An expert is a man who has made all the mistakes which can be made in a very narrow field.

Niels Bohr

Buying prescription drugs via internet

First, it's important to carefully consider the source of information and then to discuss the information you find with your health care professional. These questions and answers can help you determine whether the health information you find on the Internet or receive by e-mail from a Web site is likely to be reliable.

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

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

Drug interactions

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

Early in a drug's development, companies conduct research to detect or predict potential interactions between drugs. Experts evaluate the drug-interaction studies as part of assessing a drug's safety.

The most important enzymes in the liver that metabolize drugs are called the cytochrome P450 family of enzymes. These enzymes break down drugs when they pass through the liver or small intestine.

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

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

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

In addition to having a good grasp of drugs and their effects, doctors take medication histories, and they consult with other members of their team to guide them in making decisions about drug interactions. They also use concise drug summaries and resources on pharmacological principles.

Health professionals also use computer systems with drug-interaction screening software, electronic prescribing, and other technology. Mark Langdorf, M.D., chair of the department of emergency medicine at the University of California, Irvine, says, "In a busy emergency room, you have to quickly find out what a patient is taking and how those drugs could interact with other treatments."

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

Some antibiotics, such as rifampin, can lower the effectiveness of birth control pills. Sildenafil, the active ingredient in the erectile dysfunction drug Viagra, should not be taken with nitrates for heart treatment because of the potential for dangerously low blood pressure.

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

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