, read the label and any accompanying information. You can also consult books to learn more about the medicine. If you have unanswered questions, check with your health care professional.

The label on the container of a prescription medicine should bear your first and last name; the name of the prescriber; the pharmacy address and telephone number; the prescription number; the date of dispensing; and directions for use. Some states or provinces may have additional requirements. If the name of the drug product is not on the label, ask the pharmacist to include the brand (if any) and generic names. An expiration date may also appear. All of this information is important in identifying your medicines and using them properly. The labels on containers should never be removed and all medicines should be kept in their original containers.

Some tips for taking medicines safely and accurately include the following:

• Read the label of each medicine container three times: (1) before you remove it from its storage place, (2) before you take the lid off the container to remove the dose, and (3) before you replace the container in its storage place.
• Never take medicines in the dark, even if you think you know exactly where to find them.
• Use standard measuring devices to take your medicines (household teaspoons, cups, or glasses vary widely in the amount they hold). Ask your pharmacist for help with measuring.
• Set bottles and boxes of medicines on a clear area, well back from the edge of the surface to prevent containers and/or caps from being knocked to the floor.
• When pouring liquid medicines, pick up the container with the label against the palm of your hand to protect it from being stained by dripping medicine.
• Wipe off the top and neck of bottles of liquid medicines to keep labels from being obscured, and to make it less likely that the lid will stick.
• Shake all liquid suspensions of drug products before pouring so that ingredients are mixed thoroughly.
• If you are taking medicine with water, use a full, 8 ounce glassful, not just enough to get it down. Too little liquid with some medicines can prevent the medicine from working properly, and can cause throat irritation if the medicine does not get completely to the stomach.
• To avoid accidental confusion of lids, labels, and medicines, replace the lid on one container before opening another.
• When you are interrupted while taking your medicine, take the container with you or put the medicine out of the reach of small children. It only takes a second for them to take an overdose. When you return, check the label of the medicine to be sure you have the right one.
• Crush tablets or open capsules to take with food or beverages if your health care professional has told you that this will not affect the way the medicine works. If you have difficulty swallowing a tablet or capsule, check with your health care professional about the availability of a different dosage form.
• Follow any diet instructions or other treatment measures prescribed by your health care professional.
• If at any point you realize you have taken the wrong medicine or the wrong amount, call your health care professional immediately. In an emergency, call your local emergency number.

When you have finished taking your medicines, mark it down immediately on your medication calendar to avoid "double dosing." Also make note of any unusual changes in your body, including change in weight, color or amount of urine, perspiration, or coughed-up matter; as well as your pulse, temperature, or any other items you may have been instructed to observe for your condition or your medicine.

Try to take your medicines on time, but a half-hour early or late will usually not upset your schedule. If you are more than several hours late and are getting close to your next scheduled dose, check any instructions that were given to you by your health care professional. If you did not receive instructions about missed doses, check with your health care professional.

When your medicines are being managed by someone else (for example, when you are a patient in a hospital or nursing home), question what is happening to you and communicate what you know about your previous drug therapy or any other treatments. If you know you always take one, not two, of a certain tablet, say so and ask that your record be checked before you take the medicine. If you think you are receiving the wrong treatment or medication, do not hesitate to say so. You should always remain involved in your own therapy.

Many hospitals and nursing homes now offer counseling in medicine management as part of their discharge planning for patients. If you or a family member are getting ready to come home, ask your health care professional if you can be part of such instruction.

The 'expiration date' on medicine labels

To assure that a drug product meets applicable standards of identity, strength, quality, and purity at the time of use, an "expiration date" is added by the manufacturer to the label of most prescription and nonprescription drug products.

The expiration date on a drug product is valid only as long as the product is stored in the original, unopened container under the storage conditions specified by the manufacturer. Among other things, humidity, temperature, light, and even air can affect drugs. A medicine taken after the expiration date may have changed in potency or may have formed harmful material as it deteriorates. Contamination with germs can also occur. The safest rule is not to use any medicine beyond the expiration date.

Preventing deterioration
A drug begins to deteriorate the minute it is made. The manufacturer in calculating the expiration date factors in this rate of deterioration. Keeping the drug product in the container supplied by the pharmacist helps slow down deterioration. Storing the drug in a proper manner — for example, in a light-resistant container or in a cool, dry place (not the bathroom medicine cabinet) — also helps. The need for medicines to be kept in their containers and stored properly cannot be overstressed.

Patients sometimes ask their health care professionals to prescribe a large quantity of a particular medicine in order to "economize." Although this may be all right in some cases, this practice may backfire. If you have a large supply of your medicine and it deteriorates before you can use it all, or if your doctor changes your medicine, you may lose out.

Sometimes deterioration can be recognized by physical changes in the drug, such as a change in odor or appearance. For example, aspirin tablets develop a vinegar odor when they break down. These changes are not true of all drugs, however, and the absence of physical changes should not be assumed to mean that no deterioration has occurred.

Some liquid medicines mixed at the pharmacy will have a "beyond use" date on the label. This is an expiration date that is calculated from the date of preparation in the pharmacy. This is a definite date, after which you should throw away any remaining medicine.

If your prescription medicines do not bear an "expiration" or "beyond use" date, your dispensing pharmacist is the best person to advise you about how long they can be safely used.

Tips against tampering

Over-the-counter (OTC) or nonprescription medicines are now packaged so that it will be easier to notice signs of tampering. A tamper-evident package is required either to be unique so that it cannot be copied easily, or to have a barrier or indicator (with an identifying characteristic, such as a pattern, picture, or logo) that will be easily noticed if broken. For two-piece, unsealed, hard gelatin capsules, two tamper-evident features are required. Improved packaging also includes using special wrappers, seals, or caps on the outer and/or inner containers, or sealing each dose in its own pouch.

Even with such packaging, however, no system is completely safe. It is important that you do your part by checking for signs of tampering whenever you buy or use a medicine.

The following information may help you detect possible signs of tampering.

Protecting yourself

General common sense suggestions include the following:

• When buying a drug product, consider the dosage form (for example, capsules, tablets, syrup), the type of packaging, and the tamper-evident features. Ask yourself: Would it be easy for someone to tamper with this product? Will I be able to determine whether or not this product has been tampered with?
• Look very carefully at the outer packaging of the drug product before you buy it. After you buy it, also check the inner packaging as soon as possible.
• If the medicine has a protective packaging feature, it should be described in the labeling. This description is required to be placed so that it will not be affected if the feature is broken or missing. If the feature is broken or missing, do not buy or use the product. If you have already purchased the product, return it to the store. Always be sure to tell someone in charge about any problems.
• Do not take medicines that show even the slightest signs of tampering or do not seem quite right.
• Never take medicines in the dark or in poor lighting. Read the label and check each dose of medicine before you take it.

What to look for

Packaging

• Are there breaks, cracks, or holes in the outer or inner wrapping or protective cover or seal?
• Does the outer or inner covering appear to have been disturbed, unwrapped, or replaced?
• Does a plastic or other shrink band (tight-fitting wrap) around the top of the bottle appear distorted or stretched, as though it had been rolled down and then put back into place? Is the band missing? Has the band been slit and retaped?
• Is the bottom of the container intact?
• Does the container appear to be too full or not full enough?
• Is the cap on tight?
• Are there bits of paper or glue stuck on the rim of the container (does it seem like the container once had a bottle seal)?
• Is the cotton plug or filler in the bottle torn, sticky, or stained, or does it appear to have been taken out and put back?
• Do eye drops have a protective seal? All eye drops must be sealed when they are made, in order to keep them germ-free. Do not use if there is any sign of a broken or removed seal.
• Check the bottom as well as the top of a tube. Is the tube properly sealed? Metal tubes crimped up from the bottom like a tube of toothpaste should be firmly sealed.
• Are the expiration date, lot number, and other information the same on both the container and its outer wrapping or box?

Liquids

• Is the medicine the usual color? Thickness?
• Is a normally clear liquid cloudy or colored?
• Are there particles (small pieces) in the bottom of the bottle or floating in the solution? For some liquids, called suspensions, floating particles are normal.
• Does the medicine have a strange or different taste or odor (for example, bleach, acid, gasoline-like, or other pungent or sharp odor)? Do not taste the medicine if it has a strange odor.

Tablets

• Do the tablets look different than they usually do? Do they have unusual spots or markings? If they normally are shiny and smooth, are some dull or rough? Is there anything unusual about the color?
• Are the tablets all the same size and thickness?
• If there is printing on the tablets, do they all have the same imprint? Is the imprint missing from any?
• Do the tablets have a strange or different odor or taste?
• Are any of the tablets broken?

Capsules

• Do the capsules look different than they usually do? Are any cracked or dented? Are they all the same size and color?
• Do they have their normal shiny appearance or are some dull? Do some have fingerprints on them as though they have been handled?
• Are the capsules all the same length?
• If there is printing on the capsules, do they all have the same imprint? Is the imprint missing from any? Do the imprints all line up the same way?
• Do the capsules have an unexpected or unusual odor or taste?

Tubes and jars (ointments, creams, pastes, etc.)

• Does the product or container look different than usual?
• Are ointments and creams smooth and non-gritty? Have they separated?

Be a wise consumer. Look for signs of tampering before you buy a medicine and again each time you take a dose. Also, pay attention to the daily news in order to learn about any reported tampering.

It is important to understand that a change in the appearance or condition of a product may not mean that the package has been tampered with. The manufacturer may have changed the color of a medicine or its packaging. Also, the product may be breaking down with age or it may have had rough or unusual handling in shipping. In addition, some minor product variations may be normal.

Whenever you suspect that something is unusual about a medicine or its packaging, take it to your pharmacist. He or she is familiar with most products and their packaging. If there are serious concerns or problems, your pharmacist should report them to the FDA MedWatch Program at 1-800-FDA-1088.

Unintentional poisoning

According to information provided by the American Association of Poison Control Centers, over one million children 6 years of age and under were unintentionally poisoned in 2001.

Adults also may be unintentionally poisoned. This happens most often through carelessness or lack of information. For example, people can be poisoned by taking medicines in the dark and getting the wrong one, or taking medicine prescribed for a friend to treat "the same symptoms."

Drug poisoning from an unintentional overdose is one type of accidental poisoning contributing to these figures. Other causes include household chemical poisoning from unintentional ingestion or contact, and inhaled poisoning — for example, carbon monoxide from a car.

Children are ready victims
The natural curiosity of children makes them ready victims of poisoning. Children explore everywhere and investigate their environment. What they find frequently goes into their mouths. They do not understand the danger and possibly cannot read warning labels.

Accidental poisoning from medicine is especially dangerous in small children because a medicine's strength is usually based on its use in adults. Even a small quantity of an adult dose can sometimes poison a child.

Preventing poisoning from medicines

• Store medicines out of the sight and reach of children, preferably in a locked cabinet — not in the bathroom medicine cabinet or in a food cabinet. Always store your medicines in a secure place.
• If you have children living with you or as occasional guests, you should have child-resistant caps on your medicine containers. These will help ensure that an accidental poisoning does not occur in your home. (Adults who have difficulty opening child-resistant closures may request traditional, easy-to-open packaging for their medicines.)
• If you are called to the telephone or to answer the door while you are taking a medicine, take the container with you or put the medicine out of the reach of small children. Children act quickly — usually when no one is watching.
• Always replace lids and return medicines to their storage place after use, even if you will be using them again soon.
• Date medicines when purchased and clean out your medicines periodically. Discard prescription medicines that are past their expiration or "beyond use" date. As medicines grow old, the chemicals in them may change. In general, medicines that do not have an expiration date should not be kept for more than 1 year. Carefully discard any medicines so children cannot get them. Rinse containers well before discarding in the trash.
• Take only those medicines prescribed for you and give medicines only to those for whom they are prescribed. A medicine that worked well for one person may harm another.
• It is best to keep all medicines in their original containers with their labels intact. The label contains valuable information for taking the medicine properly. Also, in case of accidental poisoning, it is important to know the ingredients in a drug product and any emergency instructions from the manufacturer. While prescription medicines usually do not list ingredients, information on the label makes it possible for your pharmacist to identify the contents.
• Ask your pharmacist to include on the label the number of tablets or capsules that he or she put in the container. In case of poisoning, it may be important to know roughly how many tablets or capsules were taken.
• Do not trust your memory — read the label before using the medicine, and take it as directed.
• If a medicine container has no label or the label has been defaced so you are not absolutely sure what it says, do not use it.
• Turn on a light when taking or giving medicines at night or in a dark room.
• Label medicine containers with poison symbols, especially if you have children, individuals with poor vision, or other persons in your home who cannot read well.
• Teach children that medicine is not candy by calling each medicine by its proper name.
• Do not take medicines in front of children. They may wish to imitate you.
• Communicate these safety rules to any babysitters you have and remember them if you baby-sit or are visiting a house with children. Children are naturally curious and can get into a pocketbook, briefcase, or overnight bag that contains medicines.

What to do if a poisoning happens

Remember:

• There may be no immediate, significant symptoms or warning signs, particularly in a child.
• Nothing you can give will work equally well in all cases of poisoning. In fact, one "antidote" may counteract the effects of another.
• Many poisons act quickly, leaving little time for treatment.

Therefore:

• If you think someone has swallowed medicine or a household product, and the person is unconscious, having seizures (convulsions), or is not breathing, immediately call for an ambulance. Otherwise, do not wait to see what effect the poison will have or if symptoms of overdose develop; immediately call a poison control center (listed in the white pages of your telephone book under "Poison Control" or inside the front cover with other emergency numbers). These numbers should be posted beside every telephone in the house, as should those of your pharmacist, the police, the fire department, and ambulance services. (Some poison control centers have TTY capability for the deaf. Check with your local center if you or someone in your family requires this service.)
• Have the container with you when you call so you can read the label on the product for ingredients.
• Describe what, when, and how much was taken and the age and condition of the person poisoned — for example, if the person is vomiting, choking, drowsy, shows a change in color or temperature of skin, is conscious or unconscious, or is convulsing.
• Do not induce vomiting unless instructed by medical personnel. Do not induce vomiting or force liquids into a person who is convulsing, unconscious, or very drowsy.
• Stay calm and in control of the situation.

Keep a bottle of Ipecac Syrup stored in a secure place in your home for emergency use. It is available at pharmacies in 1 ounce bottles without prescription. Ipecac Syrup is often recommended to induce vomiting in cases of poisoning.

Activated Charcoal also is sometimes recommended in certain types of poisoning and you may wish to add a supply to your emergency medicines. It is available without a prescription. Before using this medicine for poisoning, however, call a poison control center for advice.

Black box warning

Before you use any medicine with a black box warning, tell your health care professional if you have any conditions or concerns related to this warning. A black box warning provides information that alerts the healthcare professional and consumer to any serious side effect or other important safety information.

Before using your medicine

Before you use any medicine, tell your health care professional:

• If you have ever had an allergic or unusual reaction to any medicine, food, or other substance, such as yellow dye or sulfites.
• If you are on a low-salt, low-sugar, or any other special diet. Most medicines contain more than their active ingredient, and many liquid medicines contain alcohol.
• If you are pregnant or if you plan to become pregnant. Certain medicines may cause birth defects or other problems in the unborn child. For other medicines, safe use during pregnancy has not been established. The use of any medicine during pregnancy must be carefully considered and should be discussed with a health care professional.
• If you are breast-feeding. Some medicines may pass into the breast milk and cause unwanted effects in the baby.
• If you are now taking or have taken any medicines or dietary supplements in the recent past. Do not forget over-the-counter (nonprescription) medicines such as pain relievers, laxatives, antacids or dietary supplements.
• If you use alcohol or tobacco. Using alcohol or tobacco while you are taking certain medicines could cause unwanted effects and should be discussed with a health care professional.
• If you have any medical problems other than the one(s) for which your medicine was prescribed.
• If you have difficulty remembering things or reading labels.

Storage of your medicine

It is important to store your medicines properly. Guidelines for proper storage include:

• Keep out of the reach of children.
• Keep medicines in their original containers.
• Store away from heat and direct light.
• Do not store capsules or tablets in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down. Also, do not leave the cotton plug in a medicine container that has been opened, since it may draw moisture into the container.
• Keep liquid medicines from freezing.
• Do not store medicines in the refrigerator unless directed to do so.
• Do not leave your medicines in an automobile for long periods of time.
• Do not keep outdated medicine or medicine that is no longer needed. Be sure that any discarded medicine is out of the reach of children.

Proper use of your medicine

Take medicine only as directed, at the right time, and for the full length of your prescribed treatment. If you are using an over-the-counter (nonprescription) medicine, follow the directions on the label unless otherwise directed by your health care professional. If you feel that your medicine is not working for you, check with your health care professional.

Unless your pharmacist has packaged different medicines together in a "bubble-pack," different medicines should never be mixed in one container. It is best to keep your medicines tightly capped in their original containers when not in use. Do not remove the label since directions for use and other important information may appear on it.

To avoid mistakes, do not take medicine in the dark. Always read the label before taking, especially noting the expiration date and any directions for use.

For oral (by mouth) medicines:

• In general, it is best to take oral medicines with a full glass of water. However, follow your health care professional's directions. Some medicines should be taken with food, while others should be taken on an empty stomach.
• When taking most long-acting forms of a medicine, each dose should be swallowed whole. Do not break, crush, or chew before swallowing unless you have been specifically told that it is all right to do so.
• If you are taking liquid medicines, you should use a specially marked measuring spoon or other device to measure each dose accurately. Ask your pharmacist about these devices. The average household teaspoon may not hold the right amount of medicine.
• Oral medicine may come in a number of different dosage forms, such as tablets, capsules, and liquids. If you have trouble swallowing the dosage form prescribed for you, check with your health care professional. Another dosage form that you can swallow more easily may be available.
• Child-resistant caps on medicine containers have decreased greatly the number of accidental poisonings that occur each year. Use of these caps is required by law. However, if you find it hard to open such caps, you may ask your pharmacist for a regular, easier-to-open cap. He or she can provide you with a regular cap if you request it. However, you must make this request each time you get a prescription filled.

For skin patches:

• Apply the patch to a clean, dry skin area that has little or no hair and is free of scars, cuts, or irritation. Remove the previous patch before applying a new one.
• Apply a new patch if the first one becomes loose or falls off.
• Apply each patch to a different area of skin to prevent skin irritation or other problems.
• Do not try to trim or cut the adhesive patch to adjust the dosage. Check with your health care professional if you think the medicine is not working as it should.

For inhalers:

• Medicines that come in inhalers usually come with patient directions. Read the directions carefully before using the medicine. If you do not understand the directions, or if you are not sure how to use the inhaler, check with your health care professional.
• Since different types of inhalers may be used in different ways, it is very important to follow carefully the directions given to you.

For ophthalmic (eye) drops:

• To prevent contamination, do not let the tip of the eye drop applicator touch any surface (including the eye) and keep the container tightly closed.
• The bottle may not be full; this is to provide proper drop control.
• How to apply: First, wash your hands. Tilt your head back and, with the index finger, pull the lower eyelid away from the eye to form a pouch. Drop the medicine into the pouch and gently close your eyes. Do not blink. Keep your eyes closed for 1 to 2 minutes.
• If your medicine is for glaucoma or inflammation of the eye: Follow the directions for application that are listed above. However, immediately after placing the drops in your eye, apply pressure to the inside corner of the eye with your middle finger. Continue to apply pressure for 1 to 2 minutes after the medicine has been placed in the eye. This will help prevent the medicine from being absorbed into the body and causing side effects.
• After applying the eye drops, wash your hands to remove any medicine.

For ophthalmic (eye) ointments:

• To prevent contamination of the eye ointment, do not let the tip of the applicator touch any surface (including the eye). After using, wipe the tip of the ointment tube with a clean tissue and keep the tube tightly closed.
• How to apply: First, wash your hands. Pull the lower eyelid away from the eye to form a pouch. Squeeze a thin strip of ointment into the pouch. A 1-cm (approximately 1/3-inch) strip of ointment is usually enough unless otherwise directed. Gently close your eyes and keep them closed for 1 to 2 minutes.
• After applying the eye ointment, wash your hands to remove any medicine.

For nasal (nose) drops:

• How to use: Blow your nose gently. Tilt your head back while standing or sitting up, or lie down on your back on a bed and hang your head over the side. Place the drops into each nostril and keep your head tilted back for a few minutes to allow the medicine to spread throughout the nose.
• Rinse the dropper with hot water and dry with a clean tissue. Replace the cap right after use. To avoid the spread of infection, do not use the container for more than one person.

For nasal (nose) spray:

• How to use: Blow your nose gently. With your head upright, spray the medicine into each nostril. Sniff briskly while squeezing the bottle quickly and firmly.
• Rinse the tip of the spray bottle with hot water, taking care not to suck water into the bottle, and dry with a clean tissue. Replace the cap right after cleaning. To avoid the spread of infection, do not use the container for more than one person.

For otic (ear) drops:

• To prevent contamination of the ear drops, do not touch the applicator tip to any surface (including the ear).
• The bottle may not be full; this is to provide proper drop control.
• How to apply: Lie down or tilt the head so the ear needing treatment faces up. For adults, gently pull the earlobe up and back (pull down and back for children). Drop the medicine into the ear canal. Keep the ear facing up for about 5 minutes so the medicine can run to the bottom of the ear canal. (For young children and other patients who cannot stay still for 5 minutes, try to keep the ear facing up for at least 1 or 2 minutes.)
• Do not rinse the dropper after use. Wipe the tip of the dropper with a clean tissue and keep the container tightly closed.

For rectal suppositories:

• How to insert suppository: First, wash your hands. Remove the foil wrapper and moisten the suppository with water. Lie down on your side. Push the suppository well up into the rectum with your finger. If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
• Wash your hands after you have inserted the suppository.

For rectal cream or ointment:

• Clean and dry the rectal area. Apply a small amount of cream or ointment and rub it in gently.
• If your health care professional wants you to insert the medicine into the rectum: First, attach the plastic applicator tip onto the opened tube. Insert the applicator tip into the rectum and gently squeeze the tube to deliver the cream. Remove the applicator tip from the tube and wash with hot, soapy water. Replace the cap of the tube after use.
• Wash your hands after you have inserted the medicine.

For vaginal medicines:

• How to insert the medicine: First, wash your hands. Use the special applicator. Follow any special directions that are provided by the manufacturer. If you are pregnant, however, check with your health care professional before using the applicator to insert the medicine.
• Lie on your back, with your knees drawn up. Using the applicator, insert the medicine into the vagina as far as you can without using force or causing discomfort. Release the medicine by pushing on the plunger. Wait several minutes before getting up.
• Wash the applicator and your hands with soap and warm water.

Precautions while using your medicine

Never give your medicine to anyone else. It has been prescribed for your personal medical problem or condition and may be harmful to another person.

Many medicines should not be taken with other medicines or with alcoholic beverages. Follow your health care professional's directions to help avoid problems.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the physician or dentist about any medicine you are taking.

If you think you have taken an overdose of any medicine or if a child has taken a medicine by accident: Call your poison control center or your health care professional at once. Keep those telephone numbers handy. Also, keep a bottle of Ipecac Syrup safely stored in your home in case you are told to cause vomiting. Read the directions on the label of Ipecac Syrup before using.

Side effects of your medicine

Along with its intended effects, a medicine may cause some unwanted effects. Some of these side effects may need medical attention, while others may not. It is important for you to know what side effects may occur and what you should do if you notice signs of them. Check with your health care professional about the possible side effects of the medicines you are taking, or if you notice any unusual reactions or side effects.

Other information

It is a good idea for you to learn both the generic and brand names of your medicine and even to write them down for future use.

Many prescriptions may not be refilled until your pharmacist checks with your health care professional. To save time, do not wait until you have run out of medicine before requesting a refill. This is especially important if you must take your medicine every day.

When traveling:

• Carry your medicine with you rather than putting it in your checked luggage. Checked luggage may get lost or stored in very cold or very hot areas.
• Make sure a source of medicine is available where you are traveling, or take a large enough supply to last during your visit. It is also a good idea to take a copy of your written prescription with you.

If you want more information about your medicines, ask your health care professional. Do not be embarrassed to ask questions about any medicine you are taking. To help you remember, it may be useful to write down any questions and bring them with you on your next visit to your health care professional.