Head Lice

Q. My school tells me that there is an outbreak of head lice amongst the children. What is the most effective shampoo that I can use to stop my daughter catching them?

A. If your daughter does not have head lice now, then you should not use any head lice treatments on her – because of the growing problem of resistance, current guidance is that they should only be used when a head louse infection is positively diagnosed. If she becomes infected, I would recommend that she does not use a shampoo – as these are not in contact with the head for very long, they are much less effective than the liquids and lotions available, which should be kept on the scalp for around 12 hours, or overnight. Using one of these products as soon as the infection is confirmed, and again one week later, should be sufficient; if this fails, another different product may be tried. Lotions can irritate the scalp and trigger asthma in sufferers, in which case a liquid is preferable; other effective forms of treatment are available and may be more convenient, including a crème rinse and a hair mousse. Mechanical methods of louse removal – ‘bug busting’ – are popular; every 2-3 days, after washing and conditioning the hair, running a fine toothed comb through the hair from root to tip can dislodge the lice.

There is also a new product called Hedrin Lotion (150ml, £11.49) which is safe for children aged 6 months and older, and removes head lice naturally without containing any organophosphate compounds. Ask your pharmacist for more advice. [back]

Fungal Nail Infections

Q. I think I have an infection under one of my toenails. What can I buy to treat this?

A. If your toenail has become infected, the nail will commonly appear very dry and darker in colour, sometimes thickened, and may have a jagged edge; this can happen when an athlete’s foot infection is left untreated. The most effective treatments involve painting an antifungal solution onto the nail surface over a period of several months so that the ingredient can penetrate through the nail, or alternatively a shorter course of antifungal tablets may be suitable.

A new product is now available without a prescription called Curanail (£18.61), a nail paint which is applied to the affected nail once a week for 9-12 months. Your pharmacist will help you to decide whether or not this is right for you. Alternatively, talk to your doctor or chiropodist for a positive diagnosis if you are not sure if your nails are infected. [back]

Acomplia / Weight Loss

Q. I have recently heard about a new medicine for obesity called Acomplia – what is it and how does it work?

A. There are now three prescription-only medicines that are licensed for the treatment of obesity; these are Xenical (orlistat), Reductil (sibutramine), and Acomplia (rimonabant). However, it's important to understand that these medicines are only prescribed for people who have attempted seriously to lose weight by diet and exercise, and whose health is at risk. They are not intended to be used on their own, but are prescribed alongside a recommendation to continue with dietary and lifestyle modifications. There are also support programmes for all three of these products to assist in keeping you motivated.

Xenical works by reducing the amount of fat absorbed by the body after each meal, whereas Reductil and Acomplia both work by affecting neurotransmitters in the brain, to make you feel satisfied after eating less food. These medicines are only prescribed by doctors for patients who are classed as obese (a Body Mass Index over 30). If you are concerned that you may be obese and you have tried changing your diet and increasing your physical activity without success, it would be worthwhile talking to your doctor. [back]

Insect Bites

Q. I’m very prone to insect bites in the summer. How can I treat them quickly?

A. There are a number of products you can use to relieve the discomfort of an insect bite, such as a simple bite cream or antiseptic, such as Savlon, TCP, or After Bite (14ml, £3.25). However, the strongest preparation is hydrocortisone cream, which is available without prescription in a 1% strength (HC45 cream, 15g £3.49); this is the most effective topical preparation for relieving itchy, sore, red, inflamed, allergic areas of skin, such as bites, stings, and contact dermatitis. There are certain times when it should not be used – for example, it must not be used on the face or the ano-genital areas, on broken or infected skin, on pregnant women or children under 10, or for longer than 7 days - but if your symptoms don't fall into those categories, this would be your best option. If hydrocortisone cream is not suitable, an antihistamine cream should be effective, such as Benadryl Skin Allergy Relief Cream (£3.55).

In addition, there are some new products that can help. Click Insect Bite Relief (£5.45) is a small device that generates a tiny electric current that relieves the urge to scratch a bite; and Bite Away (from £29.95) uses a gold-plated contact to briefly heat the bite area and reduces the pain, itching, and swelling. Both products are safe and drug-free, and can be used many times over.

If these do not help, or if the area starts weeping or the skin breaks, indicating a secondary bacterial infection, you should see your doctor. Don’t forget that there are many effective insect repellents as well – talk to your pharmacist for more advice. [back]

Heartburn/Indigestion

Q. I have often suffered with mild indigestion at night, which seems to be worse after eating spicy foods. What’s the best medicine to take for it?

A. There are several remedies available for the relief of heartburn and indigestion symptoms; simple antacids (such as Rennie Rap-Eze tablets, £3.09 for 64) are effective at neutralizing excess stomach acid quickly, however if the discomfort is worse at night, a medicine such as Gaviscon Cool Liquid (300ml, £5.53) or Rennie Liquid Relief (180ml, £3.49) may be more effective, taken after meals and before going to bed. These medicines form a ‘raft’ on the stomach contents to prevent the discomfort associated with heartburn. Alternatively, Zantac 75 tablets (48 tablets, £9.99) work by preventing the acid being produced by the stomach in the first place. These medicines can interact with some prescription medicines – check with your pharmacist to ensure they will be suitable for you. The problem may also be made worse by smoking, alcohol, obesity, and some medicines – ask your pharmacist if you need more advice.

In addition, there is a new medicine now available without a prescription for heartburn called Zanprol Tablets (14 tablets, £9.49) which contains Omeprazole; this also works by preventing the release of acid in the stomach and is taken as a short course for a few weeks. This can help to prevent your heartburn for many weeks afterwards and is a helpful option for people who have tried normal antacids without lasting relief.

It’s important to bear in mind that indigestion and heartburn that is severe enough to wake you from your sleep, becomes a problem for the first time in middle age, or persists for more than a week without getting better, should be discussed with your doctor as it might be an indication of another condition that could require treating in a different way. [back]

Migraine

Q. I occasionally suffer from migraine headaches, and find that paracetamol tablets are not effective at relieving the pain quickly. What’s the best product I can buy without a prescription for a migraine?

A. There are a number of products available without a prescription which would help you. If you have tried paracetamol or ibuprofen tablets at the recommended dose (bear in mind that ibuprofen can make your asthma worse if you are asthmatic), and find that these are ineffective, there are several products which are stronger, such as Migraleve tablets (based on paracetamol, codeine plus an anti-sickness ingredient, if you suffer from nausea); Paramol or Solpadiene tablets (paracetamol and codeine); Nurofen Plus (ibuprofen and codeine); or Syndol tablets (paracetamol and codeine, plus a muscle relaxant, which may cause drowsiness in some people). If these are not suitable, your doctor is able to prescribe a greater range of medicines that work to relieve migraine headaches in a different way, by preventing the headaches rather than acting as strong painkillers. Most migraine sufferers find that they have 'trigger factors' - circumstances which bring on their headaches, such as stress, tiredness, or certain foods and drinks (such as alcohol or coffee). If you are aware of any trigger factors, avoiding these would be beneficial.

In addition, there is a new medicine now available from pharmacies without a prescription, called Imigran Recovery (2 tablets, £7.99). This contains the same ingredient as the prescription-only medicine, Imigran, and can be used for the treatment of acute migraine attacks in patients who have had migraine previously diagnosed. Ask your pharmacist if this would be suitable for you. [back]

Thrush

Q. I have recently been experiencing vaginal itching, and a white discharge.  How can I treat this?

 A.  The symptoms you are experiencing are associated with thrush. Vaginal thrush is caused by a fungal infection (Candida albicans). Thrush can be triggered by taking antibiotics, or a sensitivity to vaginal deodorants or cleansing agents, and certain medical conditions can also make it more likely.

There are number of products available to treat the symptoms, including Canesten cream (20g, £4.15), Canesten 500mg Pessary (£7.49), and Diflucan Oral Capsule (£12.50). In addition, there is a combination pack called Canesten Duo (£12.50) which contains an oral antifungal capsule, and an external cream. The cream is applied twice a day to the affected area, and can be used in conjunction with the vaginal pessary or an oral capsule. To avoid re-occurrence of the infection you should try to avoid wearing nylon underwear and tights, using vaginal deodorants, and foam baths; you should also treat your partner with an antifungal cream, applied twice a day to the glans of the penis for 6 days.

If you are pregnant, or if your symptoms reoccur, you should seek medical advice from a pharmacist or doctor. [back]

Acne

Q. My teenage son is suffering from acne, and he’s tried most over-the-counter products to try and clear his face up, but with no success. What’s the strongest thing I can get from a pharmacy? Or would he be best seeing his doctor?

A. Acne can be a very troublesome condition, and there are many approaches to its treatment. Mild acne can be treated successfully using non-prescription products; the most important thing is to keep the face clear of excess grease and bacteria, using daily face washes, and antibacterial pads if necessary. The most effective ingredient in non-prescription products is called ‘benzoyl peroxide’, which removes the blockages from the acne and also kills bacteria. This is available in several strengths, and I would always recommend to start with the lowest strength (2.5%) as it may cause an initial reddening and irritation of the skin. Moving up to 5%, and eventually 10% strengths, should help to relieve your son’s symptoms. If not, he would be well advised to see his doctor, as there are many other prescription products which will help him.

Contrary to popular belief, there is no link between diet and acne - although sunlight can help relieve the symptoms. [back]

Zyban

Q. I understand there’s a tablet available to help me stop smoking. I’ve tried patches and gum in the past, and they haven’t worked for me. Would this tablet work, and can I buy it without a prescription?

A. The tablet which you have seen is called Zyban, and was launched a few years ago as a prescription-only medicine to help people quit smoking. Rather than supplying nicotine in a different form, such as patches or gum, it’s taken orally and works by promoting the release of the same chemicals in the brain that are released when smoking. A course normally lasts around two months, and is started whilst you are still smoking; a ‘stop date’ should be set for the second week of treatment. In tests it has been shown to be more effective at helping people quit than conventional nicotine replacement therapies – although these products are also much more effective than relying on your willpower alone!

As it’s only available on prescription, you must visit your doctor, who will decide if Zyban is suitable for you. [back]

IVF / Private Scripts

Q. I am receiving IVF treatment and am looking for the most cost effective way of obtaining my medicines. Do you have any advice?

A. Increasing numbers of women are needing IVF treatment to get pregnant. There are several prescription treatments available, which can be expensive and may cost anything up to £1,500. This depends on the length of treatment, the products prescribed, and the professional fee charged by the pharmacy. As a result, they are not universally available on the NHS. Fertility treatments need to be injected, and some need to be kept refrigerated.

There are a number of clinics that specialize in IVF treatments; often the treatment is started in the clinic and continued at home. If your specialist has issued you with a private prescription, it is worth asking for quotes from a few different pharmacies in order to find the best price. [back]

Hair loss

Q. I am a male, in my early 30s, and I'm experiencing gradual hair loss. Are there any medicines or supplements that I can take to stop this, or to make the hair grow back?

A. There are two medicines which are licensed in the UK for the treatment of pattern baldness, which are called Regaine and Propecia. Regaine is a topical application which works by increasing the bloodflow to the scalp, and has been clinically proven to prevent hair loss and to encourage hair regrowth in many cases of thinning hair; however, the manufacturer advises that where hair thinning is well established (over 10 years duration), where there is a bald patch of more than 10cm across, or where hair loss has been sudden or patchy, Regaine is less likely to work. The product's action is reversible, and treatment will need to be continued indefinitely to sustain the effect; once the product is stopped, the beneficial effects will be lost in about three or four months. Also, patients with high blood pressure should confirm with their doctor before using it.

Regaine works well for some people, and not for others. It will stop further hair loss in around 80% of suitable subjects, and will also help new hair to regrow in approximately one third of subjects. There are two types of Regaine - the normal strength (2%) and the extra strength (5%) - the extra strength is only licensed for the treatment of pattern baldness in men, however the normal strength may be used by both men and women. A three month course of the extra strength preparation costs £59.95 or less; the regular strength costs £24.95 or less for enough to last one month.

Propecia is a prescription-only medicine, and cannot be prescribed on the NHS – it is only available from pharmacies when you have a private prescription from your doctor. It’s an oral tablet, for the treatment of men with male pattern hair loss, to increase hair growth and prevent further hair loss. It is not suitable for use in women or children. It contains a medicine called ‘finasteride’, which works by inhibiting an enzyme that is responsible for converting testosterone into a more potent form called dihydrotestosterone (DHT) – this can damage hair follicles and lead to hair loss in men who are generally sensitive to it. Clinical trials have shown it to be effective at stopping further scalp hair loss in over 80% of men, and increasing hair growth in over 60% of men, however it can take between three and six months for any visible changes to become apparent, and continuous treatment is necessary to sustain any benefit. Because Propecia is only available on a private prescription, the cost of dispensing may vary between pharmacies, however a rough guide of cost would be around £1 per day. For more details about Propecia, talk to your pharmacist or doctor. [back]

Fatigue

Q. I have been feeling more and more exhausted recently, I work hard all week and never seem to be able to find the time to exercise or eat healthy foods. Are there any vitamins that will help to boost my energy levels?

A. There are a few supplements that you can buy to help, including Pro-Plus (caffeine-based and not recommended for long periods); and Red Kooga Energise Tablets (containing B vitamins, guarana and ginseng, 30 capsules, £6.99), however the most suitable supplement may be a preparation called Pharmaton Capsules, which are a high strength vitamin capsule with ginseng (100 capsules, £18.95). They contain all the vitamins you are going to need, they are safe to take all the time, and have even been licensed as a medicine for the treatment of daily fatigue, and as such are only available from pharmacies.

There is no miracle cure for the relief of fatigue - rather I would advise you to take things in small steps. Exercise is very important, and you will be aware of the vicious circle - you're so tired that you don't want to exercise, but exercise does give your body a greater capacity for work and stress, and can give you a boost after a short time; even if you undertake a modest amount of exercise - say 5 or 10 minutes per day of an exercise which leaves you slightly out of breath - this should have a great effect on your health. [back]

Excess Sweating

Q. I seem to sweat a lot, for no apparent reason. It’s very embarrassing and I’ve tried many different types of antiperspirants, with no improvement. What’s the strongest thing I can use to stop this?

A. Excessive sweating can affect anyone, and can sometimes run in families; as many as 1 in 100 people are affected at some time in their lives. It’s not necessarily linked to obesity, and can occur on many parts of the body. The most effective products that you can use are called Driclor (60ml roll-on, £4.45) and Anhydrol Forte (60ml roll-on, £4.42). These are products that were until recently been available only on prescription, and are now available from pharmacies. They are based on an ingredient which blocks the sweat glands - the excess water is safely reabsorbed into the body, and it should work within a few weeks. They are initially applied to the affected area each night, and washed off in the morning; this can be reduced to a once or twice weekly application once it has started to work. [back]

Pregnancy Tests

Q. I wish to carry out a pregnancy test, but I have a  burning pain when passing water – is this cystitis, and will it affect the outcome of my test?

A. Pregnancy tests detect the presence of a hormone in the urine called human chorionic gonadotrophin (hCG), which is present in the urine during pregnancy; many are effective from the first day of a missed period. Because tests only respond to this specific hormone, the fact that you may be suffering from cystitis should not make a difference to the test result. Cystitis is a bacterial infection of the lower urinary tract, which causes pain on urination and mild cases can be treated easily using non-prescription sachets such as Cymalon (6 sachets, £3.99) – although if your pregnancy test result is positive, I would advise you to see your doctor for the most appropriate cystitis remedy. Ask your pharmacist if you have any further concerns. [back]

Missed Pill

Q. I am 21 years old and have just started taking the contraceptive pill. If I forget to take a pill, will this stop it being effective for the whole month?

A. If you are over 12 hours late in taking your pill, especially the first one in the packet, you should continue taking the pills each day as normal – however, the contraceptive effect may be lost and you should use other methods of protection for the following seven days. If that seven days runs beyond the end of your current packet, start the next packet without a break (or in the case of ‘ED’ pills, miss out the seven inactive pills). You may not have a normal period until the end of the second packet, and you may see some bleeding on a tablet-taking day, but this is not harmful. Talk to your pharmacist or doctor for more advice, or see the information leaflet inside the pack. [back]

St John’s Wort

Q. I have heard that St John’s Wort can help to relieve mild depression – where can I buy this, and is it safe?

A. St John's Wort is a herbal supplement, popular for its antidepressant actions, available from most pharmacies (eg. Pharmacy2U St John’s Wort, 90 tablets, £6.79). Recent research suggests that it may act similarly to some prescription antidepressants. It cannot be guaranteed that there will be no side effects – it may be 'natural' but is still potent in its own way. St John's Wort tablets can sometimes cause photosensitisation (increased sensitivity of the skin to sunlight), and recent guidance shows that St John's Wort can significantly interact with a number of prescription-only medicines, including oral contraceptive pills, warfarin, digoxin, anticonvulsants, cyclosporin, and some others. If you are taking any other medicines, talk to your pharmacist to check that they will be safe to take at the same time. [back]

Minor Eye Infections

Q. My eyes have been red and sore for a few days, and the lids are crusty in the mornings. Is this conjunctivitis, and how can I treat it?

A. Conjunctivitis refers to the inflammation of the transparent layer covering the white of the eye, and can be caused by irritation, infection, or allergies. The crusts that you find on your eyelids are a common sign of infective conjunctivitis; mild cases may be treated using non-prescription eye drops and ointments such as Golden Eye (drops, £4.35) or Brolene (drops, £4.59) – however, these are not suitable if you wear contact lenses. It’s important to continue treatment for two days after the symptoms are better, and if this does not work, see your doctor. You must bear in mind that there are other serious causes of a red eye, especially those which are painful, and if you are in any doubt about the nature of your symptoms you should talk to your pharmacist, doctor, or optician for the best advice. [back]

Morning After Pill

Q. I have heard that I can now buy the morning-after pill from pharmacies. How much will it cost, and are there any restrictions?

A. After considerable recent debate about the supply of the morning-after pill without a prescription, the emergency contraceptive pill 'Levonelle' has been available from pharmacists since 2001. They will not be available to everyone - there are legal restrictions on its sale in this way, and pharmacists will be personally involved in each consultation to ensure that it is used safely and appropriately; that relevant information and advice is given; and to refer patients to other health professionals if this is necessary. The pharmacist is easily accessible and well qualified to educate the patient in their use of emergency contraception - however he or she is under no obligation to complete the sale if they feel that another health professional is better able to help you. [back]

Smoking Cessation

Q. I want to stop smoking. What are the best products available from pharmacies that can help me?

A. There are now lots of nicotine replacement therapies (NRT) available without a prescription, and the most effective product will not only depend on how many cigarettes you smoke each day, but also on your smoking habit. Some are ideal if you feel a craving as soon as you wake up (NiQuitin CQ 24-hour patches, from £17.49 per week); some mimic the shape of a cigarette (Nicorette Inhalator starter pack, £5.95); some give you more control as to when the nicotine is released (Nicotinell gum, £14.49 for 96 pieces); some have the advantages of gum but without the chewing or the strong taste (Nicorette Microtabs, £6.25 for 30). Recently the Nicorette Nasal Spray has been made available to purchase without a prescription (1 spray, £15.95). However, you still need willpower to be a successful quitter. Your pharmacist will give you more advice and can help select the product which will be most suitable for you. [back]

Coughs & Colds

Q. There are so many cough and cold remedies available – what’s the difference between them all?

A. Despite the large number of cold remedies, the number of basic ingredients between them is quite small. The main choices are between drowsy and non-drowsy products, and chesty and dry/tickly coughs; many preparations also contain decongestants (including the Sudafed range), which are not suitable for some people (including those with heart disease or asthma). Some medicines contain analgesics (such as Benylin Four Flu, Night Nurse, and Day Nurse), which can be helpful to relieve pain and fever, but you must not take other painkillers at the same time. Other products that can be helpful include mentholated pastilles or inhalations (such as Olbas Pastilles), decongestant sprays (such as Otrivine Adult Spray, £2.99), sore throat sprays/lozenges (such as Vicks Ultra Chloraseptic, £4.79, or Dequacaine Lozenges, £3.08), and not forgetting a large pack of soft tissues! Your pharmacist will help you choose the right product to match your symptoms. [back]

Threadworms

Q. I think my son has threadworms. How do I know, and how can I treat it?

A. Threadworms are a common problem in children and in most cases can be treated successfully using non-prescription medicines. The first sign is usually an itch in the anal area, especially at night, and the worms can be seen in the faeces as small white 'threads', around 1cm in length. The recommended treatment is Ovex (1 tablet, £2.05; 4 tablets, £5.35; liquid suspension, £6.99); these are effective for adults and children over 2 years, and involve taking a single one-off dose, although a repeat dose may be necessary after 2 weeks. An alternative is Pripsen (2 tablets, £2.10; 2 sachets, £2.59); neither preparation is suitable for use in pregnant women.

To prevent re-infection, it's important to treat all family members at the same time, and to use practical measures - cutting fingernails short, washing hands and brushing nails after going to the toilet and before touching food, and wearing pyjamas at bedtime to prevent scratching, can all help.

If a course of medicine does not work, or if there has been recent travel abroad, you should contact the doctor. Ask your pharmacist if you need more advice. [back]

Antibiotics / Sore Throat

Q. I have had a sore throat for 2 days now, and throat lozenges have not helped. Should I ask my doctor for antibiotics?

A. No – antibiotics are not effective at treating sore throats, coughs, colds, or flu, which are caused by a viral infection, although your doctor may prescribe them if there is a secondary bacterial infection. Because the symptoms are usually of short duration, they are best managed using non-prescription remedies – ask your pharmacist for more advice. In the case of a sore throat, an anaesthetic lozenge (such as Dequacaine Lozenges, £3.08 for 24) or a spray (such as Ultra Chloraseptic, £4.79) should help.

A recent survey has shown a great deal of misunderstanding about the conditions for which antibiotics are appropriate, and the growing problem of bacterial resistance to the antibiotics that are currently available. If you need more advice about the best course of action for your symptoms, ask your pharmacist. [back]

Malaria tablets

Q. I am going on holiday soon, and have heard recently that anti-malarial tablets need to be taken for several weeks before I travel. Is this because they need time to build up in the body?

A. There are several types of anti-malarial tablet, which you should take if you are travelling to certain areas of the world where there is an increased risk of malaria – your pharmacist will be able to tell you which tablets you need to take, if any. Some tablets are available to buy from pharmacies, whilst others are only available with a doctor’s prescription. The guidance about which type of anti-malaria medicine is right for your destination is updated regularly; your pharmacist will be able to tell you which tablets you need to take, if any, and whether or not you need a prescription. If you took a particular type of anti-malaria medicine in previous years, don’t assume that the recommendations are still the same – your pharmacist would be the best person to talk to first.

The tablets are started before you leave for your holiday – one or two days for Malarone, one week before in the case of chloroquine (Avloclor) and proguanil (Paludrine), and two to three weeks before for mefloquine (Lariam). This is not because they need time to build up in the body – it’s simply so that you can be sure the recommended tablets are suitable for you, whilst there is still time to see your doctor for an alternative, if this is necessary. If the tablets cause side effects that would prevent you from being able to take them on holiday, it’s important that you have access to alternatives before you leave.

It’s also necessary to take the tablets for four weeks after you return from your travels (only 7 days for Malarone), and to notify your doctor if you experience any flu-like symptoms during the following 3 months. Take steps to prevent mosquito bites by using repellents and mosquito nets.  Ask your pharmacist or doctor if you have any further concerns. [back]

Diabetes

Q. There is a history of diabetes in my family – is there any way to tell if I am affected?

A. Diabetes is a growing problem around the world; around one and a half million people in the UK have been diagnosed with diabetes, and it's thought that almost as many people have the condition without knowing it. Diabetes occurs when the body cannot break down sugar in the blood properly, and is classed as type 1 (early onset), caused by a reduction in the amount of insulin secreted by the body, or type 2 (late onset) which is often caused by a resistance to the action of insulin in reducing blood sugar, even though insulin levels can remain unaffected. There are many effective ways to manage the condition, from dietary measures to tablets or insulin injections, and there’s no reason why a positive diagnosis should affect a person’s quality of life.

Diabetes is often diagnosed very late, and there are many people who may be suffering with symptoms related to diabetes without being aware that this is the cause. Symptoms may include increased thirst, tiredness, weight loss, frequent urination, and recurrent thrush infections. There are self-test kits available from some pharmacies (such as the Pasante Blood Glucose Level Test, £9.99), or your doctor will be able to help. For more advice about diabetes, contact Diabetes UK on 020 7636 6112 or visit their website at www.diabetes.org.uk. [back]

Glucosamine

Q. I have heard that a supplement called glucosamine might help my arthritis. What is it, and how does it work?

A. Glucosamine has been used for several years by sportsmen and women to speed up the repair of damaged tissue, and may also relieve the pain, stiffness, and swelling of arthritis. It’s a building-block of cartilage, which cushions the bones and joints, and appears to be very effective in managing mild to moderate arthritis. Recent research has confirmed that rather than just easing the discomfort of an existing condition, glucosamine actively protects and builds cartilage; it is safe to take in the long term and appears to be free of side effects.

Glucosamine is available without a prescription, and is sometimes formulated with another similar ingredient called Chondroitin. You should not take it if you are taking Warfarin tablets from your doctor, however it’s safe to take with other tablets, but you must not stop taking any prescribed medicines for your arthritis symptoms – talk to your pharmacist or doctor if you have any questions.

Glucosamine is available from Pharmacy2U in several preparations, including our own brand (eg. 90 x 500mg tablets, £5.49; 180 x Glucsosamine and Chondroitin Tablets, £37.49) and the Seven Seas brand with cod liver oil (60, £9.35). [back]

Echinacea

Q. There is a supplement called Echinacea which is claimed to help fight colds and boost the immune system. Is it safe, and how long does it need to be taken for?

A. Echinacea is a herbal supplement that has been used for centuries to heal wounds and treat infections; it’s thought to work as a natural antibiotic, and by helping the body’s own defence mechanisms. It’s classed as a food supplement rather than a medicine, so there is less information available about its actions than for conventional treatments, but it is available from pharmacies without a prescription and has been shown to be quite safe at recommended doses. However, as with any other supplement or medicine, talk to your pharmacist or doctor before using it if you are pregnant or breast-feeding.

There is no set guidance as to how long Echinacea should be taken for; this would depend on the individual. Many people find it helps to treat colds and flu, and can prevent the condition from worsening if taken at an early stage. Follow the manufacturer’s dosage guidance, and if it is not working and your symptoms get worse, talk to your pharmacist for advice. [back]

Warts & Verrucae

Q. What is the best way to remove a wart on my son’s finger?

A. Warts will often disappear by themselves with time; however some warts can be treated using non-prescription medicines. These remedies work purely by corroding away the top layers of skin on the wart until it has gone completely, which can take anything up to 3 months – products include Bazuka Extra Strength Gel (5g, £6.35), Wartner (35ml spray, £10.95), and Salatac Wart Gel (8g, £5.26). You should see the doctor if there are many warts, or if they have recently appeared and are bleeding, itchy, or painful; or if a wart is on a sensitive area of skin, such as the face or the ano-genital area. In these situations, non-prescription treatments are not suitable. Verrucae are warts which appear on the feet and can be treated in the same way. Talk to your pharmacist for more advice. [back]

Prickly Heat

Q. I always suffer from prickly heat when I travel abroad, and I’m going on holiday in the next few weeks. Is there anything I can do to stop it?

A. There are a number of preparations which you may find helpful to relieve the symptoms of prickly heat; the most effective are oral antihistamines, such as Clarityn Allergy Tablets (30 tablets, £8.99) or Benadryl Allergy Relief Capsules (24 capsules, £6.75), which are the latest non-drowsy antihistamine to be launched without prescription. Using an antihistamine like this each day whilst you are away should prevent most of the symptoms in many people, however you may want to consider taking a cream with you such as calamine and aqueous cream, or Benadryl Cream (42g, £3.55). The use of a high factor sunscreen and an effective after-sun preparation can also prevent a lot of the discomfort. If you find that these do not help, I can only suggest that you talk to your pharmacist or doctor for more advice. [back]

Bad Breath

Q. Is there any way to stop bad breath?

A. Bad breath (halitosis) is common amongst adults and there are several possible causes, including dental decay, throat or tonsil infections, a dry mouth, problems in the airways, or the reflux or stagnation of recently ingested food. Whilst this is often a temporary problem, it can be a sign of an underlying condition if it persists over a long period of time, in which case you should see your dentist.

In the shorter term, there are many products available from pharmacies that can help to keep the problem under control, including toothpastes and mouth rinses such as Retardex (500ml oral rinse, £7.95; toothpaste, £7.95; oral spray, £2.99), and breath fresheners such as DenTek Crystal Breath Gel Capsules (90 capsules, £3.99). Good dental hygiene is very important, brushing teeth twice daily and using dental floss or an inter-dental brush to keep the teeth free of debris. Chewing sugar-free gum may also be helpful. Talk to your dentist if you are concerned or if these measures fail. [back]

Hayfever

Q. What is the most effective way to deal with my hayfever?

A. There are many medicines available from pharmacies to manage hayfever, the most common symptoms of which are an itchy, runny and/or blocked nose, sneezing, and watering eyes. One of the most effective ways to ease the symptoms is to use a nasal spray, such as Flixonase Allergy Nasal Spray (60-dose spray, £6.79) which is used each day, and can prevent most nasal symptoms from causing problems in the first place. It can even prevent watering eyes in many people. However, it’s not suitable for those under 18, patients with glaucoma, or pregnant women. Eye drops are also effective at stopping eye symptoms (such as Opticrom Allergy Eye Drops, £4.45), and these should also be used regularly for the best effect.

The alternative is to use an oral antihistamine to counteract the allergic symptoms. Non-drowsy antihistamines include Clarityn Allergy Tablets (30 tablets, £8.99) and Benadryl Allergy Relief Capsules (24 capsules, £6.75). For advice about the management of hayfever in children, or if you have any other questions, talk to your pharmacist. [back]

Painkiller Pack Sizes

Q. Is there any reason why I can’t buy bottles of 100 Paracetamol or Aspirin tablets like I could a few years ago?

A. Legislation was introduced in 1998 to limit the number of some painkillers that you can buy at any one time from a pharmacy. This was intended to reduce the number of painkiller-related deaths in the UK, by reducing stocks in the home and therefore preventing impulsive overdoses, and only applies to paracetamol and aspirin tablets. Pack sizes of these painkillers were limited to 32 tablets in pharmacies, and 16 tablets in other stores; the pharmacist can sell more if necessary, however quantities over 100 tablets require a prescription from the doctor.

A report in the British Medical Journal states that in the first year of the new legislation, deaths related to paracetamol overdosage fell by 21%, and those related to aspirin overdosage fell by 48%. The number of liver transplants due to paracetamol poisoning also fell by 66%. The aim of the legislation was to significantly reduce the number of cases of impulsive self-poisoning, and this evidence suggests that the limits have been successful. [back]

Viagra For Women

Q. Is it true that Viagra tablets are also effective in women, as well as men?

A. A recent medical trial in Italy showed that women may find some benefit from treatment with Viagra, a prescription medicine for the treatment of impotence in men. The trial found that women who suffered with ‘female sexual dysfunction’ - an inability to attain or maintain sexual arousal, which is considered the equivalent of impotence in men – found Viagra significantly more effective in the achievement of arousal and orgasm than a placebo tablet. This suggests that the physical cause of female sexual dysfunction can be treated successfully using the same approach as for male sexual dysfunction.

Viagra is currently only licensed by its manufacturer for the treatment of impotence in males, although it’s possible that this medicine, or similar medicines which are currently in development, will be licensed for the management of female sexual dysfunction in the future.

There are some companies which are marketing herbal remedies for the treatment of sexual dysfunction, however these are not usually licensed or tested in any trials before being launched and cannot be guaranteed for safety or activity. Because this problem can be a symptom of another underlying condition, it's always best to talk in confidence to your doctor in the first instance - for example, male impotence can be related to diabetes or heart disease. [back]

Asthma

Q. My young son has recently been diagnosed with asthma, and has been prescribed an inhaler. Is there anything else I can do to help him?

A. Asthma is an increasingly common problem, with around 1.5 million British children currently under treatment for the condition. The symptoms can include a feeling of tightness in the chest, a persistent dry cough, wheezing, and breathlessness, which are caused by the walls of the airways tightening up and becoming inflamed, making breathing difficult. The severity of the symptoms can vary significantly between patients, and many people find that their symptoms are triggered by different events, such as exercise, house dust mites, tobacco smoke, pets, stress, breathing in cold or hot air, or allergens such as pollen. Asthma is also more common in those who suffer from eczema and/or hay fever, as the underlying mechanisms for these conditions are very similar.

Some medicines can make asthma symptoms worse and could even trigger an attack in susceptible patients; always tell your pharmacist that your son is asthmatic when you buy any non-prescription medicines for him. There are many prescription medicines that help to relieve and prevent asthma symptoms, and if your son requires his inhaler with increasing frequency, or if his symptoms get worse, let his doctor know. Also, evidence has shown that eliminating the trigger factors listed above from the home can significantly improve asthma symptoms. Talk to your pharmacist or doctor for more advice, or contact the Asthma UK on 08457 01 02 03 or visit their website at www.asthma.org.uk. [back]

Care in the Sun

Q. What’s the best way to avoid sunburn whilst I’m on holiday this summer?

A. It’s very important to stay well protected against the potentially harmful effects of the sun; even more so for children, for people with fair skin, and those who burn easily. There are a number of ways that you can help yourself: start by using a sunscreen with a suitable sun protection factor (SPF) – the higher the SPF, the greater the protection. Start by using a product with an SPF between 8 and 20, depending on your skin type; an even higher factor may be necessary if you have a skin condition or very sensitive skin – some preparations are available in an SPF of 50. These higher factors are often available in a ‘stick’ form to rub onto the nose, shoulders, and ears. Find a sunscreen that offers both UVA and UVB protection.

The sun’s rays are strongest around mid-day – take extra care at this time. Apply the cream thickly every 1-2 hours, and don’t forget that some of the ultraviolet rays will reach you even when it’s cloudy. If you’re going to be swimming, buy a water-resistant cream and re-apply it to the skin afterwards. If you do get burnt, cool the area in tepid water and use a soothing after-sun cream.

Children should take extra care, and should stay in the shade as much as possible – infants under 1 year old should stay out of the sun completely. Bear in mind that some medicines can make the sun’s effects worse – talk to your pharmacist if you are concerned, or if you need any more advice about how to take care in the sun. [back]

Long Haul Flights and DVT

Q. I am going on holiday soon, on a long haul flight. I have seen news reports about blood clots and the ‘economy class syndrome’ – what can I do to protect myself?

A. Long haul flights are thought to increase the risk of deep vein thrombosis (DVT), although the actual extent of this risk is not yet clear; it’s possible that the extra risk is purely down to the fact that long haul flights usually involve two key trigger factors for DVT – long periods of inactivity, and dehydration.

If you are travelling on a long flight, make sure that you drink plenty of water (not alcohol, or caffeinated drinks – these make dehydration more likely); flex your legs regularly, to encourage blood flow back to the heart; don’t sit with your legs crossed; and wear loose fitting clothes. If you have any existing medical problems, you may need to take additional precautions – talk to your doctor if you are concerned.

Compression stockings (such as Scholl Flight Socks, £12.99) are another way to prevent circulation problems during long haul flights. They should be worn during the flight, and some sources recommend leaving them on for a further 24 hours. However, they are unnecessary in children, for whom the risk of DVT is minimal; and are not suitable for people who have circulation problems, are diabetic, or already use compression stockings from the doctor. Talk to your pharmacist or doctor for more advice. [back]

Cystitis

Q. I think I’m suffering from cystitis – what are the symptoms, and how can I treat it?

A. Cystitis is associated with an itching or burning pain on urination, and the desire to urinate more frequently than normal; it’s often caused by a bacterial infection in the urethra. The best way to treat mild cystitis is to drink lots of bland fluids to increase urine flow; using a product such as Canesten Oasis (6 sachets, £4.25) will make the urine more alkaline and relieve the symptoms. If left untreated, cystitis can cause bladder or kidney infections - if the pain is intense, if you experience lower back pain, if there is any blood in the urine, if you are pregnant, or if simple treatments don't work, talk to your doctor. Cystitis is very uncommon in men; in this situation it should also be treated by the doctor, as there may be another reason for the infection. It’s important to distinguish between cystitis and vaginal thrush, which is treated in a different way - talk to your pharmacist for more advice if you are concerned. [back]

Snoring

Q. My partner frequently snores, and it keeps me awake – is there anything we can do to stop it?

A. Snoring is a very common problem, affecting around 40% of adults to some degree; the noise is caused by a narrowing of the airways and a vibration of the tissues at the back of the throat, and can be due to many factors, such as enlarged tonsils, a long soft palate (the back of the roof of the mouth), nasal allergies and colds, or being overweight.

Several remedies for snoring have been developed over the years, with varying degrees of success. Products currently available include Snoreeze spray (£11.95) and oral strips (14, £4.99), and also Breathe-Right strips (30 strips, £13.99). There are also two new products called Snoreshield and Snoresolve (£34.99 and £69.99) which are placed in the mouth overnight and aim to keep the airways open to prevent snoring. Other helpful measures include trying to lose weight if you are obese, adopting a healthy lifestyle and taking exercise, avoiding alcohol and heavy meals for at least 4 hours before sleep, sleeping on your side instead of on your back, avoiding drowsy antihistamines and sleeping tablets, and using an extra pillow to raise the head slightly.

If these measures fail, or if you are concerned, talk about this with your doctor; there are other measures that may be appropriate. There is a related condition called ‘sleep apnoea’ that requires medical attention; here the airways become obstructed during sleep to such a degree that the patient stops breathing for short periods, causing a very restless night and tiredness in the daytime. [back]

Travel Sickness

Q. What is the best way to prevent travel sickness?

A. Travel sickness is a common problem, especially in children, and is caused during a journey by conflicting messages being sent to the brain from the eyes, the stomach, and the organs of balance in the ears. There are several travel sickness medicines available from pharmacies; if they are to be taken by several family members, ask your pharmacist which would be best for the desired age range. Most travel sickness tablets cause drowsiness, and shouldn’t be taken with alcohol, or by patients with prostate problems or glaucoma. Effective products include Stugeron tablets (15 tablets, £2.60), which is best when taken 2 hours before a journey, and Sea-Legs (12 tablets, £2.25) which can be taken by adults and children from the age of 2 years onwards.

Other methods of preventing travel sickness are available, including homoeopathic remedies such as Nelsons Travella, ginger supplements, and acupressure wrist bands such as Sea Bands (£7.49 each), none of which cause drowsiness; these would be more appropriate for drivers, pregnant women, or others who can’t take traditional travel sickness medicines. Also, car sickness can often be alleviated by looking at distant objects out of the car windows – perhaps made easier by sitting in the front passenger seat – to reduce any conflicting messages from the eyes and ears. Talk to your pharmacist for more advice. [back]

Scabies

Q. What symptoms are associated with a scabies infection, and how do I treat it?

A. Scabies is the name given to a contagious skin infection with the scabies mite, which can cause small grey lines between the fingers and toes - it sometimes occurs in other places, such as the wrists, armpits, or the anal / genital areas. Scabies can be uncomfortable, often causing an intense night-time itch, and may be effectively treated using non-prescription medicines in most cases. If you think you might have scabies, talk to a local pharmacist to discuss and confirm the symptoms.

Malathion (contained in Quellada-M Liquid, 200ml £8.99; and Derbac-M Liquid, 200ml £8.05) is an effective application for the treatment of scabies, and can be purchased from pharmacies, however it's important to apply this correctly. It's recommended that all members of the household are treated - typically, an adult will require 100ml of liquid for each application. This should be applied to the whole body in adults, but not the neck, face, or scalp, for a period of 24 hours. It's important to pay particular attention to the webs of the fingers and toes, and to brush the liquid underneath the ends of fingernails and toenails. If you wash your hands during this time, the liquid should be re-applied afterwards. A second treatment is usually not necessary. The itch may persist, and could get slightly worse, in the few days following treatment, because of the release of irritants from dead mites; you can use Eurax lotion (100ml £4.69) or calamine lotion to calm this down if necessary. If you still find that your scabies is present after one application, contact your doctor for more advice. [back]

Menopause

Q. I am a 50 year old woman, and have started suffering with hot flushes, which I think are related to the onset of the menopause. What can I do?

A. The symptoms associated with the menopause are all related to the reduction in the amounts of the hormones oestrogen and progesterone circulating in the blood. Some women find that the ‘change of life’ causes them no ill effects, however many women experience a disturbance of some kind - hot flushes, insomnia, mood changes, and headaches are common. The most effective way of preventing any effects caused by the changes in the body during and after the menopause is to replace the hormones which are no longer naturally produced by the ovaries, by using hormone replacement therapy (HRT); your doctor will offer more advice about the various forms of HRT available, and their suitability.

In terms of non-prescription approaches, some vitamins and supplements including calcium, magnesium, and vitamin E can be helpful; a preparation called Menopace (30 tablets, £5.95) claims to maintain health after the menopause. Try to avoid alcohol, coffee, chocolate, and spicy foods if you can (easier said than done!) as these can make hot flushes worse; take regular exercise to keep the bones strong and prevent heart disease; and some women find that soaking in a luke-warm bath each morning keeps hot flushes at bay. Stopping smoking, and eating plenty of fruit, vegetables, and calcium-rich foods, will also help to maintain your health. Discuss this with your doctor if you are concerned. [back]

Cold Sores

Q. I always seem to suffer with cold sores at this time of year. What’s the best thing I can do to treat them?

A. Before the visible signs of a cold sore appear, most sufferers will experience a tingling sensation, which often precedes the sore itself by 2-3 days. Small blisters will then form on the skin, which may contain a white substance and cause pain. These blisters then break and the following ‘weeping’ stage is the stage at which the cold sore is highly contagious. The skin will then scab over. The most effective medicines that can be purchased from pharmacies are antiviral creams containing aciclovir, such as Zovirax (2g tube, £5.99; 2g pump, £6.19), which can actually stop the sore developing any further if used at the tingle stage of a cold sore; if used at a later stage, aciclovir can reduce the duration of the symptoms by a few days. Zovirax cream should be used five times a day, for five days; treatment may be continued for a further five days if symptoms persist. Other soothing creams are available, such as Blistex cream (5g tube, £2.25), which can be used by children as well as adults.

You should see your doctor if the cold sore lasts for longer than 2 weeks, if it doesn’t respond to treatment, if it is painless, or is located around the eyes, the tip of the nose, or the inside of the nose or mouth. For more advice, talk to your pharmacist. [back]

Decongestants

Q. Most cough and cold remedies contain decongestants, but how do they actually work? Are there any situations when I shouldn’t take them?

A. Decongestant medicines, such as pseudoephedrine and xylometazoline, are common ingredients in cold remedies. They work by narrowing blood vessels in the soft tissues of the nose, which can become inflamed when you have a cold or allergy, leading to a narrowing of the nasal passages (“blocked” nose) and/or excessive mucus production (“runny” nose). Decongestants can be taken by mouth, or sprayed directly into the nose for fast relief. However, decongestants are not suitable for more than 5 days’ continuous use, because they can cause a “rebound congestion”; they are best when used to manage short-term symptoms only. If you take any other medicines from the doctor, or suffer with high blood pressure (or any circulation problems) or asthma, talk to your pharmacist first, because decongestants might not be appropriate for you.

In some situations, there are other ways to manage the underlying cause of nasal congestion - for example, antihistamine tablets or anti-inflammatory nasal sprays (such as Flixonase Allergy Nasal Spray) if the problem is allergic in nature. Your pharmacist will advise on the best way to treat your individual symptoms. [back]

High Cholesterol & Diet

Q. My doctor has told me that I have a high blood cholesterol level, and has prescribed tablets to help. Is there any point in changing my diet as well, if I’m taking tablets?

A. If you have been diagnosed with high cholesterol, your doctor may prescribe a prescription medicine to help, however it’s important to be aware that you can help yourself significantly by improving your diet. American researchers have stressed the importance of the relationship between diet and cholesterol levels in a recent study, which has shown that high cholesterol levels can be significantly reduced by modifying the diet - over and above the improvement that prescription medicines can have – so paying attention to your diet is still vital, even when you are taking tablets for your cholesterol levels.

There are many effective dietary steps that you can take, such as choosing leaner meat products, low-fat cheese, skimmed milk instead of semi-skimmed or full-fat milk, and increasing your intake of fish, fruit, vegetables, and fibre. Your doctor or pharmacist can offer further advice about your diet or your tablets if necessary.

In addition, you can now purchase a cholesterol-lowering medicine called Zocor Heart-Pro from pharmacies, which contains Simvastatin and was previously only available with a doctor’s prescription. It’s only available from pharmacies for patients who are classed as having a ‘moderate' risk of coronary heart disease in the next 10 years - those with a high risk need to see their doctor, whereas people with a low risk can keep their risk in this category with diet and lifestyle advice alone. [back]

Drugs & Driving

Q. I do a lot of driving as part of my job, and occasionally I suffer with colds and use various cough and cold remedies to help my symptoms. Is it safe for me to take these when I’m driving?

A. Many cough and cold remedies are available which do not cause drowsiness, but there are several products that can cause drowsiness and would be unsuitable for you to take when driving – and this may not be immediately apparent from the medicine packaging. Many common medicines available from pharmacies and from your doctor can impair your ability to drive safely, including certain antihistamines, painkillers, cough preparations, and antidepressants.

Whilst there is already a great public awareness about the dangers of drinking and driving, it’s true that the dangers of “drugs and driving” are not as widely appreciated, but are no less important. When you next buy any medicines for your symptoms, talk to your pharmacist to check that they would be suitable for you when driving – and ask your doctor about any prescribed medication the next time you are given a prescription. [back]

Arthritis

Q. My mother has recently been diagnosed with arthritis – what causes this condition, and how is it best treated?

A. Arthritis is a term meaning ‘joint inflammation’. Affected joints become painful and movement may be restricted. There are several different causes and types of arthritis, the most common of which are osteoarthritis (OA), and rheumatoid arthritis (RA) – it’s estimated that OA affects 10-20% of the population aged over 64 years.

In OA, the cartilage that protects the joints wears away, especially at the weight-bearing joints. Joints can lose their shape and become misaligned over time. RA is a more complex condition, thought to involve a process where the body attacks its own tissues and breaks down bone and cartilage – it’s also associated with other inflammatory problems and is difficult to diagnose because of the slow onset of symptoms.

Management of arthritis usually involves anti-inflammatory medicines from the doctor, and other practical steps including exercise, physiotherapy, and in some cases surgery or joint replacement. A supplement called Glucosamine has been used for several years by sportsmen and women to speed up the repair of damaged tissue, and may also relieve the pain, stiffness, and swelling of arthritis for some people. For more advice, talk to your doctor or pharmacist, or visit the Arthritis Research Campaign website at www.arc.org.uk. [back]

Alcohol

Q. Is it true that red wine is good for your health?

A. For many years, red wine has been thought to have several beneficial health effects; studies have linked red wine with protection against heart disease and some degenerative conditions, and even the prevention of infection with the herpes virus. A recent year-long study carried out in Spain has discovered that subjects who drank more than two glasses of red wine a day had 44% fewer colds than non-drinkers. Red wine has also been tested against other alcoholic beverages, including different wines, and has been found to have significantly greater beneficial effects on health. These effects are thought to be due to the antioxidant chemicals in red wine, which can prevent cell damage, and are also found in many other foods in the “Mediterranean diet” such as olive oil, beans, fruits and vegetables.

Of course, excessive alcohol consumption is detrimental to health, and any beneficial effects of red wine should be seen as additional to a healthy lifestyle including an appropriate diet and level of exercise. Talk to your pharmacist or doctor if you are concerned. [back]

Reclassification of Medicines

Q. Is it true that some prescription medicines will soon be available to buy from pharmacies, without a prescription?

A. Yes - this process has actually been happening for many years; many common non-prescription medicines, including nicotine patches and hayfever remedies, were only available with a doctor's prescription at one time, until they were re-classified as "pharmacy only" medicines instead of "prescription only" medicines. "Pharmacy only" is a legal category of medicines which can only be sold from pharmacies, under the supervision of trained staff; the pharmacy staff must ask a few questions to make sure that they are appropriate for the intended user, and can give more advice if required to make sure they will be used for maximum benefit. Medicines that have recently been re-classified as pharmacy-only medicines, and can therefore be purchased without a prescription from pharmacies, include Curanail nail paint (for fungal nail infections), Chloramphenicol Eye Drops (for eye infections), Imigran Recovery tablets (for migraines), and Daktacort HC Cream and Canesten Hydrocortisone Cream (antifungal and anti-inflammatory creams); several more are expected to follow soon.

Allowing more medicines to be sold from pharmacies in this way allows patients to take more responsibility for their own health, reduces the burden on GPs, and makes greater use of pharmacists' expertise to help manage minor ailments and chronic conditions. [back]