10 embarrassing questions about medications: pharmacist Victoria Bueva answers
Miscellaneous / / October 16, 2023
We have collected what you really wanted to know about, but were embarrassed to ask.
In this series articles, well-known experts answer questions that are usually awkward to ask: it seems that everyone already knows about it, and the questioner will look stupid.
Today we talked with Candidate of Pharmaceutical Sciences, pharmacist Victoria Bueva. You will find out whether generic drugs are dangerous, whether you need to take vitamins, and whether activated charcoal will save you from a hangover.
Victoria Bueva
1. Are expensive drugs better than cheap ones?
Some drugs are more expensive than others because they require more money to make. This depends on many factors:
- Raw materials purchased by the manufacturer. Chinese, Indian, Russian or some other differs in cost.
- Composition of the medicine. The more expensive components a medicine contains, the more expensive the product.
- Manufacturer's fame. If a manufacturer has a name and a place in the market, their product may be worth more.
- Dosage form. Capsules are more expensive than tablets because they require expensive equipment to make.
- Production stages and necessary equipment. The more stages of production and the more specific equipment used for this, the more expensive the medicine.
- Sterility. Sterile preparations are more expensive than non-sterile ones, because ensuring sterility - additional cleaning and processing of the production site - also costs money. Tablets are non-sterile, injections are.
- Package. The final cost is also affected by how the product is packaged, what kind of packaging, paper is used, and so on.
- Advertising costs.
Does this mean that expensive drugs are better? Not at all. Expensive drugs are simply more expensive. But some patients prefer a more expensive option, while others prefer a cheaper one.
No matter how similar they are drugs, produced at different sites, they will have very slight differences in properties. Even the order in which the manufacturer mixes the ingredients, for example, can affect how your body absorbs the medicine. We are different and perceive such micro-differences differently, even if the composition of the medicine is identical.
How can not be There are no two identical snowflakes, so there are no two identical tablets from different manufacturers. However, none of them is worse or better. Everything will depend on how your body perceives micro-differences. To find out what's right for you, you need to try both options.
2. Which medicines are better - domestic or imported?
By imported medicines we mean everything that is not produced in Russia. And here there is a feeling that in our heads domestic production is better, for example, Indian or Chinese, but worse than European.
In fact, none of them, of course, is better or worse. The quality of a medicine depends on the integrity of the manufacturer, and not on the country of production. Now on the market it is almost impossible to meet unscrupulous manufacturers of drugs (not dietary supplements), they all undergo thorough testing.
The same principle works here as with expensive and cheap medicine. Different manufacturers may have slight differences in production technology. Then, even with the same composition, two tablets - domestic and foreign - may be perceived by your body differently.
You can try the same drug produced in different countries. Perhaps it will have the same effect on you, or perhaps some will help you better. This does not mean that the same drug will help your friend just as well. Another manufacturer may suit him.
3. Are generics bad? How are they different from the original?
Generic is a medicinal product that basically has the same quantity and quality of the active substance as the original patented product.
Original medicines are unique developments invented by pharmaceutical companies from start to finish. It takes about 10 years and millions, so they are more expensive.
After the invention of the drug, the company receives a patent for the original molecule of the active substance. Exclusive rights to production and sales are retained by the company for 20 years. Others can then produce generic versions of the drug.
The new manufacturer may change the packaging and give the drug its own name. For example, there is the original drug Losek and the generic Omez.
Generics are cheaper precisely because the laboratory did not spend effort and money on searching for the molecule, preclinical and large-scale clinical studies. But before they go to market, they are also tested. The pharmaceutical company that produces the generic must prove that it the effect is comparable with the effect of the original product.
Generics are very good, you don't need to be afraid of them.
They allow us to expand the pharmaceutical market and make it more accessible.
To determine which option - the original or the generic - is best for you, again, you should try both and choose. One thing works better for some, another for others, but in general the effectiveness of the generic is not inferior to the original.
4. Do medications destroy the liver?
We must understand that liver - a strong organ designed to remove toxins from the body. And with normal therapeutic dosages of drugs, the liver is not destroyed.
There is a national library of America LiverTox, where drugs are classified according to their effect on the liver into five categories, from A (strongest) to E (weakest).
Group A includes very few drugs that can have proven negative effects. effects on the liver at dosages exceeding the required therapeutic norm - this is very important.
These include, for example, paracetamol, but at high dosages, greater than indicated in the instructions. Vitamin A, also at increased dosages, can cause damage to the liver, because it is contained in the liver itself. Some combined oral contraceptives (COOK). But it is important to note that previously the dosages of the active substance in COCs were very high and could really cause harm. Now the amount of the substance that was previously included in one tablet is contained in a whole pack, so the possible load on the liver is greatly reduced.
Moreover, the benefit of the medicine for some vital functions of the body always exceeds the harm it can cause to the liver.
For example, a person needs to take statins to reduce the risk cardiovascular diseases. Statins have the potential to harm the liver, but they are still worth taking if prescribed by your doctor because the benefits to the heart far outweigh the potential harm to the liver.
In addition, when any drugs are prescribed that can affect the liver, their use is monitored by a doctor in order to adjust the dosage or the drug itself if necessary.
5. Is it possible to replace taking medications with some home remedies?
If we are talking about something easy colds, diagnosed by a doctor, then you can really take whatever you want: fruit drinks, teas, honey, jam, ice cream. But only if you do not experience any complications.
If we are talking about some complex diseases, or even more so life-threatening, then there is no need to treat them with any home remedies.
Self-medication can make the situation worse. Home remedies have no evidence base. You don’t know how, in what dosages and what to mix. Homemade decoctions and infusions are made in unsuitable conditions in your kitchen and spoil very quickly. Something you take may cause allergic reaction. Therefore, in case of illness, it is still better to adhere to the doctor’s prescription.
6. Why take vitamins if they are found in foods?
That's a good question. Indeed, our food is rich in vitamins and minerals. If you eat a varied diet, eat fruits, vegetables, meat, fish, then everything should be in order with the balance of vitamins in your body.
Hypo- and even more so vitamin deficiency is difficult to develop. To do this you need to eat nothing. This is possible somewhere in Africa, for example.
There are only a few real shortages that we can get. For example, vitamin D, which is produced only in the sun. Until recently, there was a widespread belief in the medical community that only vitamin D should be taken by everyone. But even this has recently begun to be questioned; they want to revise the standards.
It's still quite easy to get iodine deficiency, it was common for some time. But since salt began to be iodized, this problem has disappeared.
There may be an iron deficiency. In this case, you can enrich your diet with meat, seafood, fish, legumes, and seeds.
So taking multivitamins just like that without indications may, at best, have no effect, and at worst, even cause harm. We have already mentioned vitamin A, the excess of which has a bad effect on the liver.
Therefore, before starting to take any vitamins, it is better to take a tests.
7. Do activated carbon and other sorbents help against poisoning? What about a hangover?
Activated carbon only helps with drug poisoning. At food poisoning its effect has not even been studied. Charcoal absorbs most medications. In this case, a single dose is necessary within an hour after poisoning, because charcoal can neutralize the poison only in the gastrointestinal tract. It will not help if the poison has already been absorbed into the blood.
But coal does not absorb alcohol at all. Therefore, there can be no talk of any hangover treatment with charcoal.
As for other sorbents - silicates like Enterosgel or Polysorb, their effect has also been studied very little, and there is not enough information about it in scientific sources. The sorbent can indeed have some effect on both food and alcohol poisoning. But no experiments have been conducted on humans, so there is no evidence base.
At the same time, simple food poisoning usually goes away in a few days, and auxiliary means can improve the condition only for a few hours. Here everyone decides for himself whether he needs it or not.
8. Do antivirals help against ARVI? Should I take them for prevention?
There was once evidence that there were two substances that could help against certain types of viruses: rimantadine and oseltamivir. But that was a long time ago, when there was no medicine based on a standardized method of evidence with appropriate statistical processing of data and more thorough research. It was then believed that these two drugs shortened the duration of the viral disease by 12 hours, with an average duration of the disease of 7 days.
Now rimantadine has lost its effectiveness because strains of the virus have become resistant to it. As for oseltamivir, the scientific community has questioned how it was tested in the first place. since the antiviral mechanism of action proposed by the manufacturer does not correspond to clinical data. So the effectiveness of the drug is in doubt.
In general, there are a number of questions about domestic antiviral drugs about how their effectiveness was proven. Because when tested they either did not differ from placebo, or competed with each other.
So there is no evidence that antivirals actually help.
Especially considering that flu and acute respiratory viral infections, as a rule, go away on their own within a week and are usually treated symptomatically: the high temperature is reduced, if it bothers you, take medicine for a sore throat and a runny nose. Even if you took antiviral drugs, you won’t know whether they really helped you in any way or whether you just recovered.
And even more so, there is no point in taking them for preventive purposes.
9. Are painkillers harmful and are they really addictive?
There are opioid and non-opioid pain medications.
The former have a very strong effect on the body and are taken only with a doctor’s prescription. They are prescribed for serious illnesses, such as cancer, or after some serious operations. They can be addictive. But you can’t just buy them.
Non-opioid drugs are available in any pharmacy and are taken for common pain - headaches, dental, migraines, joint pain and so on. They are not addictive and, when taken in the correct dosage, do not have a negative effect on the body.
This does not mean that such drugs can be taken every day all year round. If you are regularly tormented by some kind of pain, it is necessary to establish its cause and prescribe treatment from a doctor, and not take painkillers.
10. Is it worth spending money on dietary supplements sold in pharmacies?
No, it's not worth it. Dietary supplement is biological active additive, addition to food. This is not a medicine. We do not have a unified system for regulating the production of dietary supplements, there are no standards. They are not subject to clinical trials and are controlled as food products and not as drugs. This means that the effectiveness of dietary supplements has not been proven.
If you have any deficiency, as determined by your doctor, you will be prescribed vitamins. If the vitamin as a medicine is not available, you can replace it with a dietary supplement. But it is better to consult a doctor before doing this.
Unlimited consumption of dietary supplements is one of the leading causes of liver damage. Some consider all sorts of supplements like chlorophyll, collagen and other active substances to be natural, unlike drugs, and think that taking them in abundance will only make things better. But that's not true. Such drugs have a strong effect on the liver when taken in large quantities. In addition, we often do not know for sure what exactly certain dietary supplements contain, because It’s much easier to be an unscrupulous additive manufacturer than an unscrupulous manufacturer medicines.
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