Health information on the internet

Millions of consumers are using the Internet to get health information. And thousands of web sites are offering health information. Some of those sites are reliable and up-to-date; some are not. How can you tell the good from the bad?

Some websites that sell medicine can be not state-licensed pharmacies or aren't pharmacies at all; or may give a diagnosis that is not correct and sell medicine that is not right for you or your condition; or won't protect your personal information.

Be sure your privacy is protected: look for privacy and security policies that are easy-to-find and easy-to-understand. Don't give any personal information such as social security number, credit card, or medical or health history, unless you are sure the website will keep your information safe and private.

Make sure the site requires a prescription and has a pharmacist available for questions.

Drug interactions precautions

There are more opportunities today than ever before to learn about your health and to take better care of yourself. It is also more important than ever to know about the medicines you take.

Reading the label every time you use a nonprescription or prescription drug and taking the time to learn about drug interactions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.

When a drug is taken orally, it usually travels from the stomach to the liver, where it can be metabolized-the process of breaking down and removing chemicals from the body. Enzymes are complex proteins that act as catalysts in starting or speeding up chemical reactions. They cause a specific chemical change in other substances without being changed themselves.

A drug may affect these enzymes by inhibiting them, which causes reduced activity of the enzyme and a buildup of the drug in the body. Or drugs may "induce" the enzymes, which causes increased activity of the enzyme and a reduction of the drug in the body.

This phase of research in test tubes, known as in vitro studies, allows researchers to perform drug-interaction studies in labs by testing a drug with other drugs that have the same route. This has made the research faster and more accurate. If two drugs go through the same enzyme, the presence of one drug can prevent the metabolism of the other. So this allows you to look at the worst-case scenarios and ask: 'What if we put this drug with that one, knowing that they have the same route?'"

Not everything that happens in a test tube will become meaningful in humans, though. Results from these test-tube studies can tell us whether need to do further testing in people to find out if an interaction is clinically significant.

Three phases of clinical trials in humans must happen before a drug can be marketed. Phase 1 studies focus on a drug's side effects and how the drug is metabolized and eliminated from the body. Phase 2 studies focus on a drug's effectiveness. And Phase 3 studies gather more information on safety and effectiveness, which includes using the drug in combination with other drugs.

Researchers say there are several important variables that affect individual differences in how drugs are metabolized, including race, gender, age, and health conditions. For example, people with kidney or liver disease don't eliminate drugs from their system as well as people who are healthy. Very young children and older people have slower drug metabolism than others, and women may metabolize drugs differently than men in some cases.

Over the last several years, there has been a substantial increase in the number of drug-interaction studies the FDA sees in new drug applications. If drug interactions are significant enough, they can prevent a drug from being approved by the FDA. If the agency determines that known drug interactions can be managed and that a drug's benefits outweigh the risks for the intended population, a drug will be approved. Drug-interaction information then goes into the drug's labeling in the sections on "clinical pharmacology," "precautions," "warnings," "contraindications," and "dosage and administration."

So rather than asking patients what medications they take, doctors should make the questions specific: "Are you taking any over-the-counter medication? Are you taking any herbal treatments or vitamins?"

But it is good way -- consumers remind doctors of everything they take when they are prescribed a new medication. So a patient might say: "Now remember, I'm also taking birth control pills. Is there a risk of interaction with this new medicine?"

Drug interactions with dietary supplements includes herbs and vitamins, which can interact with drug-metabolizing enzymes. St. John's wort is an herb commonly used by people with cancer to improve mood, but research has shown it interferes with the metabolism of irinotecan, a standard chemotherapy treatment. Vitamin K (in dietary supplements or food) produces blood-clotting substances that may reduce the effectiveness of blood-thinning medicines like warfarin.

Examples of food with tyramine are cheese and soy sauce. Grapefruit juice should not be taken with certain blood pressure-lowering drugs or cyclosporine for the prevention of organ transplant rejection. Alcohol should not be taken with pain relievers such as Tylenol (acetaminophen) or ibuprofen because of the increased risk of liver damage or stomach bleeding.

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