Get help Advice and information leaflets Understanding your medicines Contents Introduction Types of medication Four questions to ask Additional questions Generic versus branded Biologic versus biosimilar Medicines adherence Side effects Medication review Preparing for a medication review More information Introduction Most people will take medicines at some point in their lives. They can be used to stop you getting ill, control a condition or cure an illness. To make the most of your medicines, you need to: Take them at the right times Take them in the right way Look out for side effects Make sure you always have enough. This leaflet is designed to help you understand your medicines and how to manage them. Your rights When you are prescribed a medicine, a health professional should sit down and discuss your options with you. They should explain the benefits and risks and answer any questions you have. The final decision is yours. You do not have to agree to anything you are not happy with. For more information on how to be involved in your treatment, see our leaflet Advanced Decision. Types of medication Prescription only You can only take these medicines if they have been prescribed by a professional, normally a doctor or nurse. Most prescriptions are now electronic. This means your medicines will be sent to a pharmacy of your choice and you do not have to hand in a paper prescription. Not all conditions or medicines require a prescription. In 2018, NHS England published new guidance for minor, short-term health conditions. It said medicines should not be routinely prescribed for conditions which: Are self-limiting – they will heal on their own (this includes minor infections which do not need antibiotic treatment) Can be treated by an over-the-counter medication Lend themselves to self-care. If you pay for your prescription, it is worth asking the pharmacist about your options. Over the counter These are medicines you can buy without a prescription. They include mild painkillers and cold remedies. Some can be bought from a supermarket. Others can only be bought at a pharmacy. You should still follow instructions on how to take over-the-counter medicines. Taking them in the wrong way or combining them with other medicines can have serious effects. Herbal These are medicines with active ingredients from plant parts. Just like conventional medicines, they have an effect on the body. They can be harmful if not used correctly. Some herbal medicines and supplements should not be taken with certain medicines. Always tell your doctor or pharmacist about any herbal medicines you are taking. Four questions to ask There are four main questions to think about when starting a new medication. Remember the initials BRAN (Benefits, Risks, Alternatives and Nothing). What are the benefits? What are the risks? What are the alternatives? What if I do nothing? Below are some suggested questions for each of those areas. Benefits What are the benefits of this medication? What are the chances it will work? How will I know if it is working? Risks How will it affect me? What are the possible side effects? How will it affect my lifestyle? Alternatives What other options do I have? Could I try one if the first option does not work? Nothing What are the benefits if I choose to do nothing now? What are the disadvantages if I do nothing now? Additional questions Below are some extra questions you may want to ask about your medication. Select a maximum of five questions below which are relevant to you to get the maximum benefit from your appointment They cover practical concerns and what to do if you are unhappy. If there is anything you are unsure about it is always best to ask. What is my medication called? Why am I being prescribed it? How and when should I take it? What should I do if I miss a dose? What will happen if I do not take the medication? How long will I need to take it for? Is there anything I should avoid? What should I do if I feel unwell? How do I get more of this medication if it runs out? What is the difference between the generic and branded version? What is the difference between the biologic and biosimilar version? Is there anything I can do to help myself? What should I do if I want to stop taking this medication? Is there anything that can remind me to take my medicines? Can I have containers that are easier to open? Could you provide the patient information leaflet in a larger print? Where can I go for more information? Generic versus branded All medicines have a patent that lasts a number of years. This means only the company which developed the medicine is allowed to sell it. All new medicines will have a ‘brand’ name and a ‘generic’ name. For example, sildenafil is the generic name of a medicine used to treat erectile dysfunction. Pfizer, the company that developed it, sells it under the brand name Viagra. When the patent expires on a medicine other companies are able to sell ‘generic’ versions of the same medicine. Are they the same? Yes. The generic versions will be the same as the branded medicine because they contain the same active ingredients. Are they safe? There are strict rules in place to make sure they work as well and are as safe as the originals. Why the change? Generics are used by the NHS because they are as effective but cost far less. It is similar to buying branded goods or a supermarket's own label – the supermarket's version is usually cheaper. Biologic versus biosimilar Biologic medicines are used to treat some long-term conditions, including Crohn’s disease and psoriasis. They are normally prescribed and given in hospitals but some may be injected at home. Biologic medicine is made from proteins and other substances produced by the body. It is a liquid given by a drip or injection pen. A biosimilar is a newer version of the original biological drug. It works in the same way. The patents on many biologics have ended. Other pharmaceutical companies are able to make biosimilars. These are now available to the NHS and you may have been asked to switch from the brand to the biosimilar. What is the difference? Biosimilars are newer versions of the original biologics. They are very similar in terms of quality, safety and clinical effectiveness. Are they safe? There are strict rules in place to make sure they work just as well and are as safe as the originals. Why the change? Biologic treatments are expensive for the NHS to buy. Biosimilars help to lower the cost. How can I find out more? For more information see our leaflet Switching to biosimilars. Medicines adherence Medicines adherence means you follow instructions on how you take your medication. If you do not take your medicines correctly this can lead to side effects or the condition getting worse. You should: Take the dose recommended by your GP or pharmacist Check the instructions to make sure you are taking it correctly Keep instructions in a safe place so you know where to find them Use your own supply – never take medication prescribed for someone else. Medication plan One way to help make sure you take your medicines correctly is to create a medication plan. This should include: A list of all your medications – including prescription, over-the-counter and herbal How often you take them What they are for Any side effects What medication you need to take each day and when. Keep a copy of your plan and share it with your GP and pharmacist. Pill organisers If you are taking a number of medications, pill organisers can be helpful. You can fill these yourself, or with help from family and carers. They have separate compartments for days and times, helping you to take your medication correctly. You can also set daily reminders on your mobile phone to prompt you to take medication. You can also ask your pharmacist for support if necessary. Side effects All medicines can have side effects. These will be listed in the leaflet which comes with your medicines. If you are having problems with your medication talk to your GP or pharmacist before making any changes. Suddenly stopping certain medicines can create new side effects or worsen your health condition. If there is an urgent or serious problem contact your doctor or pharmacist immediately. It is important to report any side effects you have. Reporting a side effect If you think a medicine has caused an unwanted side effect you can report the problem to the Medicines and Healthcare Products Regulatory Agency on a Yellow Card. Reports of unwanted side effects are collected through the Yellow Card Scheme on all types of medicine. This includes non-prescription and herbal remedies. Even if you are not sure if a medication or combination of medications has caused a side effect you should still create a Yellow Card. Yellow Card forms are available from pharmacies, other NHS outlets or by calling 0808 100 3352. Yellow Card reports can also be created at www.gov.uk/report-problem-medicine-medical-device. Medication review A ‘medication review’ or ‘medicines use review’ is a chance to discuss all your medications with your pharmacist. This is extremely beneficial for patients on long term medications. It is free but you will need to book. Meetings are confidential. What does it cover? The review is a chance to meet your pharmacist to talk about: The medicines you are taking What they do How well they work for you How to get the most out of them. Your pharmacist may be able to suggest ways to make your medication more effective. You may find you need fewer medicines than before. Who is a review for? You can ask for a review if you have been using a pharmacy for at least three months and: You regularly take more than one prescription medicine You are taking medicines for a long-term illness. Even if you are not in either of these groups you can still ask your pharmacist for advice. How do I get a review? Your pharmacist might invite you for a review or you can ask for one. Not every pharmacy offers this service. You can also discuss your medicines with your GP. What should I tell them? As much as you can. Your pharmacist will only know about the medicines you have received from that pharmacy. They will not have a record of other prescriptions, non-prescription or herbal medicines. What happens next? You will be given an Action Plan. A copy will also go to your GP to be put into your medical notes. Your pharmacist may recommend a change to your prescription. Preparing for a medication review You will have limited time during your medication review. Below are some tips to help you prepare and make the most of that time. Make a note of all your medicines Take any medicines you no longer use with you Write down your questions, concerns and suggestions Make sure you know when the review is taking place, where it is and who it is with. Concerns Issues which could be raised at your review include: Difficulty taking medicines, for example if they are hard to swallow Taking lots of different tablets at different times Not knowing what each of your medications is for Your medicines do not mix You are experiencing side effects. Urgent problems If there is an urgent problem you should not wait for a medicines review. Instead, contact your doctor or pharmacist immediately. Urgent problems include: Taking too much of any medicine An allergic reaction to a new medicine A serious side effect Unusual symptoms Your health getting worse. More information Below are some useful website links. If you do not have internet access you can go online at your local library or call the Patients Association helpline on 0800 345 7115. If you have been prescribed a medicine to treat a long-term condition for the first time you may be able to get extra support from your pharmacist through the free New Medicines Service. Ask if you can take part when you take your prescription to your pharmacy. Most long-term conditions have dedicated charities which can offer you specialised support. Useful websites nhs.uk – information on the New Medicines Service gosh.nhs.uk – advice and information on medicines for children gov.uk – report a possible side effect independentage.org – advice on managing your medicines medicines.org.uk/emc – information about prescription medicines Sources Source material for the information contained in this leaflet is available on request. Contact the Patients Association helpline The Patients Association offers a free national helpline providing specialist information and advice to help patients make sense of their health and social care. Patients can talk directly to trained advisers in strict confidence about any concerns, questions or general experiences they have regarding the NHS and social care systems. The helpline is open from 9.30 am to 5pm, Monday to Friday, and calls outside these times are returned as soon as possible during opening hours. If you would like to contact the helpline, please call free on 0800 345 7115, or visit the Patients Association helpline page on our website for more information.