Automedication.info

HOW TO USE THIS DATABASE?

This database is divided into two parts. The first provides detailed information on self-medication (benefits and limitations, rules to follow...) and on drugs (general information, populations at risk, speciﬁcities...) before considering self-care. The second part deals with generally benign health problems that can be treated by self-medication. They are listed in alphabetical order and mainly concern adults. Fourteen chapters are devoted to common health problems affecting children. Although self-medication for children should remain the exception, these dedicated chapters provide answers to the questions parents may have when faced with such situations.
How is the information organized?
For each health disorder, we indicate : The most common symptoms and causes. When self-medication is not appropriate, and how soon to consult your doctor. This deadline is indicated by a speciﬁc pictogram: XXX EMERGENCY; XX within 48 hours; X within a week; Caution, these are only indications. In case of doubt, and especially when there is a combination of symptoms (headache + strong ﬁèvre), (constipation + strong stomach pain), you MUST ALWAYS consult your doctor. Cases where self-medication may be appropriate, detailing : - preventive advice to avoid or reduce the health problem in question; - essential information on medicines and treatments available without a prescription. A complete list of all over-the-counter medicines available in pharmacies, with notes and comments for each symptom - information you won't find anywhere else.

For severe cases
We remind you of the SAMU number: 15 or 112, to be contacted preferably with a cordless phone (or a cell phone) aﬁn you can get home more easily or to facilitate the execution of a particular gesture recommended by the emergency services (in the event of a false-route, for example).

How to use this guide
At the ﬁnder of the guide, you'll find three indexes: a general index including general information on drugs, symptoms and diseases, an index of all drugs and an index of 85 favorite drugs. We remind you that what we mean by medicine is the brand name, which may be available in pharmacies in several dosages and pharmaceutical forms (tablets, capsules, gel, ointment, etc.).

By symptoms
For each symptom, one or more summary tables are provided, in which drugs are grouped by active substance and ranked in descending order of score. Select the drugs with the highest scores of 10 or more. If several drugs corresponding to this choice are proposed, choose those with the fewest excipients with a notorious effect (allergenic or likely to cause intolerance). Underneath the tables, you'll find one or more preferred specialties with their main characteristics. A preferred speciality is rarely the only one possible; it is chosen only as an example from among several identical specialities with the same indications, contraindications and adverse effects.

By drug
You can also search the index for the drug you usually use, then consult the table(s) where that drug is listed on the pages indicated, and enﬁn compare it with other drugs treating that symptom.

By active ingredient (e.g. bourdaine) or international non-proprietary name (e.g. paracetamol) It is enﬁnable to search the index for the non-proprietary name you know, and then refer to the pages indicated to find in the lists the drugs whose composition includes this active ingredient or INN.

What to ask the pharmacist:
Either the common name, specifying the pharmaceutical form that suits you best, for example : Paracetamol tablet or Paracetamol effervescent tabletOr the drug itself, e.g. DOLIPRANE, specifying the desired pharmaceutical form and the age and weight of the person for whom the drug is intended, so that the speciality proposed by the pharmacist is suitable for that person. In both cases, tell your pharmacist which excipients you do not wish to find in the drug (e.g. alcohol, lactose, parabens, etc.).
Note: when the drug name is followed by XXX, e.g. PARACETAMOL XXX, this means that there are several specialties (often generics) corresponding to this drug, with identical INNs but possibly different excipients.

SOME GOOD TRUTHS ABOUT DRUGS

Medicines, whether prescription or non-prescription, are not like other products.

WHAT YOU NEED TO KNOW
What is a drug? The French Public Health Code (Livre V, art. L511) deﬁnishes it as "any substance or composition presented as possessing curative or preventive properties with regard to human diseases, as well as any product that can be administered to man with a view to establishing a medical diagnosis or to restoring, correcting or modiﬁerating his organic functions". However this deﬁnition in no way prejudges the efﬁcacy of the drug. So, contrary to what the health authorities afﬁrment, when you buy a drug in a pharmacy, you don't know whether it's an efﬁcacious product or just a harmless, even dangerous, perlimpinpin powder.
Drug efficacy (Note) is directly dependent on the active ingredient(s) in its composition. Based on reference information, we have established several degrees of efficacy:
- Good from 15 to 18
- Average from 12 to 14
- Limited 11
- Unproven or ineffective 7

Drug categories

Medicines are designed to meet a variety of objectives. Curative, they attack the cause of the disease (antibiotics, antiparasitics...). Substitutive, they compensate for an insufﬁsance in your body that causes the disease (e.g. insulin to treat "skinny" diabetes). Preventive: they prevent the onset of disease (e.g. vaccines). Symptomatic - the most numerous - they reduce or eliminate a particular manifestation of the disease (ﬁvre, pain) but not the cause (virus or bacteria). This is particularly true of paracetamol, ibuprofen and aspirin.

WMA

Once developed, all medicines (with or without a prescription) must obtain a marketing authorization (AMM) before they can be marketed in France. This authorization is granted by the Agence Nationale de Sécurité des Médicaments (ANSM), formerly the Agence du Médicament, after an expert appraisal focusing on two main points: the existence of therapeutic efﬁcacy in specific indications, i.e. for certain diseases and only certain diseases; and the absence of toxic effects under normal conditions of use in these indications. This authorization, currently given for a period of five years, is renewable once, but may be withdrawn at any time. The marketing authorization number is printed on the drug's packaging. However, for a variety of reasons, a large number of drugs with no proven efﬁcacy in humans continue to receive marketing authorization.

With or without a prescription?
Over-the-counter medicines can be dispensed by the pharmacist at your request. However, the pharmacist can refuse you a non-prescription medication if he/she considers it harmful to your health (for example, in the case of pregnant women). The pharmacist must inform you of any contraindications (problems linked to common illnesses, diabetes, hypertension... or interactions with other medications you are taking) and remind you of the dose not to be exceeded. Some so-called ofﬁcinal medicines (around 600 in 2016) are available directly (over-the-counter) in pharmacies. Unfortunately, many of them are of no interest because of their inefﬁcacy. Some voluntary prescription drugs may be reimbursed by the French Social Security system if prescribed by a doctor. They are always less expensive than non-reimbursable non-prescription drugs. This information can be verified on the public drug database (http://base-donnees-publique.medicaments.gouv.fr). Prescription-only drugs are classified into three groups according to the nature and intensity of the harmful effects they may cause. The list includes substances that are highly toxic, such as anticoagulants, anticancer drugs, etc. The list includes substances that are dangerous because they have the same characteristics as the substances on the list, but to a lesser degree, such as certain non-steroidal anti-inﬂammatory drugs or NSAIDs, like ketoprofen (BIPROFENID®) and diclofenac (VOLTARENE®). Stupeﬁant substances can lead to addiction, physical or psychological dependence (morphine, SKENAN®, MOSCONTIN®...) as well as certain psychotropic drugs (methylphenidate, RITALINE®). Some drugs containing listed substances are optional prescriptions: non-steroidal anti-inﬂammatory drugs or NSAIDs (ibuprofen, ADVIL®...), intestinal transit slowers (loperamide, INDIARAL®, IMODIUMCAPS®...). In fact, the dose of substance contained in the box or the claimed indication are adapted to short-term treatments that can be self-medicated. Not all prescription drugs are reimbursed by Social Security.

Watch out! With or without a prescription, medication is never harmless. Unfortunately, some dangerous over-the-counter drugs are sold over the counter in France, even though they require a prescription in other countries. This is the case with certain antiparasitic drugs (GLUCANTIME®, NOTEZINE®).

In what form?
Most medicines come in a variety of forms: tablets, capsules, sachets, ampoules, drops, suppositories... If the form of your medicine doesn't suit you, ask your doctor or pharmacist to suggest another.

At what price?
The price of drugs (with or without prescription) reimbursed by the French health insurance system is ﬁxed by agreement between the laboratory and the Comité économique des produits de santé, or by ministerial decree. The price of non-reimbursable drugs (with or without prescription) is free. They vary from one pharmacy to another. Our advice: ask your pharmacist which optional prescription drugs are reimbursable, as their prices are ﬁxed by the public authorities. They are generally much less expensive than non-reimbursable drugs.

Specialty, substance and INN
In addition to administrative information, the box also contains the following information: The brand name (or drug), e.g. DOLIPRANE®, EFFERALGAN®, DAFALGAN®... In this guide, this name is always written in capital letters. Below it, in smaller type, is the name of the substance or INN (International Non-proprietary Name), e.g. Paracetamol. The INN allows you to find your medication in any country. Pay close attention to it, as it enables you to check that you are not taking the same substance several times under different specialty names. This will avoid the risk of toxic overdose. In this guide, the name of the substance is written in lower-case letters.

The leaflet
The package insert contains information on the name(s) of the drug, its composition, route of administration and other important information on conditions of administration, indications, contraindications, precautions for use and possible side effects. Unfortunately, you won't have access to this valuable information until after you've purchased the drug, unless you consult the public drug database: http://base-donnees-publique.medicaments.gouv.fr.

The leaflet paradox
The instructions in the package leaflets are extremely useful, especially if you are self-medicating. The pity is that they are often written in a language that is too medical to be accessible to the general public, and sometimes almost illegible... even if you wear glasses!

Umbrella range
A single brand name used for products that may have different statuses (drugs, medical devices or even dietary supplements), so that these products benefit from the reputation and image of the umbrella brand. The coexistence of products with different compositions under the same umbrella brand can lead to confusion and serious errors. Examples: HUMEX TOUX SECHE®, a dextromethorphan-based (opiate cough suppressant) or oxomemazine-based (first-generation antihistamine cough suppressant with atropine effects); TOPLEXIL®, an oxomemazine-based cough suppressant, or TOPLEXIL PHYTO®, a honey-based medical device, etc. We do not recommend the use of umbrella productsExamples: HUMEX (29), DRILL (15), FERVEX (11), ACTIFED (5), VICKS (25), etc.

OUR RECOMMENDATIONS
Before buying any over-the-counter medication, consult the information published in this guide (in association with a symptom) or seek the advice of your doctor or pharmacist. Carefully read the package inserts or find out more about the drug before you buy it, on the French Ministry of Health website: http://base-donnees-publique.medicaments.gouv.fr/ and strictly adhere to the dosages indicated in the inserts.

HOW DRUGS TRAVEL THROUGH THE BODY

Once swallowed, most drugs enter the bloodstream, where they are distributed throughout the body and exert their action. They are then transformed and eliminated.

WHAT YOU NEED TO KNOW
Medicines, even over-the-counter products, are not like other products: certain steps require a minimum of precautions.

Absorption
A drug taken by mouth arrives in the stomach, where it dissolves, then passes into the intestine, where it diffuses into the bloodstream. This is the process of resorption: the emptier your digestive tract, the more rapidly it is absorbed (as in the case of drugs taken on an empty stomach). However, some drugs are better absorbed during meals. But be careful! Some very common foods can increase, reduce or even cancel out the efﬁcacy of a drug due to an interaction between the drug and the food (see Drugs and foods).

Broadcasting
Once in the bloodstream, the drug gradually spreads throughout the body. Some drugs spread everywhere. Others, on the contrary, accumulate in a single organ, such as iodine, which concentrates on the thyroid gland. Certain organs, such as the brain, are protected by a barrier that prevents the spread of certain drugs. This is the case for many antibiotics, which do not easily pass the blood-brain barrier.

Mothers-to-be, be careful! Almost all drugs pass through the placenta and can reach the unborn child (see Drugs and pregnancy).

Our business
For a drug to be efﬁcient, it must arrive at the diseased site in its active form aﬁn order to penetrate the organ and heal it. Some drugs, like insulin, penetrate every cell in the body and exert a multitude of effects. Others, such as act more speciﬁcally on a single organ, as in the case of tonicardiacs (digoxin). The dosage and efﬁcacy of a drug depend on the quantity taken, with a few nuances. Below a certain quantity, the drug has no therapeutic effect. The higher the dose, the greater the effect. Beyond the maximum authorized dose, its efﬁcacy no longer increases, but the risk of accidents increases, transforming a normally well-tolerated drug into a toxic or even lethal substance. This is the case, for example, with paracetamol (DOLIPRANE®, DAFALGAN®, EFFERALGAN®...). An efﬁcacious painkiller with a maximum dose of 4 g/24 hours, it can cause serious damage to the liver if the dose is systematically exceeded. For self-medication, it's best to limit the dose to 3 g/24 hours. By vériﬁant the presence or absence of paracetamol in the medicines you take regularly, you limit the risk of unknowingly overdosing. Please note! The doses recommended on package inserts are calculated to ensure a fair balance between efﬁcacy and tolerance in healthy adult populations. However, there is no such thing as zero risk: an efﬁcient medication can still cause undesirable effects, even at the recommended dose.

Transformation, the role of the liver
A drug remains active in the body for several hours, or even days. Carried in the bloodstream, it passes repeatedly through the liver, which converts an active part of it into an inactive substance (in a few rare cases, the opposite occurs). If the liver is diseased, as in the case of cirrhosis, the drug remains in the body in its active form for too long, increasing the risk of accidents. This is why, in cases of hepatic insufﬁsance, the doses of many drugs must be reduced, and certain drugs are contraindicated. Elimination, the role of the kidneys Medicines are eliminated mainly by the kidneys, either in an inactive form after transformation by the liver, or in the initial active form. If the kidney is not functioning properly (renal insufﬁsance), the drug stays longer in the body. This explains why, in the case of renal insufﬁsance, many drugs need to be reduced in dose, and some avoided altogether. What is not eliminated by the kidneys is evacuated mainly through bile and exhaled air, but also through sweat, saliva, tears, hair, nails... and breast milk.

Young mothers, be careful!
If you are breast-feeding, do not self-medicate (see Medication and breast-feeding).

OUR RECOMMENDATIONS
Always ask your pharmacist for advice, and read on. ATTENTION the package insert to find out how to take your medication: when? On an empty stomach, with or between meals? ALWAYS keep medicines in their original packaging, with the package leaflet. Avoid self-medication if you are pregnant (see Medicines and pregnancy) or breast-feeding (see Medicines and breast-feeding). As children (see Medicines and children) and the elderly (see Medicines and the elderly) are very sensitive to medicines, keep self-medication to a minimum for these populations, and reduce the doses of medicines administered as indicated in the leaflets aﬁn to avoid the risk of incidents or accidents.

LEARN MORE
Suppositories, patches, subcutaneous and intramuscular injections pass more or less rapidly into the bloodstream. However, suppositories are more difficult to absorb. Products used locally (ointments, creams, lotions on the skin, eye drops, mouthwashes, lozenges, ear or nose drops) are not harmless. They can pass into the bloodstream and exert a general action that can lead to undesirable effects. Some medicines taken by mouth do not pass into the bloodstream: for example, medicines to treat diseases of the digestive tract (antacid stomach dressings), some medicines to treat constipation (lactulose, DUPHALAC®, macrogol, FORLAX®) and some anti-worm medicines (ﬂubendazole, FLUVERMAL®).

PLACEBO AND NOCEBO EFFECTS

How do you deﬁn the placebo and nocebo effects? The word "placebo", from the Latin "je plairai", refers to an inert substance (breadcrumbs, starch, most often lactose), devoid of activity, presented to a patient as a medicine.

The placebo effect
In certain circumstances, taking this inert substance when presented as a medicine can lead to an improvement in certain symptoms (digestive disorders, coughs, headaches, sleep disorders, anxiety) and symptoms of certain chronic diseases (osteoarthritis, eczema, etc.). These effects are known as "placebo effects". The placebo effect accounts for around 30% of the efﬁcacy of any drug, but can be 50% to 70% for headaches, 20% to 80% for rheumatic pain and 20% to 60% for digestive disorders. However, the placebo effect only lasts for a short time, as demonstrated by the studies carried out on the efﬁcacy of future drugs before they are marketed. To be marketed, candidate drugs should always have an efﬁcacy superior to the placebo to which they are compared. Unfortunately, this is not always the case! Factors that inﬂuence the placebo effect The placebo effect depends closely on the placebo itself, but also on the doctor who prescribes it and the patient who receives it. The inﬂuence of the placebo: several factors are involved The mode of administration: we can classify in order of decreasing efﬁcacy intravenous injections, intramuscular injections, drops, tablets or capsules, suppositories. Drug presentation: light blue for tranquilizers, red or bright yellow for stimulants, brown for laxatives. An unusual shape, or even a particular taste (bitter, for example), seems to ampliﬁer the efﬁcacy of the placebo. Size: a tiny or unusual size can increase the effect. Novelty, high price, the name of the drug, its composition (sometimes presented in Latin) and its prescription status are also factors favoring efﬁcacy. The doctor's personality: a warm, welcoming attitude, attention and interest not only in the patient's health problems but in his or her whole personality, the length of the consultation, the doctor's persuasiveness about the efﬁctiveness of the therapy, the personalization of care can increase the placebo effect. Patient-related factors: sensitivity to the placebo effect is more frequent in anxious, depressed and passive subjects than in strong personalities. In the same individual, the placebo effect of a drug diminishes as the patient acquires greater knowledge of his or her illness and the effects of the treatment. Conﬁdence in the doctor's ability improves the efﬁcacy of any medicine. For example, a honey candy tablet in a box with a scientiﬁc-looking name, given by a convincing attending physician, is likely to have more effect on an irritated throat than the same one bought from the conﬁseur. Especially if the patient is anxious by nature! Impure placebos Some laboratories offer drugs whose indications do not correspond to the symptoms they are supposed to treat. This is the case, for example, with the combination of several vitamins to treat transient fatigue and various magnesium-based substances to treat spasmophilia. These drugs are known as "impure placebos", as they can only act through the placebo effect. Their use must be condemned. Because of their pharmacological properties, these drugs can have undesirable side effects. Unfortunately, there are still far too many impure placebos among the 12,000 or so prescription and over-the-counter medicines currently on sale in pharmacies.

The nocebo effect
The "nocebo effect" is any unpleasantness that occurs after taking an inert substance (placebo). The most frequent manifestations of the nocebo effect are, in descending order: drowsiness (25% of cases), fatigue, digestive disorders, difﬁculty concentrating, headaches, hot flushes, tremors.

DRUGS AND PREGNANCY

The vast majority of drugs taken by the mother during pregnancy are transmitted to the embryo and fetus through blood exchanges, via the placenta. Self-medication is therefore strictly inadvisable for pregnant women.

WHAT YOU NEED TO KNOW
Even if a drug does not produce any adverse effects in a pregnant woman, it may do so in her unborn child. During pregnancy, you should ALWAYS ask your doctor or pharmacist for advice before taking any medication, even if it seems harmless. This is crucial in the first two months of gestation: during this period, taking medication can lead to serious malformations, organ damage and death of the egg or embryo. During the last three months of pregnancy, over-the-counter medications for anxiety, insomnia, certain painkillers (morphine derivatives), a large number of cough syrups, antiallergics and non-steroidal anti-inﬂammatories (aspirin, ibuprofen, diclofenac, niﬂumic acid...) can trigger various types of disorders in the baby. To put it plainly, refrain from self-medication during pregnancy and even after delivery if you're breastfeeding (see Medication and breastfeeding). Take advantage of a visit to your doctor to ask about over-the-counter medications you can take to treat minor ailments: headaches, nausea, insomnia, constipation... Only he or she can recommend a medication that is safe. You can also consult the CRAT (Centre de référence sur les agents tératogènes): http://lecrat.fr/.

OUR RECOMMENDATIONS
If possible, opt for hygiene measures rather than medication. If you have trouble sleeping, cut out the caffeine in tea, coffee, chocolate, Coca-Cola®, Pepsi-Cola®... and follow our advice (see Insomnia). In the event of constipation, follow our lifestyle advice (see Constipation). If this proves insufﬁsant, you can use a mild laxative, but NEVER take irritant laxatives. If in doubt, consult your doctor. In case of nausea and vomiting, try our suggestions (see Nausea and vomiting). Do not take any medication without your doctor's advice. In case of headache, ﬁvre or temporary pain, you can take paracetamol, not exceeding 3 g/24 hours. But NEVER take non-steroidal anti-inﬂammatory drugs (NSAIDs): aspirin, ibuprofen... Totally banish alcohol (even a glass of wine), tobacco (your cigarettes and those of others) and avoid all toxic fumes (stain removers, household paint strippers, herbicides, fresh paints...). A great opportunity to adopt a healthy lifestyle and conﬁ er the household chores to others! Avoid dietary supplements and herbal products, including essential oils, vitamin and mineral cocktails containing iron, iodine, vitamin A, etc., as they may be harmful to your health.

LEARN MORE
Substances to avoid during pregnancy Alcohol can cause mental retardation, growth retardation, facial deformities and organ malformations. Tobacco can stunt growth. Toxic fumes can cause neurological disorders. If you work in a chemical environment, be vigilant. For more details, visit the INRS (Institut national de recherche et de sécurité pour la prévention des accidents du travail et des maladies professionnelles) website: www.inrs.fr.

DRUGS AND BREASTFEEDING

Are you breast-feeding your child? You're right, because there's nothing better than breast milk to nourish a newborn: it contains the nutrients your child needs in an easily assimilated form, as well as vitamins, minerals and substances that protect against infection (antibodies), enabling the infant to better resist certain illnesses such as measles or mumps. But be careful with medicines!

WHAT YOU NEED TO KNOW
The vast majority of drugs taken by the mother pass into the milk. This is very harmful for newborns and infants, as their liver and kidneys do not yet destroy or eliminate drugs perfectly.

OUR RECOMMENDATIONS
Keep up the healthy lifestyle measures you adopted during your pregnancy: - avoid tobacco and smokers; - don't drink alcohol or excitants (coffee), as they pass in large quantities into the milk and can disturb your baby. Be careful not to come into contact with pollutants (hexachlorobenzene), insecticides, paint or stain removers (tetrachloroethylene). Their vapors are toxic and can find their way into your bloodstream and then into your milk. Tell your doctor that you are breast-feeding your child, and ask what over-the-counter medications you can safely take for minor health problems (headaches, ﬁèvre, pain). If your doctor prescribes medication, take it immediately after feeding (not before). If you have to take a short-term treatment that could be harmful to your baby, it's best to suspend breastfeeding temporarily and wait 48 hours after the ﬁnding to resume. Ask your doctor for details. Avoid applying products for external and local use to the breast, especially to cracks (e.g. ointments containing vitamin A). As they never fully penetrate the skin, your baby runs the risk of absorbing them when suckling.

TO FIND OUT MORE Over-the-counter medicines prohibited when breast-feeding : Bromide-based tranquilizers. Iodine-based medicines. Cough syrups containing codeine or codethyline. All irritant laxatives: senna, borage, cascara, bisacodyl, etc. Non-steroidal anti-inﬂammatories (aspirin, ibuprofen, ketoprofen) used as painkillers. High-dose vitamin D. H1 antihistamines, first-generation anti-allergics. Certain vaccines.

MEDICINES AND CHILDREN

Self-medication by deﬁnition should only apply to oneself. However, many parents are tempted to treat their children's seemingly benign health problems on a daily basis, without consulting their doctor. But this is not without danger!

OUR RECOMMENDATIONS
To ensure responsible, risk-free self-medication for your children, follow these guidelines: Never self-medicate a newborn baby. Does your baby look sick? Does his ﬁvre temperature exceed 38.5°C? Call your doctor or, in an emergency, the SAMU (15 or 112). They'll advise you while you wait for a consultation. Self-medication should be the exception in infants. Don't rush! Take the time to analyze the symptoms presented in this guide aﬁ nd out whether it is necessary to take a particular medication. If in doubt, call your doctor. Only use medicines specifically formulated for "infants" or "children". Solid forms (capsules, tablets, lozenges, gum) are contraindicated for children under 6. Vériﬁez dans la notice la dose exacte à administrer selon le âge et le poids. Calculate three times rather than once, and respect the recommended time interval between doses. Any new symptom (such as fever) should alert you to the benefits of the medication you have given your child. If in doubt, call your doctor. Do not present a medicine to a child as a pleasant-tasting treat. Medicine must remain medicine. Your child is taking it because he or she is ill. Bear in mind that some minor problems can be treated without medication (see Childhood fever, Childhood constipation, Childhood acute diarrhea), but always proceed with caution. As a general rule, when you self-medicate, you can only treat a single symptom (ﬁèvre or sore throat or vomiting). In the event of a combination of symptoms (e.g. ﬁèvre + vomiting), you should consult your doctor. Never prolong self-medication beyond 48 hours ifyou don't notice any improvement, but call your doctor.

LEARN MORE
Age and medication A child under 1 month of age is a newborn. A child aged between 1 and 30 months is an infant. From 30 months to 15 years, a child is a toddler. After the age of 15, a child is considered an adult in medical terms, particularly with regard to drug dosage.

DRUGS AND THE ELDERLY

When it comes to self-medication - an area normally reserved for healthy populations - the elderly and those around them need to proceed with caution. WHAT YOU NEED TO KNOW The elderly are major consumers of medication, and this is not without risks. 20% of hospital admissions among the elderly are due to medication-related accidents. The risk of accidents is three times higher in a 75-year-old man than in a 50-year-old man. CAUSES The functions of the liver and kidneys slow down with age (see The course of drugs through the body). As age increases, recommended dosages must be reduced to avoid overdosing. Elderly people, generally suffering from multiple disorders, consume a large number of medications. This increases the risk of drug interactions and overdose by 20%. The elderly are frequently treated for osteoarthritis with non-steroidal anti-inﬂammatory drugs (NSAIDs). To treat a ﬁvre or minor pain, aspirin, ibuprofen and ketoprofen (NSAIDs) should therefore be avoided because of the increased risk of digestive bleeding. Paracetamol should be preferred, initially not exceeding 2 g/24 hours. Certain chronic diseases common to the elderly (high blood pressure, heart, eye and prostate problems, constipation) are totally incompatible with many medications, including some sold over the counter (e.g. high blood pressure and NSAIDs). Drug leaflets are not always adapted to the needs of the elderly: they are often printed in small type, and the vocabulary used is sometimes "inaccessible". As a result, this population doesn't always understand how to take medication (whether prescribed by a doctor or not), which is not without its risks!

OUR RECOMMENDATIONS FOR SENIORS AND THEIR FAMILIES
Don't take "over-the-counter" medication on your own, unless it's really necessary (e.g. paracetamol for a fever). Limit use to a short period of time (48 hours), respecting all the information on the package leaflet. When taking medication prescribed by a doctor, strictly adhere to the doses (do not increase or decrease them) and duration indicated. Use a weekly planner, and if you find it difficult to divide the treatment for a week yourself, ask those around you (or your pharmacist) to prepare one for you. Do not discontinue treatment on your own initiative. If you feel you are having a problem taking a drug, ask your doctor for advice. If it's a medication you're taking for life (for high blood pressure, heart disease or diabetes, for example), there's NO question of stopping it on your own, even temporarily. If you have any doubts, call your doctor. Report to your doctor any incident, however minor, involving a particular drug. If you find it difficult to count drops, break an ampoule, halve a tablet, swallow a capsule or take suppositories, ask your doctor to prescribe the same medicines in a different form. If you have any questions about your treatment, don't hesitate to ask your doctor or pharmacist for clarification. Don't forget that certain herbal teas, particularly laxative ones, and certain essential oils can lead to incidents or even serious accidents. Report any problems with these products to your doctor. Get vaccinated against the flu at the start of winter, and make sure your tetanus vaccination is up to date.

DRUGS AND ALCOHOL

The combination of alcohol and medication (prescription or over-the-counter) can be dangerous, and in some cases can lead to serious accidents. These accidents can happen whenever you take your medication (before, during or after alcohol consumption).

WHAT YOU NEED TO KNOW
The consequences of combining drugs and alcohol can be serious: increased drug activity, more drug-related accidents, modiﬁcation of alcohol breakdown in the body ("antabuse" effect). Alcohol increases the effect of all drugs that reduce brain activity, further accentuating problems of attention, concentration and vigilance. Caution when driving! Alcohol also increases the risk of respiratory problems when combined with certain medications. This is the case with hypnotics, tranquilizers, neuroleptics, antidepressants and several over-the-counter drugs: all codeine- and codethyline-based cough suppressants, and all antihistamines. Alcohol associated with diabetic medications (insulin and oral hypoglycemic agents) can lead to hypoglycemic coma. Alcohol associated with antihypertensives and coronary vasodilators can cause a drop in blood pressure. Alcohol can ampliﬁer accidents associated with certain medications. For example, it can accentuate bleeding in the digestive tract caused by non-steroidal anti-inﬂammatory drugs (NSAIDs) such as aspirin and ibuprofen... Certain drugs can slow or stop the breakdown of alcohol in the body to the hypertoxic acetaldehyde stage. This is known as the "antabuse" effect (see "Hangover"), and can lead to very unpleasant (flushed face, headache, malaise, nausea, vomiting) or even dangerous (tachycardia, drop in blood pressure, coma) symptoms. This is the case with certain antibiotics and many antidiabetic and antifungal drugs, as well as certain antiparasitic drugs, many of which are available over the counter. Alcohol diminishes the activity of certain drugs in chronic drinkers, as in the case of many epilepsy drugs and anticoagulants.

OUR RECOMMENDATIONS
Before buying any medication, ask your pharmacist for advice. Be vigilant. Several hundred medicines contain alcohol in varying amounts. This is the case with many Syrups and the vast majority of drinkable ampoules, including many homeopathic specialties. These drugs can cause an "antabuse" effect. Read ATTENTION leaflets. Keep medicines containing alcohol, especially syrups, out of the reach of children. Don't take aspirin with a hot toddy: a radical recipe to make your stomach bleed! Don't take aspirin-based medicines (such as ALKA SELTZER®) to prevent or treat a "hangover": stomach damage is guaranteed.

DRUGS AND FOOD

Medicines and food don't always mix, and food can even counteract their efﬁcacy!

WHAT YOU NEED TO KNOW
Some drugs must be taken on an empty stomach (1? to 2 hours before any food intake), as their passage through the bloodstream can be slowed or even reduced by the presence of food. This is the case for many antibiotics. Some drugs need to be taken with a meal, so that more of them enter the bloodstream during digestion: for example, certain griseofulvin-based skin fungus killers (GRISEFULINE®). Aspirin, ibuprofen and other non-steroidal anti-inﬂammatory drugs (NSAIDs) should be taken with a meal to reduce stomach irritation and damage. Digestive dressings should always be taken after meals (at best 1 hour after) and not before or at mealtime, as meals act as natural "dressings". Always swallow pills, tablets, capsules, granules or pills with a full glass of water aﬁ nd make sure they don't stick to the esophagus, which could lead to irritation and ulcers. Avoid drinks other than water (milk, fruit juices, Coca-Cola®...), which can modiﬁer the action and tolerance of the medication. If you enjoy grapefruit, grapefruit juice or blood orange juice, tell your doctor if you are taking a new treatment, as this fruit combined with certain drugs can considerably increase their concentration, with sometimes very serious consequences for the body (overdose).

OUR RECOMMENDATIONS
Take your medication standing up or sitting down, and avoid the risk of indigestion by placing it on the back of your tongue, without throwing your head back. Never open capsules, as their contents (powder) must dissolve only once in the stomach. Do not cut your tablets without first consulting your doctor or pharmacist: some medicines cannot be broken.

LEARN MORE
Immunosuppressants: ciclosporin (NEORAL®), everolimus (CERTICAN®), sirolimus (RAPAMUNE®), tacrolimus (ADOPORT®, ADVAGRAF®, etc.). Cardiovascular drugs: aliskiren (RASILEZ®, etc.), dronedarone (MULTAQ®), ivabradine (PROCORALAN®). Erectile dysfunction drugs: avanaﬁl (SPEDRA®), vardénaﬁ (LEVITRA®). An anti-cholesterol drug (statin): simvastatin (ZOCOR®, etc.). An anti-epileptic: carbamazepine (TEGRETOL®, etc.). An anticancer agent: regorafenib (STIVARGA®). An antidepressant: sertraline (ZOLOFT®, etc.). An antiplatelet agent: ticagrelor (BRILIQUE®).

ASSOCIATED DRUGS OR DRUG INTERACTIONS

To treat certain illnesses, your doctor may prescribe several drugs aﬁn order to increase therapeutic efﬁcacy, reduce the risk of accidents or treat several disorders. While the combination of several drugs is generally risk-free as part of a medical follow-up program, this is not the case with self-medication.

WHAT YOU NEED TO KNOW
A drug can modiﬁer the activity or inﬂuer the fate of another drug in your body, leading to incidents or even accidents (this is often the case with the elderly). This is known as drug interaction. Aspirin and other non-steroidal anti-inﬂammatory drugs (NSAIDs) can reduce the activity of diuretics, antihypertensives and heart failure drugs. Over-the-counter phytotherapy (herbal) products containing St. John's wort, used to treat mild, transient depression, can reduce the efﬁcacy of a great many drugs: the pill (and cause an unwanted pregnancy), drugs used to treat heart rhythm disorders, antihypertensives, cholesterol-lowering drugs, antivirals, antibiotics, tranquilizers... Certain over-the-counter products used to unblock the nose, containing vasoconstrictors such as pseudoephedrine, can reduce the efﬁcacy of your anti-hypertensive treatment. Over-the-counter stomach dressings particularly reduce the efﬁcacy of many absorbable drugs taken by mouth (anti-tuberculosis drugs, aspirin, some antibiotics, some neuroleptics, cortisone derivatives, digoxin, ﬂuor, osteoporosis drugs, thyroid drugs, digestive ulcer drugs such as H2 antihistamines, phosphorus, etc.); and generally all drugs taken by mouth.); and generally all oral medications (swallowed by mouth). Take them at a distance (if possible, 2 hours before or after). Over-the-counter iron-based anti-anemics can reduce the activity of certain antibiotics. Over-the-counter vitamin B6 can reduce the action of levodopa, a drug used to treat Parkinson's disease. One drug may increase the effect of another Aspirin and other non-steroidal anti-inﬂammatory drugs (NSAIDs) may increase the activity of certain antidiabetic drugs, methotrexate or anticoagulants. Over-the-counter antihistamine tranquilizers (see Insomnia), combined with certain cough suppressants also available without prescription, increase drowsiness (see Drugs and driving and Drugs with a sedative effect).

OUR RECOMMENDATIONS
Do not self-medicate if you are already being treated for another illness without first speaking to your doctor or pharmacist. If you are being treated for a chronic illness, ask your doctor what medicines he or she will allow you to take for minor health problems. When self-medicating, always opt for single-substance products. Avoid medicines containing more than two substances: they are often old, outdated, poorly designed, inefﬁcient and not without risk. When it comes to medicines, 1 + 1 does not double the efﬁcacy, but generally doubles the risks. Use short courses of treatment (usually 5 days). If symptoms persist or worsen, consult your doctor.

DRUGS AND DRIVING

Some drugs are bad road companions, due to their sedative effect, which reduces reﬂexes, alertness and vision.

WHAT YOU NEED TO KNOW
Apart from alcohol, which is responsible for many traffic accidents, many medicines (with or without a prescription) can seriously impair driving by causing reduced alertness and reﬂexes, drowsiness, dizziness, vertigo, vision problems, hearing problems, a drop in blood pressure, even fainting, and behavioral modiﬁcations. The main families of drugs available without a prescription that present a risk for driving (reduced vigilance and reﬂexes) are: Calcium bromide-based tranquilizers in many forms, sometimes even present in herbal preparations (phytotherapy). Painkillers, especially those containing codeine in addition to aspirin or paracetamol. Anti-allergics (H1 antihistamines); available over-the-counter, these can cause reduced alertness and even drowsiness. Anti-motion sickness" drugs; also H1 antihistamines, they have the same disadvantages. Cough suppressants: all those containing codeine, codethyline, dextromethorphan, promethazine, alimemazine or bromide. What's more, syrups frequently contain alcohol, which is obviously inadvisable when driving a car (when the excipient dose is equal to or greater than 3 g/day). Antivertigo drugs; meclozine (AGYRAX®). Vasoconstrictor-based decongestants for the eye, which can lead to blurred vision. All these negative effects can be ampliﬁed by alcohol. Caution! Drugs such as opium, cannabis, cocaine, amphetamine or LSD, taken alone or in combination, are the cause of many accidents.

OUR RECOMMENDATIONS
If you are taking over-the-counter medication in any of the above categories, take special care when driving a car or operating machinery. If you have drunk alcohol and/or eaten a heavy meal, do not drive. When driving, avoid smoking, do not overheat the vehicle, and ventilate very often. Stop every 2 hours and take a few steps to stretch your legs. Drink water regularly.

LEARN MORE
Prescription drugs and driving The following families of drugs present a risk for driving: tranquilizers or anxiolytics; neuroleptics; antidepressants; antiepileptics; non-steroidal anti-inﬂammatory drugs (NSAIDs); morphine painkillers; antihypertensives; antidiabetics; heart rhythm disorder drugs; antivertiginous drugs, etc. If you are being treated with one of these drugs and experience drowsiness or reduced alertness, talk to your doctor: the disadvantages of these drugs are not always clearly indicated in the leaflets. Don't stop taking any medication abruptly. Long-term treatments, such as those for hypertension, heart rhythm disorders, diabetes or epilepsy, MUST NOT be interrupted.

MEDICATION AND DRY MOUTH

The atropine effect is one of the undesirable effects of a number of drugs. It always manifests itself as dry mouth.

WHAT YOU NEED TO KNOW
Atropine is a substance extracted from the belladonna plant, with certain properties including an antispasmodic action, used to treat pain associated with contractures and to treat certain inﬂammations of the eye. A great many drugs produce the same undesirable effects as atropine. These are known as anticholinergic or atropinic drugs. Peripheral: dry mouth, constipation, accelerated pulse, increased tension inside the eye, visual disturbances due to lack of accommodation, contraction of the bladder sphincter, relaxation of the lower esophageal sphincter... These various effects are due to the blockage of a substance present in the body: acetylcholine. Central (through passage of the blood-brain barrier): confusion, disorientation, visual hallucinations, delirium, aggressiveness, etc. These drugs, some of which are available without prescription, are easily identiﬁed by reading the leaflets: they are all contraindicated in cases of angle-closure glaucoma or urine retention (prostate problems...).

OUR RECOMMENDATIONS
If you suffer from angle-closure glaucoma or urinary retention (e.g. prostate problems), be particularly careful when buying over-the-counter medication. Always seek the advice of your doctor or pharmacist before buying. Read the package inserts and keep them in their original packaging.

LEARN MORE
Categories of drugs with an atropinic effect Tricyclic antidepressants based on imipramine (TOFRANIL®...) or amitriptyline (ELAVIL®, LAROXYL®...). Diphenhydramine-based anti-motion sickness drugs: NAUTAMINE® (sold over the counter), scopolamine-based: SCOPODERM TTS®. Certain antiparkinsonian agents based on trihexyphenidyl (ARTANE®) or biperiden (AKINETON®). Atropine as an antispasmodic: ATROPINE LAVOISIER®, ATROPINE AGUETTANT®, etc. Phenothiazine neuroleptics, based on chlorpromazine (LARGACTIL®). Ipratropium-based bronchodilators (ATROVENT®). First-generation H1 antihistamines based on dexchlorpheniramine (POLARAMINE®), brompheniramine (DIMEGAN®), alimemazine (THERALENE®), promethazine (PHENERGAN®), oxomemazine (TOPLEXIL®...), etc. An analgesic, nefopam (ACUPAN®). A disopyramide-based antiarrhythmic: RYTHMODAN®.

DRUGS WITH A SEDATIVE EFFECT

Many drugs are sedative, causing drowsiness, which can be dangerous when driving (see Drugs and driving).

WHAT YOU NEED TO KNOW
Several families of drugs can impair alertness: either because it is their main action, which is why they are prescribed. This is the case with tranquilizers and sleeping pills; or because it is one of their side effects. This is the case with certain over-the-counter allergy medications. How does it manifest itself? It can range from a simple slowdown in reﬂexes, imperceptible to the patient, to a state of drowsiness that interferes with everyday life. These drugs, which are central nervous system depressants, can also cause respiratory depression.

OUR RECOMMENDATIONS
If you buy an over-the-counter medication in one of the following categories, be careful! Read the package leaflet CAREFULLY and follow the warnings. All sleeping pills or hypnotics. All tranquilizers or anxiolytics. All neuroleptics. Certain antidepressants: imipramine, amitriptyline, trimipramine, doxepin, mianserin, etc. Anti-epileptics. Antinauseants and certain antivertiginous drugs (some of which are available over the counter). Opiate derivatives (painkillers and others): opium (LAMALINE®...), tramadol (CONTRAMAL®...), morphine (SKENAN®...), codeine (CODOLIPRANE®...), methadone, buprenorphine (SUBUTEX®...), etc. Cough suppressants: codeine, codethyline, dextromethorphan (over-the-counter). First-generation H1 antihistamines based on dexchlorpheniramine (POLARAMINE®), brompheniramine (DIMEGAN®), alimemazine (THERALENE®), promethazine (PHENERGAN®), oxomemazine (TOPLEXIL®), diphenhydramine (NAUTAMINE®), etc. Certain central antihypertensives: alphamethyldopa (ALDOMET®), clonidine (CATAPRESSAN®), moxonidine (PHYSIOTENS®). Medicines containing alcohol (over-the-counter syrups, oral ampoules). A muscle relaxant: baclofen (LIORESAL®). Thalidomide, used in the treatment of certain cancerous conditions.

LEARN MORE
How to interpret warning pictograms? If you are taking a medicine belonging to one of the above-mentioned categories, check the box or leaflet for the warning level drawn up by the Agence des produits de santé (pictogram showing a black car in a triangle), aﬁ n order to assess your risk more accurately. Level 1 + The risk is low and depends on individual sensitivity. Patients will find warnings in the package leaflet indicating when they should refrain from driving. Level 2 + pictogram on orange background The risk is high. It is essential to seek the advice of your doctor (or pharmacist in the case of over-the-counter medication) before driving or working on machinery. Level 3 + pictogram on red background The risk is very high. It is totally contraindicated to drive (car or machine) with this type of medication. The doctor must indicate when the patient may drive again.

DRUGS AND LABORATORY TESTS

Many medications can modiﬁ er blood and urine tests. WHAT YOU NEED TO KNOW As an example, here are the over-the-counter drugs most often responsible for these modiﬁcations: Vitamin C can modiﬁer urine sugar, cholesterol, creatinine and uric acid levels... Aspirin can modiﬁer blood or urine uric acid levels and bleeding time, up to eight days after taking a tablet. Paracetamol can distort blood sugar and uric acid tests. Vitamin B2 and certain irritant laxatives can distort some urine tests, particularly sugar tests. For your information, urine can change color and turn: brown or red under the effect of irritant laxatives (senna, cascara, rhubarb), but also if you eat beet; dark yellow under the effect of vitamin B2; brownish-black or green under the effect of methocarbamol (LUMIRELAX®); reddish-brown under the effect of metronidazole (FLAGYL®, RODOGYL®, etc.); reddish-brown under the effect of metronidazole (FLAGYL®, RODOGYL®, etc.).); reddish-brown with vitamin B12.

OUR RECOMMENDATIONS
If your doctor prescribes a laboratory test, please inform him or her of the following ALWAYS any medication you take regularly (with or without a prescription). This will avoid difﬁcult-to-interpret or false-positive/negative results and unnecessary expenses.

DRUGS AND EXCIPIENTS

All medicines are made up of two parts: the molecule(s) or substance(s), and the excipients. However, excipients are not always neutral.

WHAT YOU NEED TO KNOW
Excipients are substances with no therapeutic activity, but which are essential to the manufacture of a medicine for a number of reasons: To stabilize the active ingredient. To facilitate dissolution (solubilization). To improve the appearance and taste of the drug (coloring or sweetening). Preservation (antiseptics, preservatives). Help or delay drug absorption. To obtain the deﬁnitive pharmaceutical form (powder, tablet, capsule, suppository, liquid, etc.). The notorious effect An excipient with a notorious effect is any excipient whose presence may necessitate precautions for use in particular categories of patients, for example: - in certain pathologies; - in infants or young children; - in cases of allergy; - in the case of special diets. Whether or not these excipients are taken into account depends on the route of administration and/or the quantity contained in the drug. 47 excipients (or groups of excipients) are listed as excipients with a notorious effect by the French Medicines Agency. The table below lists the excipients that may be present in marketed products.

EXCIPIENTS	WAY (S)	Risk
Wheat starch	Oral	Wheat allergy (other than gluten intolerance or celiac disease).
Peanut oil	All	Allergy to peanuts or soy (urticaria, anaphylactic shock: generalized rash, breathing difficulties, drop in blood pressure).
Azo dyes (tartrazine E102, orange yellow S E110, azorubin E122, amaranth E123, cochineal red A E124, allura red AC E129, brilliant black E151)	Oral	Allergy (e.g. eczema, urticaria, asthma, naphylactic shock). Cross-allergy (allergy to one of the colorants leads to allergy to the other components in the class).
Aspartam	Oral	In case of phenylketonuria (rare hereditary genetic disease). Baume du Pérou Cutaneous Allergy (e.g. eczema).
Benzalkonium	Eyepiece	Eye irritation. Skin Allergy. Respiratory Swelling of nasal mucosa, respiratory discomfort.
Benzoic acid and benzoates	Cutaneous	Skin, eye and mucous membrane allergy. Injectable Jaundice (infants under 1 month).
Benzyl alcohol	Injectable	Allergy or toxicity in children under 1 month or 3 years of age, depending on dose. Bergamot oil Cutaneous Photosensitization (sensitivity to light). Bronopol Cutaneous Skin allergy (e.g. eczema). Cetostearyl, cetyl alcohol Cutaneous Skin allergy (e.g. eczema). Chlorocresol Cutaneous Allergy.
Ethanol (alcohol)	Oral, injectable	Dangerous for alcoholics. Children, patients with impaired liver function, epileptics, pregnant or breast-feeding women. Interactions with other drugs, driving or operating machinery (3 g daily or more).
Formaldehyde	Cutaneous	Skin allergy (e.g. eczema).
	Oral	Digestive disorders.
Fructose	Oral, injectable	Harmful to teeth. Fructose intolerance (rare hereditary disease). Low-sugar diet or diabetes (5 g or more per day).
Galactose	Oral, injectable	Galactose intolerance (rare hereditary disease). Low-sugar diet or diabetes (5 g or more per day).
Glucose	Oral, injectable	Harmful to teeth. Glucose intolerance (rare hereditary disease). Low-sugar diet or diabetes (5 g or more per day).
Liquid maltitol (hydrogenated glucose syrup)	Oral	Fructose intolerance (rare hereditary disease). Caloric intake and laxative effect (from 10 g per day). Glycerol Oral Headache and diarrhea (from 10 g/day).
Heparin	Injectable	Allergy to heparins and heparin derivatives. Thrombocytopenia (coagulation disorder) due to heparins.
Butylated hydroxyanisole E320	Cutaneous	Skin allergy (e.g. eczema), eye and mucous membrane irritation.
Butylated hydroxytoluene E321	Cutaneous	Skin allergy (e.g. eczema), eye and mucous membrane irritation.
Lactitol E966	Oral	Lactitol intolerance (rare hereditary disease). Caloric intake, digestive disorders and laxative effect (from 10 g per day).
Lactose	Oral	Lactose intolerance (rare hereditary disease). Low-sugar diet or diabetes (from 5 g per day). Lanolin (wool fat) Cutaneous Skin allergy (e.g. eczema). Latex (natural rubber) present in syringe caps, for example All Skin or general allergy (urticaria, asthma, anaphylactic shock...).
Maltitol E965, isomaltitol E953	Oral	Fructose intolerance (rare hereditary disease). Digestive disorders and laxative effect (from 10 g per day). Mannitol E421 Oral Digestive disorders and laxative effect (from 10 g per day).
Organomercurials (thiomersal, mercury derivatives, etc.)	Ocular, injectable	Allergy. Cutaneous Skin allergy (e.g. eczema), depigmentation.
Parabens (parahydroxybenzoates...)	Oral, ocular, cutaneous	Skin or mucous membrane allergy.
	Injectable, respiratory	Allergy (hives, respiratory discomfort).
Phenylalanine	All	In case of phenylketonuria (rare hereditary genetic disease).
Potassium	Oral, injectable	Low potassium diet, renal failure. Intravenous Pain at IV injection site, phlebitis.
Propylene glycol and derivatives	Cutaneous	Skin allergy (e.g. eczema).
	Oral, injectable	Alcohol-like symptoms (from 400 mg/kg in adults or 200 mg/kg in children).
Castor oil and derivatives	Cutaneous	Skin allergy (e.g. eczema).
	Injectable	Skin or general allergy (respiratory problems, anaphylactic shock). Oral Laxative effect, digestive disorders.
Sucrose	Oral, injectable	Harmful to teeth. Sucrose intolerance (rare hereditary disease). Low-sugar diet or diabetes (from 5 g per day). Sesame oil All skin or general allergies. Sodium Oral, injectable Low-sodium diet.
Soybeans and derivatives	All	Allergy to peanuts or soy (urticaria, anaphylactic shock: generalized rash, breathing difficulties, drop in blood pressure). Sorbic acid and sorbates Cutaneous Skin allergy (e.g. eczema).
Sorbitol	Oral, injectable	Fructose intolerance (rare hereditary disease). Laxative effect. Stearyl alcohol Cutaneous Allergy (e.g. eczema).
Invert sugar	Oral	Harmful to teeth. Fructose or glucose intolerance (rare hereditary disease). Low-sugar diet or diabetes (5 g or more per day).
Sulﬁtes and derivatives (sulphur dioxide, sulﬁte de...)	Oral, injectable, respiratory	Skin allergy (e.g. urticaria) or general allergy (breathing difficulties, anaphylactic shock). Xylitol Oral Laxative effect, digestive disorders (from 10 g/day).

OUR RECOMMENDATIONS
Ifyou are prone to allergies, ask your doctor or pharmacist for advice before buying any over-the-counter medication.

DRUGS AND GENERICS

The share of generic drugs in volume terms in France is around 35%, which is still very low compared to the rates afﬁchés in Germany (72%), the UK (71%) and the US (80%), due to a lack of communication on the part of public authorities and lobbying by certain laboratories.

WHAT YOU NEED TO KNOW
A generic drug is a copy of a brand-name drug whose patent has fallen into the public domain. It contains the same substance, but not necessarily the same excipients (see Drugs and excipients). It has the same therapeutic activity. It is subject to the same controls as the reference drug and, like all drugs, must obtain a marketing authorization (AMM) issued by the ANSM, the French national agency for drug and health product safety (see Some good truths about drugs). It generally costs around 30% less than the reference drug (the "originator"), as the laboratory producing it does not have to amortize the research costs incurred in its development. The vast majority of over-the-counter medicines have generic equivalents. Most illnesses can be treated with generics, which are available in various forms: tablets, capsules, syrups, suppositories, etc. Some doctors prefer to treat their patients with the reference drug. In such cases, they mark their prescriptions with a NS (for "non substitutable").

OUR RECOMMENDATIONS
If you are taking a treatment with a generic drug, it is preferable to continue this treatment with the same generic, especially for drugs whose quantity of substance must be very precise (narrow therapeutic margin). This applies in particular to anti-epileptics: sodium valproate (DEPAKINE®), lamotrigine (LAMICTAL®), etc.; thyroid medications: levothyroxine (LEVOTHYROX®).

DRUGS AND THE INTERNET

Over the past few years, there has been a proliferation of web-based drug marketing sites offering treatments for overweight, erectile dysfunction and even cancer. Beware, however, that this is not without health risks. WHAT YOU NEED TO KNOW Buying medicines over the Internet is totally irresponsible, for several reasons: 50% of medicines sold over the Internet are counterfeit (source: World Health Organization, WHO). Some products contain too little active ingredient, and are therefore inefﬁcient, while others contain potentially toxic overdoses, or are at best mere window dressing. Russian roulette! Having free access to prescription-only drugs is idiotic. If many drugs in France are prescription-only, it's because taking them must be supervised by your doctor, because of the risks associated with interactions, contraindications, misuse... The provenance of drugs on the Internet is unknown. Even if they bear a well-known name already marketed in France, you have no guarantee of their authenticity, as their distribution circuit (outside the French legal framework) escapes the controls of the health authorities. Self-medication or not, with or without a prescription, medicines are not goods like any others. You certainly wouldn't buy a box of aspirin from a stranger in the street!

OUR RECOMMENDATIONS
Don't buy any medicines over the Internet, except from pharmacy websites recognized by the French Pharmacists' Association (Conseil de l'ordre des pharmaciens).

DRUGS AND HEART RHYTHM DISORDERS

Some drugs can cause a severe heart rhythm disorder known as "torsades de pointes", a variety of very serious ventricular tachycardia, which occurs in certain circumstances. Take care when self-medicating if you suffer from heart rhythm disorders!

WHAT YOU NEED TO KNOW
The risk of "torsades de pointes" is increased when combined with drugs that reduce potassium levels in the blood (hypokalemia), e.g. over-the-counter irritant laxatives, cortisone and its derivatives (glucocorticoids), tetracosactide (SYNACTHENE®) or hypokalemic diuretics.

OUR RECOMMENDATIONS
Be careful when self-medicating! If you have heart rhythm problems, do not take NEVER irritating laxatives, or you risk a serious accident. If you have any in your medicine cabinet, it's best to get rid of them! Drugs available in pharmacies with a risk of torsades de pointe Anti-arrhythmics: amiodarone (CORDARONE®, etc.), disopyramide (RYTHMODAN®, ISORYTHM®), dronedarone (MULTAQ®), hydroquinidine (SERECOR®), sotalol (SOTALEX®, etc.). Neuroleptics : amisulpride (SOLIAN®), chlorpromazine (LARGACTIL®), cyamemazine (TERCIAN®), ﬂ upentixol (FLUANXOL®), ﬂ uphenazine (MODECATE®), haloperidol (HALDOL®), levomepromazine (NOZINAN®), pipamperone (DIPIPERON®), pipotiazine (PIPORTIL®), pimozide (ORAP®), sulpiride (DOGMATIL®, etc.), tiapride (TIMATIL®, etc.).), tiapride (TIAPRIDAL®, etc.), zuclopenthixol (CLOPIXAN®). Antidepressants: citalopram (SEROPRAM®, etc.), escitalopram (SEROPLEX®, etc.). H1 antihistamines: hydroxyzine (ATARAX®, etc.), mequitazine (PRIMALAN®). Antiparasitics: chloroquine (NIVAQUINE®), lumefantrine (RIAMET®), pentamidine (PENTACARINAT®), piperaquine (EURARTESIM®), quinidine (QUINIMAX®). Anticancer agents: toremifene (FARESTON®), vandetanib (CAPRELSA®). Antibiotics: spiramycin (RODOGYL®, etc.), moxiﬂ oxacin (IZILOX®, etc.). Antiemetic: domperidone (MOTILIUM®, etc.). An antirheumatic and dermatological drug: hydroxychloroquine (PLAQUENIL®). A laxative: prucalopride (RESOLOR®). A drug for opiate dependence: methadone (METHADONE APHP®).

MEDICATION AND SUN

Certain medications can cause abnormal skin reactions when exposed to the sun. Be careful if you're on medication!

WHAT YOU NEED TO KNOW
Several classes of medication can cause skin reactions of varying degrees of severity: phototoxicity and photoallergy. Phototoxicity is an excessive reaction of the skin to areas exposed to the sun. It can manifest itself from the first exposure as a banal sunburn to a superﬁ cielle second-degree burn, depending on the duration of exposure. Photoallergy is triggered after a second exposure to the sun, a few days after the first. It manifests as an eczema-like rash. It spreads to unexposed parts of the body. What drugs are involved? Certain locally-applied medications: colored antiseptics such as merbromine (MERCURESCEINE AQUEUSE GIFRER®), eosin or local anti-fungal treatments, anti-allergy creams (antihistamines such as promethazine, like PHENERGAN®), certain anti-acne products based on vitamin A derivatives or benzoyl peroxide (CURASPOT®, PAPCLAIR®...). This is also the case for drugs taken by mouth: several antibacterial drugs such as sulfonamides, tetracyclines (doxycycline, minocycline), some antidiabetics or diuretics, some antiallergics, some antidepressants, some neuroleptics, some anti-fungi, some urinary antiseptics, some heart medications, some anticoagulants, some contraceptive pills.

OUR RECOMMENDATIONS
Ifyou are undergoing medical treatment, before going out in the sun, ask your doctor for advice. ALWAYS Ask your doctor or pharmacist for advice, and read the package inserts carefully.

BEST PRACTICES :

MEDICINE CABINET

Indispensable for saving time in an emergency, a well-designed family medicine cabinet is the basic tool for safe, efﬁcient self-medication.

WHAT YOU NEED TO KNOW
Which container? Choose an unglazed wooden or metal cabinet with plenty of compartments and shelves for easy storage. Place the medicine cabinet in a dry place, away from sources of heat (so not in the kitchen!). Medicines can lose their efﬁcacy and even become dangerous if exposed to heat, humidity and light. Place the cabinet in a place that is completely inaccessible to children. Ideally, it should be lockable (with the key in a safe place) to prevent accidents.

LEARN MORE
Drug poisoning is the second leading cause of accidents in children under 15. In 55% of cases, the drugs involved are sleeping pills, tranquilizers, aspirin in all its forms, sweet-tasting chews and syrups. What can be put in it? Essential medicines, dressings and instruments to treat minor health problems and accidents (scratches, superﬁcial burns...) that can happen at any time (even at night and on Sundays!). Apart from that, any medication prescribed by your doctor for you and your family. All prescriptions, placed in a pouch, eliminating as you go along those that are no longer valid. Small items Sterile compresses in individual packs. Hypoallergenic adhesive bandages. Plasters. Absorbent cotton. Unbreakable electronic mouth thermometer or forehead temperature gauge. Round-tipped scissors. Tweezers. Stretch bandage, such as VELPEAU®. Safety pins. Dental ﬁl. Condoms. Essential medicines 70° alcohol to disinfect the skin (before an injection). An antiseptic for skin wounds, e.g. aqueous chlorhexidine, such as DOSISEPTINE®, and povidone-iodine, such as BETADINE DERMIQUE® (see Superﬁcial wounds and cuts). Paracetamol, such as PARACETAMOL EG LABO® (see Fever, Pain) in various dosages. A non-steroidal anti-inﬂ ammatory (NSAID) such as ibuprofen, type ANTARENE®. Single-dose saline solution for nose and eyes, such as PHYSIODOSE®. A cetirizine-based antihistamine, such as CETIRIZINE SANDOZ CONSEIL®. A dextromethorphan-based cough medicine (see Cough), such as PULMODAXE® or TUSSIDANE®. A mild laxative (see Constipation) based on lactulose, such as LACTULOSE MYLAN®, lactitol, such as IMPORTAL®, or macrogol, such as MACROGOL SANDOZ®. An antidiarrheal: a transit-slowing and antisecretory agent based on loperamide, such as LOPERAMIDE ARROW CONSEIL®, or racecadotril, an antisecretory agent such as TIORFAST® (see Diarrhea). A 0.5% hydrocortisone ointment or cream for insect bites and other minor itching, such as CORTAPAISYL®. A phloroglucinol-based antispasmodic, such as SPASFON LYOC®. An antacid stomach dressing, such as XOLAAM®. Oily tulle for burns (see Skin burns). Anti-hemorrhagic wadding, such as COALGAN® wadding (see Nosebleed or epistaxis). Arnica-based anti-ecchymosis cream, such as ARNICA BOIRON®. The right organization
Put doctor-prescribed medicines on one side. On the other, medicines to treat minor everyday health problems. Carefully separate medicines for adults from those for children (paracetamol, syrups, nasal drops, etc.). Keep all medicines and package inserts in their original packaging. This will enable you to check the indications, conditions of use, dosage, contraindications and expiry date each time you use them. Post the list of medications inside the cabinet. Keep medical prescriptions in a pouch. How to manage your medicine cabinet Eliminate all medicines without packaging or instructions. Be careful with liquid medications, especially eye medications. Eye drops expire very quickly (2 weeks) after the ﬂacon has been opened, even if the expiration date has not passed. Keep your vaccines cool, at 4°C in your refrigerator, until you use them. Vériﬁez ou faire contrôler vos médicaments, une fois par an, par votre médecin ou votre pharmacien, aﬁn d'éliminer ceux qui sont périmés ou devenus inutiles. Avoid pouring liquid medicines down the drain (sink or WC): some products are toxic and can pollute the environment. Avoid burning liquid medicines yourself, as burning them can either produce noxious fumes or cause a small fire. At the ﬁn of any treatment prescribed by your doctor, dispose of ALL unused medicine boxes - yes, even antibiotics! This will prevent you from self-medicating, which is NEVER recommended. Don't throw them in the garbage can: this can be dangerous, as they can be picked up and reused. Take them to your pharmacist. Essential numbers Stick a list of emergency telephone numbers on the medicine cabinet door: EMS number: 15 or 112 Fire brigade number: 18 Doctor's number Police emergency number: 17. You can also get the number of the doctor or pharmacy on call. No. of your local poison control center No. of your local burn center No. of nearest hospital No. of ambulance company No. of cab company (or nearest taxi rank)

CAR FIRST-AID KIT

Even if you're not crossing the Gobi Desert or the Amazon, it's a good idea to pack a small first-aid kit, especially if you're traveling with children.

WHAT YOU NEED TO KNOW
What type of kit? Ideally, you should buy a small kit in isothermal fabric to protect your medicines from the heat. Keep the kit in the trunk, cooler than the glove compartment, in an easily accessible place. Check its contents once a year (e.g. before the summer vacations) and adapt it to the people you're carrying and the trip you're planning. What it should contain Small items Sterile compresses. Adhesive bandages. Round-tipped scissors, tweezers. Elastic band with safety pin. Medication An antiseptic solution based on aqueous chlorhexidine, such as DOSISEPTINE®. A painkiller: paracetamol that can be taken without water (PARALYOC®). An antiallergic: cetirizine, such as CETIRIZINE SANDOZ CONSEIL®. An anti-itching agent or, in the case of insect bites: hydrocortisone 0.5%, such as CORTAPAISYL®. Anti-motion sickness": diphenhydramine, such as NAUTAMINE® (not to be given to drivers, as it may cause drowsiness). Physiological saline solution in pods, such as PHYSIODOSE®. An arnica-based anti-ecchymosis product, such as ARNICA BOIRON®. Hygiene and cosmetics A tube of ﬁltrant sun cream (see Sunburn or sun rash). A pair of quality sunglasses. Mosquito repellent: diethyltoluamide-based DEET, such as INSECT ECRAN®.

TRAVELER'S FIRST-AID KIT

Even if you're not going away for very long or very far, you need to pack a small first-aid kit, especially if you're traveling abroad or with children.

WHAT YOU NEED TO KNOW
This kit should contain the prescription medications you take regularly. Evaluate 48 hours before departure (to give yourself time to stock up) the number of medicines you will need for the duration of your stay. To be on the safe side, take a copy of your prescriptions and keep it with your papers. Add any medicines and medical supplies you may need on site. This list should be adapted to your destination. If you're staying in France or going to a large city, all you need is your personal medication, a painkiller (always useful), sun cream (winter and summer), a few adhesive bandages and an antiseptic spray. But if you're traveling in more precarious conditions, be prepared! Painkillers: paracetamol, such as PARACETAMOL EG LABO®, ibuprofen, such as ANTARENE® (see Fever). A phloroglucinol-based antispasmodic, such as SPASFON LYOC® (to calm any painful intestinal crisis). A cetirizine-based anti-allergic, such as CETIRIZINE SANDOZ CONSEIL®, to deal with minor allergic problems. A loperamide-based transit decelerator, such as LOPERAMIDE ARROW CONSEIL®, or racecadotril, such as TIORFAST®, for diarrhea without ﬁèvre. A mild osmotic laxative, such as MACROGOL SANDOZ®, if you are prone to constipation when traveling. An antinauseant such as NAUSICALM® in case of vomiting. An antibiotic for urinary problems: for example, oﬂoxacin (MONOFLOCET®) or fosfomycin (MONURIL®) prescribed by your doctor. Physiological saline solution in pods, such as PHYSIODOSE®, to wash your eyes or unblock your nose. 0.5% hydrocortisone ointment for itching and insect bites, such as CORTAPAISYL®. Chloroquine-based anti-malarial drugs, such as NIVAQUINE® (for prevention and possible cure), prescribed by your doctor for malaria-endemic countries, and a more speciﬁc anti-malarial drug prescribed by your doctor for resistant regions. Medical equipment and dressings to take with you Sterile compresses, an antiseptic solution based on aqueous chlorhexidine, such as DOSISEPTINE®, and antiseptic adhesive dressings. Electronic thermometer or forehead temperature gauge. Round-tipped scissors, tweezers. ﬁltrant sun creams. DEET (diethyltoluamide)-based mosquito repellents, such as INSECT ECRAN®. A mosquito net impregnated with mosquito repellent (such as INSECT ECRAN MOUSTIQUAIRE®) if you are staying in a highly malarious area. Antiseptic tablets: HYDROCLONAZONE® or better: AQUATABS®, for water disinfection.

OUR RECOMMENDATIONS
Forget suppositories, glass containers, alcohol, ether, colored antiseptics and tablets without packaging or instructions. If you take your kit with you in the airplane cabin, check with your airline for current standards. For further information Information centers for the prevention of travel-related illnesses: Centre médical Institut Pasteur, www.pasteur.fr; Santé Voyages, Hôpital Bichat-Claude-Bernard, tel. 01 40 25 88 92. To find the telephone number of the Santé Voyages center in your area, search the Internet for "Santé Voyages" followed by the name of your nearest university town.

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If you're abroad, you can find the name of a drug by its INN (International Non-proprietary Name), which is the name of the substance. It is always written in small type on medicine boxes, just below the brand name. Specialty names, i.e. the trade names written on medicine boxes, are written in CAPITAL LETTERS and vary from country to country. Example: DOLIPRANE® (brand name) Paracetamol (INN) Vaccinations Childhood nightmares for some, vaccinations
- mandatory or not - are a medical procedure and must be supervised by your doctor.

WHAT YOU NEED TO KNOW
Vaccination against an infectious disease (virus or bacterium) consists in inoculating, i.e. transmitting to a person (or animal) the germ responsible for the disease, after having first killed or modiﬁed it. Vaccination is generally carried out by injection. Once modiﬁed or killed, the germ cannot transmit the disease, but only provokes the body to form defense substances called antibodies. It is these antibodies that will protect the vaccinated person if they subsequently come into contact with the germ in question. But be careful! For protection to be efﬁcacious, the vaccine must be repeated twice, a few weeks apart, except in the case of influenza vaccination, for example. Vaccination does not provide eternal protection. Boosters are therefore required every 5 or 10 years. To make it easier to keep track of your vaccinations, it's a good idea to keep an up-to-date vaccination record. Have it signed by your doctor every

VACCINATIONS

Even though many vaccines are available without a prescription, we recommend that you always consult your doctor beforehand. He or she will decide whether or not vaccination is advisable, and will take into account any contraindications to vaccination in relation to your state of health. Principle The vaccination calendar ﬁxe the vaccinations applicable to people residing in France, according to their age. The compulsory vaccinations are as follows: - against diphtheria, tetanus and poliomyelitis (DTP); - against yellow fever (infection caused by a virus transmitted by mosquitoes) for residents of the French Guiana department aged over 12 months or any person staying there. Persons with parental authority must ensure that this obligation is respected. Recommended vaccinations cover: - diseases such as tuberculosis (BCG), whooping cough, rubella, measles, mumps, chicken pox, influenza, hepatitis B, shingles; - invasive Haemophilus inﬂuenzae type B, pneumococcal and meningococcal C infections. Please note! Even though vaccines are generally available without a prescription, you should always seek your doctor's advice before being vaccinated. Be aware of the "health" context of the person to be vaccinated: people undergoing certain treatments, pregnant or breast-feeding women, ﬁve states, illnesses... Vaccination, a tool for eradicating epidemics!

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In 1945, 1,000 people died of tetanus in France, compared to just 11 deaths between 2008 and 2011, and smallpox was eradicated in 1977 thanks to smallpox vaccination. Individual protection through vaccination, extended to the entire population, has thus proved to have a collective prevention dimension. Today, an anti-vaccination campaign is spreading on the Internet which, by highlighting the few cases of intolerance, feeds the idea that all vaccines equal danger, thus ignoring medical history. According to the WHO (1994), vaccinations (diphtheria, tetanus, whooping cough, measles, poliomyelitis, tuberculosis) prevent three million deaths every year. In addition to the danger to a child of not being vaccinated against the most serious contagious infectious diseases, this hostility to vaccines reduces the community's protection against certain epidemics such as measles (according to the Agence nationale de santé publique, from January 1, 2008 to May 31, 2016, more than 24,000 cases of measles were reported in France, including almost 15,000 cases notiﬁés in 2011 alone. Nearly 1,500 cases presented with severe pneumopathy, 34 with neurological complications and 10 died).

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The usefulness of the vaccination booklet: How do you know if your vaccinations are up to date? Ideally, you should have a vaccination booklet for each member of your family, and keep it with passports or in the family medicine cabinet. Don't know if you're up to date with your vaccinations and have misplaced your booklet? Ask your doctor for advice. For example, if you often garden, it's essential to be vaccinated against tetanus (it still kills in France!). The booster is given every ten years. Are you traveling and unsure of your vaccinations? Some vaccinations are compulsory, such as yellow fever (Guyana and certain countries). If you're planning a trip to a developing country, consult your doctor (or pharmacist) three months before departure. He or she will tell you which vaccinations are recommended, depending on the destination, duration and conditions of the trip, as well as your individual case. To find out more: http://social-sante.gouv.fr/IMG/pdf/calendrier_ vaccinal_2016.pdf

ADULT SYMPTOMS AND ILLNESSES

Acne (adults/adolescents)
Allergies
Bulbs
Angina
Anxiety
Mouth ulcers
Smoking cessation and smoking withdrawal
Asthma
Bloating, flatulence and aerophagia
Bruises and hematomas
Cold sores or herpes labialis
Acute benign bronchitis
Heartburn
Skin burns
Hair loss or alopecia
Muscle strain
Conjunctivitis, eye and eyelid disorders
Constipation
Contraception
Corns, calluses and partridge eyes
Heat stroke or sunstroke
Sunburn and sun allergy
Curvatures
Muscle cramp
Cystitis and urinary tract infection
Itching or pruritus
Teeth and gums
Mild depression
Seborrheic dermatitis
Acute diarrhea
Difficult digestion or dyspepsia
Pain
Osteoarthritis and other joint pains
Anal pain
Ear pain and wax plugs
Back pain
Fatigue or asthenia
Fever
Folliculitis, boils and anthrax
Scabies
Flu and flu-like conditions
"Hangover
Hemorrhoids (hemorrhoidal crises)
Benign prostatic hyperplasia (difficulty urinating)
Insomnia (minor sleep disorder)
Heavy legs
Sore throat
Seasickness, Motion sickness
Bad breath or halitosis
Headaches and migraines
Athlete's foot
Nail fungus
Vaginal mycosis or candidiasis
Nausea and vomiting
Panaris
Morning-after pill
Insect bites
Superficial wounds and cuts
Lice, nits and crabs
Weight gain and obesity
Gastroesophageal reflux disease
Painful periods or dysmenorrhea
Rhinopharyngitis
Head cold or coryza
Hay fever and other allergic rhinitis
Nosebleeds or epistaxis
Dry mouth or xerostomia
Dry eyes
Spasmophilia
Pregnancy tests
Torticollis and neck pain
Cough
Menopausal disorders and hot flashes
Warts
Intestinal worms
Dizziness

CHILDREN'S SYMPTOMS AND ILLNESSES

Constipation in children
Acute diarrhea in children over 3 years of age
Pain in children
Ear pain and otitis in children
Red baby bottom or diaper rash
Childhood fever
Sore throat and angina in children
Motion sickness in children
Children's tummy aches
Teething
Lice and nits in children
Regurgitation and vomiting in infants
Rhinopharyngitis in children
Childhood cough