HowToLiveBetter.THE BETTER LIFE HANDBOOK
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YOUR LIFE, YOUR OWN PACE

Use the medicines in your home safely

Explore each chapter to understand the effort, benefits and context.

Read the chapter introduction

Fever reducers, painkillers, cold remedies, stomach medicines, and diarrhea treatments are often available directly from a pharmacy. Being available without a prescription does not mean a medicine is safe however you take it. This chapter does not try to prescribe a treatment for every illness. It focuses on a few simple actions that can prevent serious harm.

All entries use the mortality-based framework, which also includes health outcomes such as liver failure, gastrointestinal bleeding, and kidney failure in newborns. Most benefits amount to avoiding a serious incident. The research usually cannot tell us what percentage of incidents a particular action would prevent, so the benefit ratings reflect the severity of the consequences. Each entry's notes explain that judgment.

For topics covered elsewhere, follow these links: what to do after swallowing the wrong medicine or a cleaning product is in entry 13-20; taking long-term medicines for the prescribed duration is in entry 16-1; and prescription review when buying medicines online is in entry 28-6.

The beneficiaries in this chapter are you and your family, the two highest-priority groups in the book's framework.

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Health

Before combining cold remedies or painkillers, check the ingredients: only one product should contain acetaminophen

Many cold remedies contain acetaminophen, also called paracetamol. Taking two such products together doubles up on the same drug, and an overdose can damage the liver. In a US study of acute liver failure caused by acetaminophen, nearly three in ten patients died without receiving a transplant. The cited Chinese over-the-counter labeling recommends no more than 2 grams a day. Avoid alcohol while taking it, too.

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Do not use aspirin, nimesulide, or metamizole for a child's fever; do not give minors cold remedies containing metamizole

Avoid these three medicines for childhood fever. Aspirin is associated with Reye's syndrome, which damages the brain and liver. About three in ten affected children died in US surveillance, and reported cases fell by over 90% after warnings were issued. Under the cited Chinese restrictions, nimesulide is contraindicated below age 12, and metamizole below age 18.

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Ask a clinician before taking an NSAID painkiller if you are 60 or older, have had stomach bleeding, or take an anticoagulant or steroid

Painkillers such as ibuprofen, naproxen, and aspirin can injure the stomach. In trials using high doses, ibuprofen was associated with about four times the risk of serious upper gastrointestinal complications, including bleeding and perforation, compared with placebo. Older age, previous stomach bleeding, anticoagulant or steroid use, and daily alcohol use increase concern.

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Follow the Chinese OTC omeprazole label's seven-day limit; difficulty swallowing, vomiting blood, or black stools require medical care

Omeprazole enteric-coated tablets became available without a prescription in China in 2022. The cited label limits self-treatment to seven days and says not to repeat it within two months. Do not self-treat if swallowing is difficult or painful, you vomit blood, or you pass bloody or black stools: these can signal a serious condition. Omeprazole can also mask stomach cancer symptoms and delay diagnosis.

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Treat diarrhea-related fluid loss with oral rehydration salts; do not give antidiarrheal drugs to children under five

The priority with diarrhea is replacing lost fluid. Mix oral rehydration salts with water exactly as directed; sugary juice drinks are not a substitute and may worsen dehydration. Do not give children under five antidiarrheal medicines such as loperamide. Serious adverse effects include potentially fatal intestinal paralysis and obstruction.

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Track painkiller days: frequent use can itself cause headaches

Repeated headaches followed by daily painkillers can become a cycle in which the medicine contributes to the headaches. This is called medication-overuse headache. Diagnostic overuse thresholds are at least 15 days a month for ordinary non-opioid painkillers and at least ten days a month for combination painkillers, for more than three months, in someone meeting the other headache criteria. Most patients improve after the overused medicine is withdrawn. These are diagnostic thresholds, not a guarantee that taking medicine just below them is safe.

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