Wrong choices can compromise the efficacy of therapy and expose the patient to risks. The first rule to avoid damage is to follow the prescription. The same pill taken in insufficient quantity is useless, dangerous if excessive
The ancient Greeks already knew: the word
pharmakon
to them it meant poison or medicine. Why change the cards on the table the dose: the same substance can be useless at a minimal dosage, become a medicine with a therapeutic effect in a specific range of quantities, prove toxic when overdoing it. The dose is therefore a decisive element when treating drugs, as was emphasized during the last congress of the Italian Society of Pharmacology (Sif), and not only the doctor who prescribes them but also the patient must be aware of it when taking them. or trouble is around the corner.
Paracetamol
The most typical example is paracetamol, which is found in many over-the-counter products and used as an antifebrile and analgesic: the maximum daily dose is 3 grams, overdose may involve even severe side effects on the livereven acute hepatitis that can lead to transplantation, he explains Alessandro Mugelli, former president Sif. Excessive and involuntary intake is not unlikely because the active ingredient is found in many different products, alone or in combination with other molecules used to treat flu symptoms or minor ailments. It is therefore necessary to be aware of it and read what’s in the pill we take as self-care
, keeping track of what we take during the day: in Italy there are no packs of dozens of pills like in the US, having to open a blister already helps a little to keep attention on the act of taking the drug. And if we have equivalent drugs at home, especially for self-medication, it is better to always choose the same product: different generics do not have different effects, to change excipients and packages, thus increasing the risk of getting confused and taking the same medicine several times, believing that you have “changed” the therapy, resulting in an over-dosage. In general, it is always advisable to ask the doctor or pharmacist for advice on doses and methods of therapy, do-it-yourself can lead to errors.
Avoid duplication
The duplication of treatment that occurs by taking two products with the same active ingredient can be avoided by keeping an updated list of all drugs in use and bringing it to medical visits, but also avoiding taking medicines already prescribed in the past on their own initiative. a risk, then, to forget one dose and to double the next one: it does not make up for the lack, but the amount of drug in the blood is doubled with sometimes dangerous effects, a sort of temporary overdose that can accentuate the adverse events of the product. The same happens if you increase the dosage so that the drug takes effect sooner or you take a new dose without waiting for the hours indicated on the package or prescription to have passed: the idea that after all it does not hurt to change the dosage to lighten or weigh it down depending on the time and the presumed needs wrong and may expose you to a greater risk of side effects.
The therapeutic window
The issue is particularly delicate if the therapy involves the use of drugs with one therapeutic window narrow, which have a limited dosage range within which they are effective and non-toxic: with these an oversight can be more harmful and not a niche phenomenon, but a danger that affects many patients because they belong to this category. on the cardiovascular system, such as antiarrhythmics, heart failure drugs and the like. The formulations are designed to allow for a wide tolerance, especially in the case of syrups with which it is taken for granted that an excess or a short spoonful dosage is inevitable; however, always stick to the prescription. And not only to avoid excesses, but also to avoid going to the opposite extreme of the low dose or even none of those who stop taking a drug: the consequences are just as dangerous because as Mugelli explains Therapy is useless if it is not taken properly. With many chronic conditions that do not cause symptoms, such as hypertension and diabetes, non-adherence to treatment and drug abandonment is common but risky because you are not being treated for something that jeopardizes your health. as dangerous as taking drugs in excess, a more typical occurrence of diseases with several symptoms and which the patient wants to get rid of quickly, often giving in to the temptation to take a little more medicine.
Personalized therapies
In the middle lies the virtue, or rather the doctor’s prescription: sticking to that is the first rule even if, as the pharmacologist observes, the dose should be better managed even by the doctors themselves: what cures a slender jockey weighing 50 kilos cannot be same treatment scheme applies to a 100-pound bodybuilder, even if both are adult males. Customize the dosage, at least on the basis of body weight, essential for effective and safe therapies: it should also and especially happen in children, whom we should not consider small adults and simply treat by halving the dose. For new drugs, the European Medicines Agency now requires that studies are always carried out on children, so as to know how to behave and validate pediatric dosages, but for the products already on the market there are often no specific pediatric formulations and so most of them are actually used off label, i.e. outside the approved indications. Thus the dosages are halved or a piece of the pill is taken, but a more careful definition of the dosage by the pediatrician would be necessary based on the weight and time of development, as well as on the sex and other characteristics of the child or young boy, concludes Mugelli.
July 14, 2022 (change July 14, 2022 | 14:58)
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