HOW TO EFFECTIVELY USE THIS DATABASE?


This database is divided into two parts. The first provides precise information on self-medication (its benefits and limitations, rules to follow, etc.) and on medications (general information, at-risk populations, specificities, etc.) before one considers self-treatment. The second part addresses generally benign health issues that can be managed through self-medication. These are classified alphabetically and primarily concern adults. Fourteen chapters are dedicated to common health problems in children. Even though self-medication for children should remain exceptional, these dedicated chapters aim to answer parents' questions when faced with such situations.
How is the information structured?
For each health issue, we provide: The most common manifestations and frequent causes. Cases where self-medication is not appropriate and the timeframe within which to consult a doctor. This timeframe is indicated by a specific pictogram: XXX EMERGENCY; XX within 48 hours; X within a week. Please note that these are only guidelines. In case of doubt, particularly when symptoms are combined (e.g., headache + high fever, or constipation + severe abdominal pain), you MUST ALWAYS consult your doctor. Cases where self-medication may be suitable, detailing: – prevention advice to avoid or alleviate the health issue concerned; – essential information on available over-the-counter medications and treatments. A comprehensive list of all over-the-counter medications available in pharmacies, rated and commented for each symptom – information you will not find anywhere else.

For serious cases
we remind you of the SAMU emergency number: 15 or 112. It is preferable to contact these numbers using a cordless or mobile phone, which allows for easier movement within your home or facilitates the execution of specific instructions provided by emergency services (e.g., in cases of choking).

How to Use This Guide
At the end of this guide, you will find three indexes: a general index covering medications, symptoms, and illnesses; an index of all medications; and an index of the 85 preferred medications. We clarify that by 'medication,' we refer to the brand name, which may be available in pharmacies in various dosages and pharmaceutical forms (e.g., tablets, capsules, gel, ointment).

By Symptom
For each symptom, one or more summary tables are provided, grouping medications by active ingredients and classifying them by descending ratings. Select medications with the highest ratings, specifically those rated 10 or above. If multiple medications meet this criterion, prioritize those with the fewest excipients known to have significant effects (i.e., allergens or those likely to cause intolerances). Below these tables, one or more preferred specialties are listed, with their main characteristics highlighted. A preferred specialty is rarely the sole option; it is merely presented as an example among several identical specialties that share the same indications, contraindications, and adverse effects.

By Medication
Alternatively, you can search the index for a medication you commonly use. Then, refer to the indicated pages to find the table(s) where this medication is listed and compare it with other medications that treat the same symptom.

By Active Ingredients (e.g., buckthorn) or International Nonproprietary Names (e.g., paracetamol) Finally, you can search the index for a common name you are familiar with, then refer to the indicated pages to find medications in the lists that contain this active ingredient or INN.

What to Ask Your Pharmacist:
Either the common name, specifying the pharmaceutical form that best suits you, for example: Paracetamol tablet or Paracetamol effervescent tablet, and the pharmacist, who is familiar with common names, will be able to suggest the specific product that matches your choice. Alternatively, you can specify the medication itself, for example: DOLIPRANE, also indicating the desired pharmaceutical form, the age, and the weight of the person for whom the medication is intended, so that the product proposed by the pharmacist is suitable. In both cases, inform your pharmacist of any excipients you wish to avoid in the medication (e.g., alcohol, lactose, parabens, etc.).
Note: When a medication's name is followed by XXX, for example: PARACETAMOL XXX, it signifies that several specific products (often generics) correspond to this medication, sharing an identical International Nonproprietary Name (INN) but potentially containing different excipients.

SOME IMPORTANT TRUTHS ABOUT MEDICATIONS


A medication, whether prescription or non-prescription, is not an ordinary product.

WHAT YOU NEED TO KNOW
What is a Medication? The Public Health Code (Book V, Article L511) defines it as "any substance or compound presented as possessing curative or preventive properties with regard to human diseases, as well as any product that can be administered to humans for the purpose of establishing a medical diagnosis or restoring, correcting, or modifying organic functions." However, this definition does not in any way prejudge the efficacy of the medication. Thus, contrary to what health authorities claim, when you purchase a medication from a pharmacy, you do not know whether it is an effective product or a useless concoction without efficacy, or even a dangerous one.
The Efficacy of a Medication (Note) is directly dependent on the active ingredient(s) contained in its composition. Based on reference information, we have established several degrees of efficacy:
• Good 15 to 18
• Average 12 to 14
• Limited 11
• Undemonstrated or Ineffective 7


Categories of Medications


Medications are designed to serve various purposes. Curative medications target the cause of the illness (e.g., antibiotics, antiparasitics). Substitutive medications compensate for an organic deficiency in your body that causes the illness (e.g., insulin to treat Type 1 diabetes). Preventive medications prevent the onset of illness (e.g., vaccines). Symptomatic medications – the most common type – reduce or eliminate specific manifestations of the illness (fever, pain) but not the underlying cause (virus or bacteria). This is particularly true for paracetamol, ibuprofen, or aspirin.

Marketing Authorization


Once developed, all medications (prescription or non-prescription) must obtain a marketing authorization (MA) to be sold in France. This authorization is granted by the National Agency for the Safety of Medicines and Health Products (ANSM), formerly the Medicines Agency, after an expert assessment focusing primarily on two points: the existence of therapeutic efficacy for specific indications, meaning for certain diseases and only those; and the absence of toxic effects under normal conditions of use for these indications. This authorization, currently granted for a period of five years, is renewable once but can be withdrawn at any time. The marketing authorization number is printed on the medication box. However, for various reasons, a large number of medications lacking any demonstrated efficacy in humans continue to receive marketing authorization.

Prescription or Non-Prescription?
Optional prescription medications, known as "non-prescription" or "over-the-counter" drugs, can be dispensed by the pharmacist upon your request. Nevertheless, the pharmacist may refuse to dispense an over-the-counter medication if they deem it harmful to your health (for example, in the case of pregnant women). The pharmacist must inform you of contraindications (problems related to common diseases such as diabetes, hypertension, etc., or interactions with medications you are currently taking) and remind you of the maximum dosage not to exceed. Some medications, referred to as officinal medications (approximately 600 in 2016), are available for direct access (self-service) in pharmacies. Unfortunately, a large number of these are of no benefit due to their ineffectiveness. Certain optional prescription medications may be reimbursed by Social Security if prescribed by a doctor. They are always less expensive than non-reimbursable over-the-counter medications. This information can be verified on the public database of medications (http://base-donnees-publique.medicaments.gouv.fr). Medications dispensed only with a medical prescription, known as "prescription medications" (issued by doctors), are classified into three groups according to the nature and intensity of the harmful effects they may cause. The first list includes substances with significant toxicity, such as anticoagulants, anticancer drugs, etc. The second list contains substances deemed dangerous because they exhibit characteristics similar to those on the first list, but to a lesser degree, for example, certain non-steroidal anti-inflammatory drugs or NSAIDs, such as ketoprofen (BIPROFENID®) and diclofenac (VOLTARENE®). Narcotic Substances can lead to drug addiction, physical or psychological dependence (e.g., morphine, SKENAN®, MOSCONTIN®), as well as certain psychotropic drugs (e.g., methylphenidate, RITALINE®). Some medications containing listed substances are available without prescription: non-steroidal anti-inflammatory drugs or NSAIDs (e.g., ibuprofen, ADVIL®), and intestinal transit inhibitors (e.g., loperamide, INDIARAL®, IMODIUMCAPS®). This is because the dose of the substance contained in the packaging or the claimed indication is adapted for short-term treatments that can be used for self-medication. Not all medications dispensed with a medical prescription are reimbursed by Social Security.

Warning! Whether prescription or non-prescription, a medication is never harmless. Some medications, which are dangerous without a prescription, are unfortunately available over-the-counter in France, whereas they are sold by prescription abroad. This is the case for certain antiparasitic drugs (e.g., GLUCANTIME®, NOTEZINE®).

In What Forms?
Most medications are available in various forms: tablets, capsules, sachets, ampoules, drops, suppositories, etc. If the current form of your medication is not suitable, consult your doctor or pharmacist to request an alternative.

At what price?
The price of medications (prescription or over-the-counter) eligible for reimbursement by the Health Insurance is fixed by agreement between the pharmaceutical company and the Economic Committee for Health Products, or failing that, by ministerial decree. The price of non-reimbursable medications (whether requiring a prescription or not) is unregulated. It varies from one pharmacy to another. Our advice: ask your pharmacist for reimbursable over-the-counter medications, as their prices are regulated by public authorities. They are generally much less expensive than non-reimbursable medications.

Brand Name, Substance, and INN
The packaging lists (in addition to administrative information): The brand name (or fancy name) of the medication, for example, DOLIPRANE®, EFFERALGAN®, DAFALGAN®, etc. In this guide, this name is always written in capital letters. Below it, in smaller characters, is the name of the substance or INN (International Nonproprietary Name), for example, Paracetamol. The INN allows you to identify your medication in any country. Pay close attention to it, as it helps you verify that you are not taking the same substance multiple times under different brand names. This will help you avoid the risk of a toxic overdose. In this guide, the name of the substance is written in lowercase letters.

The Patient Information Leaflet
The patient information leaflet provides details regarding the medication's name(s), composition, route of administration, and other crucial information concerning administration conditions, indications, contraindications, precautions for use, and potential side effects associated with taking the medication. Unfortunately, you will only have access to this valuable information after purchasing the medication, unless you consult the public database of medicines: http://base-donnees-publique.medicaments.gouv.fr.

The Paradox of Patient Information Leaflets
The information provided in patient information leaflets is highly useful, especially for self-medication. However, it is regrettable that they are often written in language that is too medical for the general public to understand and can sometimes be almost unreadable… even with glasses!

Umbrella Brand
A single brand used for products that may have different statuses (medications, medical devices, or even food supplements), allowing these products to benefit from the recognition and image of the umbrella brand. The coexistence of products with different compositions under the same umbrella brand poses a risk of confusion and serious errors. Examples include: HUMEX TOUX SECHE®, a medication that may contain dextromethorphan (an opiate antitussive) or oxomemazine (a first-generation antihistamine antitussive with atropine-like effects); TOPLEXIL®, an antitussive medication based on oxomemazine, or TOPLEXIL PHYTO®, a medical device based on honey, etc. We advise against using products from umbrella brands, for example: HUMEX (29), DRILL (15), FERVEX (11), ACTIFED (5), VICKS (25), etc.

OUR RECOMMENDATIONS
Before purchasing an over-the-counter medication, consult the information published in this guide (in conjunction with a symptom) or seek advice from your doctor or pharmacist. Carefully read the patient information leaflets or research the medication before buying it, on the Ministry of Health's website: http://base-donnees-publique.medicaments.gouv.fr/ and strictly adhere to the dosages indicated in the leaflets.

THE JOURNEY OF MEDICATIONS IN OUR BODY

Once ingested, most medications enter the bloodstream to be distributed throughout the body and exert their effects. They are then metabolized and eliminated.

WHAT YOU NEED TO KNOW
A medication, even an over-the-counter one, is not an ordinary product: certain stages require a minimum of precautions.

Absorption
A medication taken orally reaches the stomach, where it dissolves, then passes into the intestine where it diffuses into the bloodstream. This process is called resorption, and it is faster when your digestive tract is empty (as with medications taken on an empty stomach). However, some medications are better absorbed during meals. Caution! Certain common foods can increase, reduce, or even nullify the effectiveness of a medication due to an interaction between the medication and the food (see Medications and Food).

Distribution
Once in the bloodstream, the medication gradually distributes throughout the body. Some medications spread everywhere. Others, conversely, accumulate in a single organ, such as iodine, which concentrates in the thyroid gland. Certain organs, like the brain, are protected by a barrier that prevents the diffusion of some medications. This is the case for many antibiotics that do not readily cross the blood-brain barrier.

Expectant Mothers, Please Note! Almost all medications cross the placenta and can reach the unborn child (see Medications and Pregnancy).

The activity
For a drug to be effective, it must reach the affected area in its active form so that it can penetrate the organ and treat it. Some drugs, such as insulin, enter all the cells in the body and exert a wide range of effects there. Others act more specifically on a single organ; this is the case with cardiac glycosides (digoxin). The dosage and efficacy of a drug depend on the amount taken, with a few exceptions. Below a certain amount, the drug has no therapeutic effect. The higher the dose, the greater the effect. Above the maximum authorized dose, its effectiveness no longer increases, but the risk of adverse events rises, transforming a drug that is normally very well tolerated into a toxic, even lethal, substance. This is the case, for example, with acetaminophen (DOLIPRANE®, DAFALGAN®, EFFERALGAN®, etc.). An effective pain reliever up to a maximum of 4 g per 24 hours, it can cause severe liver damage if the dose is consistently exceeded. When self-medicating, it is best to limit yourself to 3 g per 24 hours. By checking whether or not the medications you take regularly contain acetaminophen, you can limit the risk of unintentional overdose. Warning! The recommended doses listed on package inserts are calculated to ensure a balance between efficacy and tolerability in healthy adults. However, there is no such thing as zero risk: an effective medication can still cause side effects, even at the recommended dose.

Metabolism: The Role of the Liver
A drug remains active in the body for several hours or even several days. Carried by the bloodstream, it passes through the liver several times, where the active portion is converted 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 for too long in its active form, leading to an increased risk of adverse effects. This is why, in cases of liver failure, the doses of many drugs must be reduced and certain drugs are contraindicated. Elimination: The Role of the Kidneys Medications are primarily eliminated by the kidneys, either in an inactive form after conversion by the liver or in their initial active form. If the kidneys are not functioning properly (renal failure), the medication remains in the body longer. This explains why, in cases of renal failure, the doses of many medications must be reduced and certain medications avoided. What is not eliminated by the kidneys is primarily excreted through bile and exhaled air, but also through sweat, saliva, tears, hair, nails… and breast milk.

New moms, take note!
If you are breastfeeding, do not self-medicate (see Medications and Breastfeeding).

OUR RECOMMENDATIONS
Always ask your pharmacist for advice and read CAREFULLY Read the package insert to find out how to take your medication: when should you take it? On an empty stomach, during meals, or between meals? ALWAYS keep medications in their original packaging along with the package insert. Avoid self-medication if you are pregnant (see Medications and Pregnancy) or if you are breastfeeding (see Medications and Breastfeeding). Since children (see Medications and Children) and the elderly (see Medications and the Elderly) are highly sensitive to medications, keep self-medication to a minimum for these groups and reduce the doses of medications administered as indicated in the package inserts to minimize the risk of adverse events or accidents.

LEARN MORE
Suppositories, patches, and subcutaneous and intramuscular injections enter the bloodstream at varying rates. However, the absorption of suppositories is more unpredictable. Topical products (ointments, creams, skin lotions, eye drops, mouthwash, lozenges, ear drops, or nasal drops) are not harmless. They can enter the bloodstream and have a systemic effect, potentially causing side effects. Some medications taken by mouth do not enter the bloodstream: for example, medications for digestive tract disorders (antacid stomach liners), certain medications for constipation (lactulose, DUPHALAC®, macrogol, FORLAX®), and certain medications for worms (flubendazole, FLUVERMAL®).

PLACEBO EFFECT AND NOCEBO EFFECT


How can we define the placebo effect and the nocebo effect? The word “placebo,” from the Latin “I shall please,” refers to an inert substance (bread crumbs, starch, most often lactose) with no active ingredients, given to a patient as a medication.

The placebo effect
Under certain circumstances, taking this inert substance when it is presented as a medication can lead to an improvement in certain symptoms (digestive problems, cough, headaches, sleep disturbances, anxiety) and in symptoms of certain chronic conditions (osteoarthritis, eczema, etc.). These effects are known as “placebo effects.” The placebo effect accounts for about 30% of a drug’s overall efficacy but can range from 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 period; this is demonstrated by studies conducted on the efficacy of future drugs prior to marketing. To be marketed, candidate drugs must always be more effective than the placebo against which they are compared. Unfortunately, this is not always the case! Factors influencing the placebo effect The placebo effect depends closely on the placebo itself, but also on the doctor prescribing it and the patient receiving it. The influence of the placebo: several factors are at play The method of administration: In order of decreasing efficacy, these include intravenous injections, intramuscular injections, drops, tablets or capsules, and suppositories. The presentation of the medication: light blue enhances the efficacy of tranquilizers, bright red or yellow that of stimulants, and brown that of laxatives. A unique shape, or even a distinctive taste (such as bitterness), seems to amplify the placebo effect. Size: a tiny or unusual size can enhance the effect. Novelty, high price, the drug’s name, its composition sometimes listed in Latin, and the fact that it is prescription-only are also factors that enhance effectiveness. The doctor’s personality: a welcoming and warm demeanor, attention and interest directed not only toward the patient’s health issues but toward their entire personality, the duration of the consultation, the doctor’s conviction regarding the treatment’s efficacy, and personalized care can enhance the placebo effect. Factors related to the patient: sensitivity to the placebo effect is reportedly more common among anxious, depressed, or passive individuals than among those with strong personalities. In the same individual, the placebo effect of a medication diminishes as the patient gains a better understanding of their illness and the treatment’s effects. Confidence in the doctor’s ability enhances the efficacy of any medication. For example, a honey lozenge presented as a tablet in a box bearing a scientific-sounding name and given by a convincing treating physician will likely have a greater effect on a sore throat than the same product purchased from a candy store. Especially if the patient is of an anxious disposition! Impure Placebos Some pharmaceutical companies offer medications whose indications do not match the symptoms they are supposed to treat. This is the case, for example, with combinations of various vitamins to treat temporary fatigue and different magnesium-based substances to treat spasmophilia. These medications are called “impure placebos” because, in this case, they can only work through the placebo effect. Their use must be condemned. Indeed, due to their pharmacological properties, these medications can cause adverse effects. Unfortunately, there are still far too many impure placebos among the approximately 12,000 medications (prescription and over-the-counter) currently available in pharmacies.

The nocebo effect
The term “nocebo effect” refers to any adverse reaction that occurs after taking an inert substance (placebo). The most common manifestations of the nocebo effect, in descending order, are: drowsiness (25% of cases), fatigue, digestive problems, difficulty concentrating, headaches, hot flashes, and tremors.

MEDICATIONS AND PREGNANCY


The vast majority of medications taken by the mother during pregnancy are passed on to the embryo and fetus through the blood supply, via the placenta. Self-medication is therefore strongly discouraged for pregnant women.

WHAT YOU NEED TO KNOW
Even if a medication does not cause any problems for the pregnant woman, it may cause problems for the baby she is carrying. During pregnancy, it is important to ALWAYS Consult your doctor or pharmacist before taking any medication, even if it seems harmless. This is crucial during the first two months of pregnancy: during this period, taking medication can cause serious birth defects, damage to certain organs, and the death of the fertilized egg or embryo. During the last three months of pregnancy, over-the-counter medications for anxiety and insomnia, certain pain relievers (morphine derivatives), many cough syrups, antihistamines, and nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, diclofenac, niflumic acid, etc.) can trigger various types of problems in the baby. In short, avoid self-medication during your pregnancy and even after giving birth if you are breastfeeding (see Medications and Breastfeeding). Take advantage of a visit to your doctor to ask which over-the-counter medications you can take to treat minor ailments: headaches, nausea, insomnia, constipation… Only your doctor can recommend a medication that poses no risk. You can also consult the CRAT (Reference Center on Teratogenic Agents): http://lecrat.fr/.

OUR RECOMMENDATIONS
Whenever possible, choose lifestyle changes over medication. If you have trouble sleeping, avoid caffeine—found in tea, coffee, chocolate, Coca-Cola®, Pepsi-Cola®, etc.—and follow our advice (see Insomnia). If you have constipation, follow our lifestyle advice (see Constipation). If this proves insufficient, you may use a mild laxative, but NEVER take stimulant laxatives. If you have any doubts, consult your doctor. If you experience nausea and vomiting, try our suggestions (see Nausea and Vomiting). Do not take any medication without consulting your doctor. If you have a headache, fever, or temporary pain, you can take acetaminophen, not exceeding 3 g per 24 hours. But NEVER take nonsteroidal anti-inflammatory drugs (NSAIDs): aspirin, ibuprofen… Completely avoid alcohol (even a glass of wine), tobacco (your cigarettes and those of others), and avoid all toxic fumes (dry-cleaning stains removers, household cleaners, herbicides, fresh paint, etc.). A great opportunity to adopt a healthy lifestyle and delegate household chores to others! Avoid dietary supplements and herbal products, including essential oils, and vitamin and mineral supplements containing iron, iodine, vitamin A, etc.

LEARN MORE
Substances to Avoid During Pregnancy Alcohol can cause mental and physical developmental delays, facial deformities, and malformations of certain organs. Tobacco can lead to growth delays. Toxic fumes can cause neurological disorders. If you work in an environment with chemicals, be vigilant. For more details, visit the INRS website (National Institute for Research and Safety on the Prevention of Workplace Accidents and Occupational Diseases): www.inrs.fr.

MEDICATIONS AND BREASTFEEDING


Are you breastfeeding your baby? You’re right, because there’s nothing better than breast milk for feeding a newborn: it contains the nutrients your baby needs in an easily digestible form, as well as vitamins, minerals, and substances that protect against infections (antibodies), helping your baby better resist certain illnesses like measles or mumps. But be careful with medications!

WHAT YOU NEED TO KNOW
The vast majority of medications taken by the mother pass into breast milk. This is extremely harmful to newborns and infants because their livers and kidneys are not yet fully capable of breaking down or eliminating these medications.

OUR RECOMMENDATIONS
Continue to follow the healthy lifestyle guidelines you adopted during your pregnancy: – avoid tobacco and smokers; – do not drink alcohol or stimulants (such as coffee), as they pass into your breast milk in significant amounts and can affect your baby. Make sure you avoid contact with pollutants (hexachlorobenzene), insecticides, paint, and stain removers (tetrachloroethylene). Their vapors are toxic and can enter your bloodstream and then your breast milk. Tell your doctor that you are breastfeeding your child and ask which over-the-counter medications you can safely take for minor health issues (headaches, fever, pain). If they prescribe a medication, take it immediately after breastfeeding (not before). If you need to take a short-term treatment that poses a risk to the baby, it is best to temporarily stop breastfeeding and wait 48 hours after the treatment ends before resuming breastfeeding. Ask your doctor for details. Avoid applying topical products to your breasts, especially to cracked areas (for example, ointments containing vitamin A). Since these products never fully penetrate the skin, your baby may absorb them while nursing.

LEARN MORE Over-the-counter medications prohibited during breastfeeding: Bromide-based tranquilizers. Iodine-based medications. Cough syrups containing codeine, codethyline. All irritating laxatives: senna, buckthorn, cascara, bisacodyl, etc. Non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, ketoprofen) used as pain relievers. High-dose vitamin D. First-generation H1 antihistamines, anti-allergics. Certain vaccines.

MEDICATIONS AND CHILDREN


Self-medication, by definition, should only apply to oneself. However, many parents are tempted to treat seemingly benign health issues in their children daily without consulting their doctor. Be aware, this is not without risk!

OUR RECOMMENDATIONS
To practice responsible and risk-free self-medication for your children, follow these guidelines: Never self-medicate a newborn. Does your baby seem ill? Does he or she have a fever above 38.5 °C? Call your doctor or, in an emergency, SAMU (15 or 112). They will advise you while you await the consultation. Self-medication should be exceptional for infants. Do not rush! Take the time to analyze the symptoms presented in this guide to determine if a particular medication is essential. If in doubt, call your doctor. Only use medications specifically dosed for "infants" or "children." Solid forms (capsules, tablets, lozenges, gummies) are contraindicated for children under 6 years of age. Check the leaflet for the exact dose to administer according to age and weight. Calculate the dose three times rather than once and adhere to the recommended interval between doses. Any new symptom (e.g., a rising fever) should prompt you to question the suitability of the medication you have given your child. If in doubt, call your doctor. Do not present medication to a child as a pleasant-tasting treat. Medication must remain medication. Your child takes it because they are ill. Keep in mind that some minor issues can be treated without medication (see Child Fever, Child Constipation, Acute Child Diarrhea), but always proceed with caution. As a general rule, with self-medication, you can only treat one symptom (fever or sore throat or vomiting). If symptoms are combined (e.g., fever + vomiting), you must consult your doctor. Never extend self-medication beyond 48 hours if you do not observe any improvement; instead, call your doctor.

LEARN MORE
Age and Medications A child under 1 month old is a newborn. A child aged 1 month to 30 months is an infant. From 30 months to 15 years, they are referred to as a child. After 15 years, a child is considered an adult from a medical perspective, particularly regarding medication dosages.

MEDICATIONS AND THE ELDERLY


Regarding self-medication, a practice generally reserved for healthy individuals, elderly people and their caregivers must exercise caution. WHAT YOU NEED TO KNOW Elderly individuals are significant consumers of medications, which is not without risk. 20% of hospitalizations among older adults are due to incidents related to medication intake. These risks are three times higher for a 75-year-old man than for a 50-year-old man. THE CAUSES Liver and kidney functions slow down with age (see The Journey of Medications in Our Body). As age increases, recommended dosages must be reduced to avoid overdose. Elderly individuals, often suffering from multiple conditions, consume a large number of medications. This increases the risks associated with drug interactions or overdose by 20%. Elderly people are frequently treated for osteoarthritis with non-steroidal anti-inflammatory drugs (NSAIDs). To treat a fever or minor pain, aspirin, ibuprofen, and ketoprofen (NSAIDs) should therefore be avoided due to the increased risk of gastrointestinal bleeding. Paracetamol should be preferred, initially not exceeding 2 g/24 hours. Certain chronic diseases common in older adults (high blood pressure, heart problems, eye conditions, prostate issues, constipation) are completely incompatible with many medications, including some sold without a prescription (e.g., high blood pressure and NSAIDs). Medication leaflets are not always adapted for elderly individuals: they are often printed in small characters, and the vocabulary used can sometimes be "inaccessible." Consequently, this population does not always understand how to take medications (whether prescribed or not by a doctor), which is not without risk!

OUR RECOMMENDATIONS FOR ELDERLY INDIVIDUALS AND THEIR CAREGIVERS
Do not take an "over-the-counter" medication on your own, unless it is truly essential (for example, paracetamol for a fever episode). Limit its use to a short period (48 hours), adhering to all information provided in the leaflet. For medications prescribed by a doctor, strictly follow the indicated doses (do not increase or decrease them) and duration. Use a weekly pill organizer, and if you find it difficult to manage your weekly medication regimen yourself, ask a family member (or your pharmacist) to prepare it for you. Do not stop treatment on your own initiative. If you experience a problem related to taking a medication, seek your doctor's advice. If it is a lifelong prescribed medication (for hypertension, heart conditions, or diabetes, for example), you MUST NOT stop the treatment yourself, even temporarily. If you have any doubts, call your doctor. Report any incident, even minor, that occurred with any medication to your doctor. If you have difficulty counting drops, breaking an ampoule, dividing a tablet in half, swallowing a capsule, or inserting suppositories, ask your doctor to prescribe the same medications in a different form. If you have questions about your treatment, do not hesitate to ask your doctor or pharmacist for explanations. Remember that certain herbal teas, particularly laxative teas, and some essential oils can lead to incidents, or even serious accidents. Report any problems related to these products to your doctor. Get vaccinated against the flu at the start of winter and ensure your tetanus vaccination is up to date.

MEDICATIONS AND ALCOHOL


Combining alcohol and medications (whether prescription or over-the-counter) can be dangerous and, in some cases, lead to serious incidents. These incidents can occur regardless of when you take the medications (before, during, or after alcohol consumption).

WHAT YOU NEED TO KNOW
The consequences of combining medications and alcohol can be severe: increased medication activity; increased medication-related incidents; altered alcohol breakdown in the body ("antabuse" effect). Alcohol enhances the effect of all medications that reduce brain activity, further exacerbating issues with attention, concentration, and alertness. Exercise caution when driving! Furthermore, alcohol increases the risk of respiratory problems when combined with certain medications. This applies to hypnotics, tranquilizers, neuroleptics, antidepressants, and several over-the-counter medications: all cough suppressants containing codeine, codethyline, and all antihistamines. Alcohol combined with diabetes medications (insulin and oral hypoglycemics) can lead to hypoglycemic coma. Alcohol combined with antihypertensives and coronary vasodilators can cause a drop in blood pressure. Alcohol can amplify incidents related to taking certain medications. For instance, it can worsen gastrointestinal bleeding caused by non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, etc. Some medications can slow down or stop the breakdown of alcohol in the body at the acetaldehyde stage, a highly toxic product. This is known as the "antabuse" effect (see "Hangover"), causing very unpleasant symptoms (significant facial redness, headaches, malaise, nausea, vomiting), or even dangerous ones (tachycardia, drop in blood pressure, coma). This is the case for certain antibiotics and several medications for diabetes, fungal infections, and some antiparasitics, several of which are available over-the-counter. Alcohol reduces the activity of certain medications in chronic drinkers, such as several epilepsy medications and anticoagulants.

OUR RECOMMENDATIONS
Before purchasing any medication, seek advice from your pharmacist. Be vigilant. Several hundred medications contain varying amounts of alcohol. This is true for numerous syrups and the vast majority of drinkable ampoules, including many homeopathic preparations. These medications can cause an "antabuse" effect. Read CAREFULLY the leaflets. Do not leave medications containing alcohol, especially syrups, within reach of your children. Do not take aspirin with a hot toddy: a drastic recipe for stomach bleeding! Do not take aspirin-based medications (such as ALKA SELTZER®) to prevent or treat a "hangover": stomach damage is guaranteed.

MEDICATIONS AND FOOD


Medications and food do not always mix well, as food can even counteract their effectiveness!

WHAT YOU NEED TO KNOW
Some medications must be taken on an empty stomach (1.5 to 2 hours before any food intake) because their absorption into the bloodstream can be slowed down or even reduced by the presence of food. This applies to several antibiotics. Certain medications should be taken during a meal to ensure greater absorption into the bloodstream during digestion: for example, some skin antifungals based on griseofulvin (GRISEFULINE®). Aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs) should be taken with a meal to reduce stomach irritation and damage. Digestive antacids should always be taken after meals (ideally 1 hour after) and not before or during meals, as food itself acts as a natural "dressing." Always swallow pills, tablets, capsules, caplets, granules, and pills with a large glass of water to prevent the medication from sticking to the esophagus, which can cause irritation and eventually an ulcer. Avoid beverages other than water (milk, fruit juices, Coca-Cola®...), as they can alter the action and tolerance of medications. If you consume grapefruit or grapefruit juice or blood orange, inform your doctor if you start a new treatment, as this fruit, when combined with certain medications, can significantly increase their concentration, sometimes leading to very serious consequences for the body (overdose).

OUR RECOMMENDATIONS
Take your medications while standing or sitting and prevent choking by placing them at the back of your tongue without tilting your head back. Never open capsules, as their contents (powder) should only dissolve once they reach the stomach. Do not cut your tablets without first consulting your doctor or pharmacist: some medications are not designed to be split.

LEARN MORE
Oral medications incompatible with grapefruit: Immunosuppressants: ciclosporin (NEORAL®), everolimus (CERTICAN®), sirolimus (RAPAMUNE®), tacrolimus (ADOPORT®, ADVAGRAF®, etc.). Cardiovascular medications: aliskiren (RASILEZ®,...), dronedarone (MULTAQ®), ivabradine (PROCORALAN®). Erectile dysfunction medications: avanafil (SPEDRA®), vardenafil (LEVITRA®). An anticholesterol medication (statin): simvastatin (ZOCOR®, etc.). An antiepileptic: carbamazepine (TEGRETOL®, etc.). An anticancer drug: regorafenib (STIVARGA®). An antidepressant: sertraline (ZOLOFT®, etc.). An antiplatelet agent: ticagrelor (BRILIQUE®).

COMBINED MEDICATIONS OR DRUG INTERACTIONS


To treat certain illnesses, your doctor may prescribe several medications to increase therapeutic efficacy, reduce the risk of adverse events, or treat multiple conditions. While combining several medications is generally safe under medical supervision, this is not the case with self-medication.

WHAT YOU NEED TO KNOW
One medication can alter the activity or influence the fate of another medication in your body, leading to incidents or even accidents (this is often the case in elderly individuals). This is referred to as a drug interaction. Different types of drug interactions: A medication can decrease the effect of another medication. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the activity of diuretics, antihypertensives, and heart failure medications. Over-the-counter herbal products (plants) containing St. John's Wort, used to treat mild and temporary depression, can reduce the effectiveness of numerous medications: birth control pills (potentially leading to unwanted pregnancy), medications for heart rhythm disorders, antihypertensives, cholesterol-lowering drugs, antivirals, antibiotics, tranquilizers, etc. Certain over-the-counter vasoconstrictor-based nasal decongestants, including pseudoephedrine, can diminish the effectiveness of your hypertension treatment. Over-the-counter stomach antacids particularly reduce the effectiveness of many orally absorbed medications (antituberculosis drugs, aspirin, certain antibiotics, certain neuroleptics, cortisone derivatives, digoxin, fluoride, osteoporosis medications, thyroid medications, H2 antihistamine-type digestive ulcer medications, phosphorus, etc.); and generally all orally administered medications. Take them separately (if possible, 2 hours before or after). Over-the-counter iron-based antianemic medications can decrease the activity of certain antibiotics. Over-the-counter vitamin B6 can reduce the action of levodopa, a medication used in the treatment of Parkinson's disease. A medication can increase the effect of another medication. Aspirin, like other non-steroidal anti-inflammatory drugs (NSAIDs), can increase the activity of certain antidiabetic drugs, methotrexate, or anticoagulants. Over-the-counter antihistamine-based tranquilizers (see Insomnia), when combined with certain over-the-counter cough suppressants, increase drowsiness (see Medications and Driving and Sedative Medications).

OUR RECOMMENDATIONS
Do not use self-medication if you are already being treated for another illness without first consulting your doctor or pharmacist. If you are on treatment for a chronic condition, ask your doctor which medications they authorize for minor health issues. For self-medication, always prefer medications composed of a single substance. Avoid medications that contain more than two substances: these are often old, outdated, poorly designed, ineffective, and not without risks. In the realm of medication, 1 + 1 does not double efficacy but generally doubles the risks. Opt for short-term treatments (generally 5 days). If symptoms persist or worsen, consult your doctor.

MEDICATIONS AND DRIVING


Certain medications are poor companions for travel due to their sedative effect, which reduces reflexes, alertness, and vision.

WHAT YOU NEED TO KNOW
Beyond alcohol, which is responsible for numerous traffic accidents, many medications (prescription or over-the-counter) can seriously impair driving by causing reduced alertness and reflexes, drowsiness, lightheadedness, dizziness, visual disturbances, auditory problems, a drop in blood pressure, or even fainting, and behavioral changes. The main categories of over-the-counter medications that pose a driving risk (reduced alertness and reflexes) are: Tranquilizers containing calcium bromide in various forms, sometimes even present in herbal preparations (phytotherapy). Pain relievers; particularly those containing codeine in addition to aspirin or paracetamol. Antiallergics (H1 antihistamines); available without prescription, they can lead to reduced alertness or even drowsiness. "Anti-motion sickness" medications; also H1 antihistamines, they present the same drawbacks. Cough suppressants; all those containing codeine, codethyline, dextromethorphan, promethazine, alimemazine, bromide. Furthermore, syrups frequently contain alcohol, which is obviously not recommended when driving (when the dose as an excipient is equal to or greater than 3 g per day). Antivertigo medications; meclozine (AGYRAX®). Vasoconstrictor-based eye decongestants; these can cause visual disturbances. All these negative effects can be amplified with alcohol consumption. Warning! Drugs such as opium, cannabis, cocaine, amphetamine, or LSD, taken alone or in combination, are responsible for a great many accidents.

OUR RECOMMENDATIONS
If you are taking an over-the-counter medication from one of the categories mentioned, exercise particular caution when driving a car or operating machinery. If you have consumed alcohol and/or had a heavy meal, do not drive. While driving, avoid smoking, do not overheat the vehicle, and ventilate frequently. Stop every 2 hours and walk a few steps to stretch. Drink water regularly.

LEARN MORE
Prescription Medications and Driving The following categories of medications pose a risk to vehicle operation: tranquilizers or anxiolytics; neuroleptics; antidepressants; antiepileptics; non-steroidal anti-inflammatory drugs (NSAIDs); opioid pain relievers; antihypertensives; antidiabetics; medications for heart rhythm disorders; antivertigo medications, etc. If you are being treated with one of these medications and experience drowsiness and reduced alertness, discuss this with your doctor: the drawbacks of these medications are not always clearly indicated in the leaflets. Do not abruptly stop an ongoing treatment. Long-term treatments, such as those for hypertension, heart rhythm disorders, diabetes, or epilepsy, for example, MUST NOT be interrupted.

MEDICATIONS AND DRY MOUTH


The atropinic effect is one of the undesirable side effects of a number of medications. It always manifests as dry mouth.

WHAT YOU NEED TO KNOW
Atropine is a substance extracted from a plant, belladonna, possessing certain properties including an antispasmodic action, used to treat pain related to muscle spasms and to manage certain eye inflammations. Numerous medications produce the same undesirable effects as atropine. These are referred to as "anticholinergic or atropinic medications." Atropinic substances cause adverse effects: Peripheral: dry mouth, constipation, accelerated pulse, increased intraocular pressure, visual disturbances due to impaired accommodation, contraction of the bladder sphincter, relaxation of the lower esophageal sphincter, etc. These various effects are due to the blockade of a substance present in the body: acetylcholine. Central (due to passage across the blood-brain barrier): confusion, disorientation, visual hallucinations, delirium, aggression, etc. These medications, some of which are available without prescription, are easily identifiable by reading the leaflets: they are all contraindicated in cases of angle-closure glaucoma or urinary retention (prostatic issues, etc.).

OUR RECOMMENDATIONS
If you suffer from angle-closure glaucoma or urinary retention (e.g., prostate problems), be particularly vigilant when purchasing an over-the-counter medication. Always seek advice from your doctor or pharmacist before making a purchase. Read the medication leaflets and keep them in their original packaging.

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

MEDICATIONS WITH SEDATIVE EFFECTS


Many medications are sedative, causing drowsiness, which can be dangerous when driving (see Medications and Driving).

WHAT YOU NEED TO KNOW
Several families of medications can impair alertness: either because it is their primary action, which is why they are prescribed. This is the case for tranquilizers or sleeping pills; or because it is one of their side effects. This applies to certain antiallergic medications (sold over-the-counter). How does this manifest? It can range from a simple slowing of reflexes, imperceptible to the patient, to a state of drowsiness that interferes with daily life. These medications, which are central nervous system depressants, can also lead to respiratory depression.

OUR RECOMMENDATIONS
If you purchase an over-the-counter medication belonging to the following categories, be vigilant! Read the leaflet CAREFULLY and adhere to the warnings. Categories of medications with sedative effects: All sleeping pills or hypnotics. All tranquilizers or anxiolytics. All neuroleptics. Certain antidepressants: imipramine, amitriptyline, trimipramine, doxepin, mianserin… Antiepileptics. Antinauseants or certain anti-vertigo medications (some of which are sold over-the-counter). Opiate derivatives (painkillers and others): opium (LAMALINE®…), tramadol (CONTRAMAL®…), morphine (SKENAN®…), codeine (CODOLIPRANE®…), methadone, buprenorphine (SUBUTEX®…), etc. Antitussives: codeine, codethyline, dextromethorphan (sold 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®). Medications containing alcohol (syrups, drinkable ampoules, sold over-the-counter). 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 medication belonging to any of the categories mentioned above, check the box or leaflet for the warning level established by the Health Products Agency (pictogram showing a black car in a triangle), in order to more precisely assess the risk you face. Level 1 + pictogram on a yellow background The risk is low and depends on individual sensitivity. The patient will find warnings in the medication leaflet indicating when they should refrain from driving. Level 2 + pictogram on an orange background The risk is significant. It is essential to seek advice from your doctor (or pharmacist if it is an over-the-counter medication) before driving or operating machinery. Level 3 + pictogram on a red background The risk is very high. It is absolutely contraindicated to drive (a car or vehicle) while taking this type of medication. The doctor must indicate when the patient can resume driving.

MEDICATIONS AND LABORATORY TESTS


Many medications can alter blood and urine tests. WHAT YOU NEED TO KNOW As examples, here are the over-the-counter medications most often responsible for these alterations: Vitamin C can alter urine sugar tests, cholesterol, creatinine, and uric acid levels… Aspirin can alter uric acid levels in blood or urine and bleeding time, up to eight days after taking a tablet. Paracetamol can skew blood glucose levels and uric acid tests. Vitamin B2 and certain irritating laxatives can skew some urine tests, particularly for sugar. For your information, urine can change color and turn: brown or red under the effect of irritating laxatives (based on senna, cascara, rhubarb), but also if you eat beetroot; dark yellow under the effect of vitamin B2; brown-black or green under the effect of methocarbamol (LUMIRELAX®); reddish-brown under the effect of metronidazole (FLAGYL®, RODOGYL®, etc.); brown-red under the effect of vitamin B12.

OUR RECOMMENDATIONS
If your doctor prescribes a laboratory test, inform them ALWAYS of the medications you take regularly (with or without a prescription). This will prevent results that are difficult to interpret, falsely positive or negative, and unnecessary expenses.

MEDICATIONS AND EXCIPIENTS


All medications are composed of two parts: the molecule(s) or active substances, and the excipients. However, the latter are not always inert.

WHAT YOU NEED TO KNOW
Excipients are substances without therapeutic activity, essential for the manufacture of a medication for multiple reasons: To stabilize the active ingredient. To facilitate its dissolution (solubilization). To improve the appearance and taste of the medication (coloring or sweetener). To promote its preservation (antiseptics, preservatives). To aid or delay the absorption of the medication. To allow for the final pharmaceutical form (powder, tablet, capsule, suppository, liquid…). Excipients with known effect An excipient with known effect is any excipient whose presence may require precautions for use in certain specific patient categories, for example: – in certain pathologies; – in infants or young children; – in case of allergy; – in case of a special diet. The consideration of these excipients depends on the route of administration of the medication and/or the quantity contained in the medication. 47 excipients (or groups of excipients) are listed as excipients with known effect by the Medicines Agency. The table below lists excipients with effects that may be present in marketed specialties.

EXCIPIENTS

ROUTE(S) OF ADMINISTRATION

Risk

Wheat starchOralWheat allergy (other than gluten intolerance or celiac disease).
Peanut oilAllAllergy to peanuts (groundnuts, etc.) or soy (hives, anaphylactic shock: generalized rash, respiratory difficulties, drop in blood pressure).
Azo dyes (tartrazine E102, sunset yellow S E110, azorubine E122, amaranth E123, cochineal red A E124, allura red AC E129, brilliant black E151)OralAllergy (e.g., eczema, hives, asthma, anaphylactic shock). Cross-allergy (allergy to one dye leads to allergy to other components of the class).
AspartameOralIn cases of phenylketonuria (a rare hereditary genetic disease). Balsam of Peru Cutaneous Skin allergy (e.g., eczema).
BenzalkoniumOcularEye irritation. Cutaneous Skin allergy. Respiratory Swelling of the nasal mucosa, respiratory discomfort.
Benzoic acid and benzoatesCutaneousSkin, eye, and mucous membrane allergy. Injectable Jaundice (infants under 1 month).
Benzyl alcoholInjectableAllergy or toxicity in children under 1 month or under 3 years depending on the dose. Bergamot oil Cutaneous Photosensitization (sensitivity to light). Bronopol Cutaneous Skin allergy (e.g., eczema). Cetostearyl alcohol, cetyl alcohol Cutaneous Skin allergy (e.g., eczema). Chlorocresol Cutaneous Skin allergy.
Ethanol (alcohol)Oral, injectableDangerous for alcoholics. Children, individuals with liver insufficiency, epileptics, pregnant or breastfeeding women. Interactions with other medications, driving vehicles or operating machinery (from 3 g per day).
FormaldehydeCutaneousSkin allergy (e.g., eczema).
OralDigestive disorders.
FructoseOral, injectableHarmful to teeth. Fructose intolerance (rare hereditary disease). Low-sugar diet or diabetes (from 5 g per day).
GalactoseOral, injectableGalactose intolerance (rare hereditary disease). Low-sugar diet or diabetes (from 5 g per day).
GlucoseOral, injectableHarmful to teeth. Glucose intolerance (rare hereditary disease). Low-sugar diet or diabetes (from 5 g per day).
Liquid Maltitol (hydrogenated glucose syrup)OralFructose intolerance (rare hereditary disease). Caloric intake and laxative effect (from 10 g per day). Glycerol Oral: Headaches and diarrhea (from 10 g per day).
HeparinInjectableAllergy to heparins and derivatives. Thrombocytopenia (a blood clotting disorder) due to heparins.
Butylated Hydroxyanisole E320CutaneousSkin allergy (e.g., eczema), eye and mucous membrane irritation.
Butylated Hydroxytoluene E321CutaneousSkin allergy (e.g., eczema), eye and mucous membrane irritation.
Lactitol E966OralLactitol intolerance (rare hereditary disease). Caloric intake, digestive disorders, and laxative effect (from 10 g per day).
LactoseOralLactose 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), for example, in syringe caps: Allergic skin reactions or systemic allergy (hives, asthma, anaphylactic shock, etc.).
Maltitol E965, Isomaltitol E953OralFructose 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, injectableAllergy. Cutaneous: Skin allergy (e.g., eczema), depigmentation.
Parabens (parahydroxybenzoates, etc.)Oral, ocular, cutaneousSkin or mucous membrane allergy.
Injectable, respiratoryAllergy (hives, respiratory discomfort).
PhenylalanineAllIn cases of phenylketonuria (a rare hereditary genetic disorder).
PotassiumOral, injectableLow-potassium diet, renal insufficiency. Intravenous: Pain at the IV injection site, phlebitis.
Propylene glycol and derivativesCutaneous Skin allergy (e.g., eczema).
Oral, injectableSymptoms similar to those caused by alcohol (from 400 mg/kg in adults or 200 mg/kg in children).
Castor oil and derivativesCutaneousSkin allergy (e.g., eczema).
InjectableSkin or general allergy (respiratory discomfort, anaphylactic shock). Oral: Laxative effect, digestive disorders.
SucroseOral, injectableHarmful to teeth. Sucrose intolerance (a rare hereditary disorder). Low-sugar diet or diabetes (from 5 g per day). Sesame oil: Skin or general allergy. Sodium: Oral, injectable. Low-sodium diet.
Soy and derivativesAllAllergy to peanuts or soy (hives, anaphylactic shock: generalized rash, breathing difficulties, drop in blood pressure). Sorbic acid and sorbates: Cutaneous. Skin allergy (e.g., eczema).
SorbitolOral, injectableFructose intolerance (a rare hereditary disorder). Laxative effect. Stearyl alcohol: Cutaneous. Skin allergy (e.g., eczema).
Invert sugarOralHarmful to teeth. Fructose or glucose intolerance (a rare hereditary disorder). Low-sugar diet or diabetes (from 5 g per day).
Sulfites and derivatives (sulfur dioxide, sulfite of...)Oral, injectable, respiratorySkin allergy (e.g., hives) or general allergy (respiratory discomfort, anaphylactic shock). Xylitol: Oral. Laxative effect, digestive disorders (from 10 g per day).
OUR RECOMMENDATIONS
If you are prone to allergies, seek advice from your doctor or pharmacist before purchasing an over-the-counter medication.

MEDICATIONS AND GENERICS


The volume share of generic medications in France is approximately 35%, a rate still very low compared to the figures displayed in Germany (72%), Great Britain (71%), and the United States (80%). This can be explained by a lack of communication from public authorities and lobbying by certain pharmaceutical companies.

WHAT YOU NEED TO KNOW
A generic medication is a copy of a brand-name medication whose patent has entered the public domain. It contains the same active substance, but not necessarily the same excipients (see Medications and Excipients). It possesses the same therapeutic activity. It is subject to the same controls as the reference medication and, like all medications, must obtain a marketing authorization (AMM) issued by the ANSM, the National Agency for the Safety of Medicines and Health Products (see Some Good Truths to Tell About Medications). It generally costs approximately 30% less than the reference medication (the "princeps"), as the producing laboratory does not have to amortize the research costs incurred for its development. A large majority of over-the-counter medications (optional prescription) have generic equivalents. Most diseases can be treated with generics, which are available in various forms: tablets, capsules, syrups, suppositories… Some doctors prefer to treat their patients with the reference medication. In such cases, they mark their prescription with an NS (for "non-substitutable").

OUR RECOMMENDATIONS
If you are undergoing treatment with a generic medication, it is preferable to continue this treatment with the same generic, particularly for medications where the quantity of the active substance must be very precise (narrow therapeutic index). This is notably the case for antiepileptics: sodium valproate (DEPAKINE®), lamotrigine (LAMICTAL®), etc.; and thyroid medications: levothyroxine (LEVOTHYROX®).

MEDICATIONS AND THE INTERNET


For several years, websites selling medications have proliferated on the Web, offering, among other things, treatments for overweight, erectile dysfunction, and even cancer. Be aware, this is not without health risks. WHAT YOU NEED TO KNOW Buying medications online is completely irresponsible for several reasons: 50% of medications sold online are counterfeits (source: World Health Organization, WHO). Some products are too weakly dosed in active ingredient, making them ineffective, while others present a potentially toxic overdose or are, at best, mere placebos. It's a real game of Russian roulette! Having free access to mandatory prescription medications is ill-advised. If many medications in France are only sold by prescription, it is because their use must be supervised by your doctor due to risks related to interactions, contraindications, misuse, etc. The origin of medications purchased online is unknown. Even if they display a known name already marketed in France, you have no guarantee of their authenticity because their distribution channel (outside the French legal framework) escapes the controls of health authorities. Self-medication or not, with or without a prescription, medications are not commodities like any other. You would certainly not buy a box of aspirin from a stranger on the street!

OUR RECOMMENDATIONS
Refrain from purchasing any medications online, except from pharmacy websites recognized by the French Council of Pharmacists.

MEDICATIONS AND HEART RHYTHM DISORDERS

Certain medications can cause a severe heart rhythm disorder, known as "Torsades de Pointes," a very serious form of ventricular tachycardia that occurs under specific circumstances. Exercise caution with self-medication if you suffer from heart rhythm disorders!

WHAT YOU NEED TO KNOW
The risk of "Torsades de Pointes" is increased when combined with medications that cause a decrease in blood potassium (hypokalemia), for example, during treatments with irritating laxatives (sold over-the-counter), cortisone and its derivatives (glucocorticoids), tetracosactide (SYNACTHENE®), or potassium-depleting diuretics.

OUR RECOMMENDATIONS
Caution with self-medication! If you have heart rhythm disorders, do not take NEVER Irritant laxatives can lead to extremely serious complications. If you have any in your medicine cabinet, it’s best to get rid of them! Medications available at pharmacies that carry a risk of torsades de pointes Antiarrhythmics: amiodarone (CORDARONE®, etc.), disopyramide (RYTHMODAN®, ISORYTHM®), dronedarone (MULTAQ®), hydroquinidine (SERECOR®), sotalol (SOTALEX®, etc.). Neuroleptics: amisulpride (SOLIAN®), chlorpromazine (LARGACTIL®), cyamemazine (TERCIAN®), flupentixol (FLUANXOL®), fluphenazine (MODECATE®), haloperidol (HALDOL®), levomepromazine (NOZINAN®), pipamperone (DIPIPERON®), pipotiazine (PIPORTIL®), pimozide (ORAP®), sulpiride (DOGMATIL®, etc.), tiapride (TIAPRIDAL®, etc.), zuclopenthixol (CLOPIXAN®). Antidepressants: citalopram (SEROPRAM®, etc.), escitalopram (SEROPLEX®, etc.). H1 antihistamines: hydroxyzine (ATARAX®, etc.), mequitazine (PRIMALAN®). Antiparasitic drugs: chloroquine (NIVAQUINE®), lumefantrine (RIAMET®), pentamidine (PENTACARINAT®), piperaquine (EURARTESIM®), quinidine (QUINIMAX®). Anticancer drugs: toremifene (FARESTON®), vandetanib (CAPRELSA®). Antibiotics: spiramycin (RODOGYL®, etc.), moxifloxacin (IZILOX®, etc.). An antiemetic: domperidone (MOTILIUM®, etc.). An antirheumatic and dermatological medication: hydroxychloroquine (PLAQUENIL®). A laxative: prucalopride (RESOLOR®). A medication for opioid dependence: methadone (METHADONE APHP®).

MEDICATIONS AND SUN


Certain medications can cause abnormal skin reactions when exposed to the sun. Be careful if you are taking medication!

WHAT YOU NEED TO KNOW
Several classes of medications can cause skin reactions of varying severity: phototoxicity and photoallergy. Phototoxicity is an excessive skin reaction in areas exposed to the sun. Depending on the duration of exposure, it can range from a simple sunburn to a superficial second-degree burn, even after the first exposure. Photoallergy occurs after a second exposure to the sun, a few days after the first. It manifests as an eczema-like skin rash. It spreads to unexposed parts of the body. Which medications are involved? Certain topically applied medications: colored antiseptics such as merbromin (MERCURESCEINE AQUEUSE GIFRER®), eosin, or topical antifungal treatments; anti-allergy creams (antihistamines such as promethazine, e.g., PHENERGAN®); certain acne treatments containing vitamin A derivatives or benzoyl peroxide (CURASPOT®, PAPCLAIR®, etc.). This also applies to oral medications: several antibacterials such as sulfonamides, tetracyclines (doxycycline, minocycline), certain antidiabetics or diuretics, certain antiallergics, certain antidepressants, certain neuroleptics, certain antifungals, certain urinary antiseptics, certain heart medications, certain anticoagulants, and certain birth control pills.

OUR RECOMMENDATIONS
If you are taking medication, ask your doctor before going on vacation to a sunny destination ALWAYS Consult your doctor or pharmacist and read the medication labels carefully.

GOOD PRACTICES:


MEDICINE CABINET

Essential for saving time in an emergency, a well-organized family medicine cabinet is the basic tool for effective and safe self-medication.

WHAT YOU NEED TO KNOW
What kind of storage unit? Choose a wooden or metal cabinet without glass doors, with plenty of compartments and shelves to make organization easier. Place the medicine cabinet in a dry spot, away from any heat sources (so not in the kitchen!). Medications can lose their effectiveness and even become dangerous if exposed to heat, humidity, and light. Place the cabinet in a location completely out of children’s reach. Ideally, choose a model that locks (with the key kept in a safe place) to prevent accidents.

LEARN MORE
Medication poisoning is the second leading cause of accidents among children under 15. In 55% of cases, the medications involved are sleeping pills, tranquilizers, aspirin in all its forms, sweet-tasting lozenges or chewable tablets, and syrups. What should you include? Medications, bandages, and essential supplies for treating minor health issues and accidents (scrapes, superficial burns, etc.) that can happen at any time (especially at night and on Sundays!). Also, medications prescribed by your doctor for you and your family. All prescriptions, kept in a pouch, discarding those that are no longer valid as needed. Small supplies Individually wrapped sterile compresses. Hypoallergenic adhesive bandages. Adhesive tape. Cotton balls. An unbreakable electronic oral thermometer or forehead temperature sensor. Scissors with rounded tips. Tweezers. An elastic bandage, such as VELPEAU®. Safety pins. Dental floss. Condoms. Essential medications 70% alcohol for disinfecting the skin (before an injection). An antiseptic for skin wounds based, for example, on 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 nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen, such as ANTARENE®. Saline solution in single-dose packets for the nose and eyes, such as PHYSIODOSE®. An antihistamine containing cetirizine, such as CETIRIZINE SANDOZ CONSEIL®. A cough medicine (see Cough) containing dextromethorphan, such as PULMODAXE® or TUSSIDANE®. A mild laxative (see Constipation) containing lactulose, such as LACTULOSE MYLAN®, lactitol, such as IMPORTAL®, or macrogol, such as MACROGOL SANDOZ®. An antidiarrheal: a transit-slowing and antisecretory medication containing loperamide, such as LOPERAMIDE ARROW CONSEIL®, or racecadotril, an antisecretory medication such as TIORFAST® (see Diarrhea). A 0.5% hydrocortisone ointment or cream for insect bites and other minor itching, such as CORTAPAISYL®. An antispasmodic containing phloroglucinol, such as SPASFON LYOC®. An antacid stomach lining, such as XOLAAM®. Sterile gauze for burns (see Skin Burns). Hemostatic cotton wool, such as COALGAN® cotton wool (see Nosebleeds or Epistaxis). An arnica-based bruise remedy, such as ARNICA BOIRON®. Good organization
Keep prescription medications on one side. On the other side, keep medications for treating minor everyday health issues. Carefully separate medications for adults from those for children (acetaminophen, syrup, nasal drops, etc.). Always keep all medications and their package inserts in their original packaging. This way, you can check the indications, usage instructions, dosages, contraindications, and expiration dates every time you use them. Post a list of medications inside the cabinet. Keep medical prescriptions in a folder. How to properly manage your medicine cabinet Discard all medications without packaging or instructions. Be careful with liquid medications, especially eye drops. Note that eye drops expire very quickly (2 weeks) after opening the bottle, even if the expiration date has not passed. Store your vaccines in the refrigerator at 4°C until use. Check your medications, or have them checked, once a year by your doctor or pharmacist to discard any that have expired or are no longer needed. Avoid pouring liquid medications down the drain (sink or toilet): some products are toxic and can pollute the environment. Avoid burning liquid medications yourself, as their combustion can produce harmful fumes or cause a small fire. At the end of any treatment prescribed by your doctor, dispose of ALL unused medication boxes—yes, even antibiotics! This will prevent you from using them for self-medication, which is NEVER recommended. Do not throw them in the trash: this can be dangerous, as they may be picked up and reused. Return them to your pharmacist. Essential numbers: Post a list of emergency phone numbers on the door of your medicine cabinet: Emergency medical services (SAMU): 15 or 112; Fire department: 18; Your doctor’s number; Police emergency: 17. You can use this number to get the number of the on-call doctor or pharmacy. Number for your local poison control center Number for your local burn treatment center Number for the nearest hospital Number for an ambulance service Number for a taxi company (or the nearest taxi stand)

CAR FIRST-AID KIT


Even if you’re not traveling through 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 kind of kit? Ideally, you should buy a small kit made of insulated fabric to protect your medications from heat. Keep the kit in the trunk, which is cooler than the glove compartment, in an easily accessible spot. Check its contents once a year (for example, before summer vacation) and adjust what’s inside based on who’s riding along and the trip you’re planning. What it should contain Small supplies Sterile compresses. Adhesive bandages. Round-tipped scissors, tweezers. An elastic bandage with a safety pin. Medications An antiseptic solution based on aqueous chlorhexidine, such as DOSISEPTINE®. A pain reliever: acetaminophen that can be taken without water (PARALYOC®). An antihistamine: cetirizine, such as CETIRIZINE SANDOZ CONSEIL®. An anti-itch medication or, for insect bites: 0.5% hydrocortisone, such as CORTAPAISYL®. A motion sickness remedy: diphenhydramine, such as NAUTAMINE® (do not give to the driver due to the risk of drowsiness). Saline solution in single-dose vials, such as PHYSIODOSE®. An arnica-based bruise treatment, such as ARNICA BOIRON®. Hygiene and cosmetic products A tube of sunscreen (see Sunburn or sun rash). A pair of high-quality sunglasses. A mosquito repellent: DEET-based, such as INSECT ECRAN®.

TRAVELER'S MEDICINE KIT


Even if you’re not going away for very long or very far, you should 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. Estimate the amount of medication you’ll need for the duration of your trip 48 hours before departure (to give yourself time to stock up). For safety’s sake, bring a copy of your prescriptions and keep it with your documents. Include any medications and medical supplies that might come in handy while you’re there. This list should be adjusted based on your destination. If you’re staying in France or visiting a major city, you’ll only need your personal medications, a pain reliever (always useful), sunscreen (in both winter and summer), a few adhesive bandages, and an antiseptic spray. But if you’re traveling under more challenging conditions, be prepared! Medications to bring A pain reliever: acetaminophen, such as PARACETAMOL EG LABO®, or ibuprofen, such as ANTARENE® (see Fever). A phloroglucinol-based antispasmodic, such as SPASFON LYOC® (to relieve a potentially painful intestinal cramp). A cetirizine-based antihistamine, such as CETIRIZINE SANDOZ CONSEIL®, to treat minor allergic reactions. A transit-slowing medication for diarrhea without fever, based on loperamide, such as LOPERAMIDE ARROW CONSEIL®, or racecadotril, such as TIORFAST®. A mild osmotic laxative, such as MACROGOL SANDOZ®, if you are prone to constipation while traveling. An anti-nausea medication such as NAUSICALM® in case of vomiting. An antibiotic for urinary tract issues: for example, ofloxacin (MONOFLOCET®) or fosfomycin (MONURIL®) prescribed by your doctor. Sterile saline solution in single-dose packets for eye irrigation or to clear a stuffy nose, such as PHYSIODOSE®. A 0.5% hydrocortisone ointment for itching and insect bites, such as CORTAPAISYL®. Antimalarial drugs prescribed by your doctor for malaria-endemic countries, based on chloroquine, such as NIVAQUINE® (for prevention and potential treatment), and, for regions with drug resistance, a more specific antimalarial drug prescribed by your doctor. First-aid supplies and bandages to bring Sterile gauze pads, an antiseptic solution containing aqueous chlorhexidine, such as DOSISEPTINE®, and antiseptic adhesive bandages. An electronic thermometer or a forehead temperature sensor. Round-tipped scissors and tweezers. Sunscreen with SPF. DEET-based (diethyltoluamide) mosquito repellents, such as INSECT ECRAN®. Depending on the country you are visiting A mosquito net treated with mosquito repellent (such as INSECT ECRAN MOUSTIQUAIRE®) if you are staying in an area with high malaria risk. Antiseptic tablets: HYDROCLONAZONE® or, better yet, AQUATABS®, for water purification.

OUR RECOMMENDATIONS
Forget about suppositories, glass containers, alcohol, ether, colored antiseptics, and unpackaged tablets without instructions. If you’re bringing your first-aid kit into the airplane cabin, check with your airline to find out about their current regulations. For further information: Travel Medicine Information Centers: Institut Pasteur Medical Center, www.pasteur.fr; Santé Voyages, Bichat-Claude-Bernard Hospital, tel. 01 40 25 88 92. To find the phone number for the Santé Voyages center in your area, search online for “Santé Voyages” followed by the name of the university town closest to you.

LEARN MORE
If you are abroad, you can find the name of a medication using its INN (International Nonproprietary Name), which is the name of the active ingredient. It is always printed in small print on medication boxes, just below the brand name. Brand names, i.e., the commercial names printed on medication boxes, are written in ALL CAPS and vary from country to country. Example: DOLIPRANE® (brand name) Paracetamol (INN) Vaccinations: A childhood nightmare for some, vaccinations
– whether mandatory or not – are a medical procedure and must be supervised by your doctor.

WHAT YOU NEED TO KNOW
Vaccination against an infectious disease (caused by a virus or bacteria) involves inoculating—that is, introducing into a person (or animal) the pathogen responsible for the disease—after it has been killed or modified. Vaccination is generally administered via an injection. Once modified or killed, the pathogen cannot transmit the disease but only triggers the body’s production of defense substances, known as antibodies. These antibodies will protect the vaccinated person if they come into contact with the pathogen in the future. Important! For protection to be effective, the vaccine must be administered twice, a few weeks apart, except in cases such as the flu vaccine. Vaccination does not provide lifelong protection. Booster shots are therefore necessary every 5 to 10 years. To help track vaccinations, it is important to keep a vaccination record up to date. Have your doctor sign it at each

VACCINATIONS


Although many vaccines are available without a prescription, we recommend that you always consult your doctor first, who will determine whether vaccination is appropriate and take into account any contraindications based on your health status. Overview: The vaccination schedule outlines the recommended vaccinations for residents of France, based on their age. The mandatory vaccinations are as follows: – against diphtheria, tetanus, and polio (DTP); – against yellow fever (an infection caused by a virus transmitted by mosquitoes) for residents of the department of French Guiana over 12 months of age or anyone staying there. Persons with parental authority must ensure compliance with this requirement. Recommended vaccinations include: – diseases such as tuberculosis (BCG), pertussis, rubella, measles, and mumps, chickenpox, influenza, hepatitis B, and shingles; – invasive infections caused by Haemophilus influenzae type B, pneumococcus, and meningococcus C. Important! Even though vaccines are generally available without a prescription, remember that you should always consult your doctor before getting vaccinated. Be mindful of the health status of the person being vaccinated: individuals undergoing certain treatments, pregnant or breastfeeding women, those with a fever, or those with underlying medical conditions… Vaccination: A Tool for Eradicating Epidemics!

LEARN MORE
In 1945, tetanus claimed 1,000 lives in France, compared to just 11 deaths between 2008 and 2011, and smallpox vaccination led to the eradication of the disease by 1977. Individual protection through vaccination, extended to the entire population, has thus proven to have a collective preventive dimension. Today, an anti-vaccination campaign is spreading online; by highlighting a few cases of adverse reactions, it fuels the idea that all vaccines are dangerous, thereby ignoring medical history. In fact, according to the WHO (1994), vaccinations (against diphtheria, tetanus, pertussis, measles, polio, and tuberculosis) prevent three million deaths each year. Beyond the danger to a child posed by the lack of vaccination against the most serious contagious infectious diseases, this hostility toward vaccines reduces the community’s protection against certain epidemics such as measles (according to the National Public Health Agency, from January 1, 2008, to May 31, 2016, more than 24,000 cases of measles were reported in France, including nearly 15,000 cases reported in 2011 alone. Nearly 1,500 cases developed severe pneumonia, 34 had neurological complications, and 10 died).

LEARN MORE
The Importance of a Vaccination Record: How Do You Know If Your Vaccinations Are Up to Date? Ideally, you should have a vaccination record for each member of your family and keep it with your passports or in your medicine cabinet. Not sure if your vaccinations are up to date and have lost your record? Ask your doctor for advice. For example, if you garden frequently, it’s essential to be vaccinated against tetanus (it still kills people in France!). The booster shot is given every ten years. Are you traveling and unsure about your vaccinations? Some vaccinations are mandatory, such as yellow fever (French Guiana and certain countries). If you’re planning a trip to a developing country, consult your doctor (or pharmacist) three months before departure. They’ll tell you which vaccinations are recommended based on your destination, the length of your trip, travel conditions, and your specific situation. For more information: http://social-sante.gouv.fr/IMG/pdf/calendrier_ vaccinal_2016.pdf

TABLE OF CONTENTS


ADULT SYMPTOMS AND ILLNESSES


Acne (adults/teens)
Allergies
Blisters
Sore Throat
Anxiety
Mouth Ulcers
Smoking Cessation and Nicotine Withdrawal
Asthma
Bloating, Flatulence, and Aerophagia
Bruises, Ecchymoses, and Hematomas
Cold Sores or Oral Herpes
Acute Benign Bronchitis
Heartburn
Skin Burns
Hair Loss or Alopecia
Muscle Strain
Conjunctivitis, Eye and Eyelid Disorders
Constipation
Contraception
Corns, Calluses, and Soft Corns
Heatstroke or Sunstroke
Sunburn and Sun Allergy
Muscle Aches
Muscle Cramp
Cystitis and Urinary Tract Infection
Itching or Pruritus
Teeth and Gums
Mild depression
Seborrheic dermatitis
Acute diarrhea
Indigestion or dyspepsia
Pain
Osteoarthritis pain and other joint pain
Anal pain
Ear pain and earwax buildup
Back pain
Fatigue or asthenia
Fever
Folliculitis, boils, and carbuncles
Scabies
Influenza and flu-like illnesses
“Hangover”
Hemorrhoids (hemorrhoidal flare-ups)
Benign prostatic hyperplasia (difficulty urinating)
Insomnia (minor sleep disturbance)
Heavy legs
Sore throat
Seasickness, Motion sickness
Bad breath or halitosis
Headaches and migraines
Athlete's foot or fungal foot infection
Nail fungus
Vaginal Yeast Infection or Vaginal Candidiasis
Nausea and Vomiting
Paronychia
Morning-After Pill
Insect Bites
Minor Wounds and Cuts
Head Lice, Nits, and Pubic Lice
Weight Gain and Obesity
Gastroesophageal Reflux
Painful Periods or Dysmenorrhea
Nasopharyngitis
Head Cold or Coryza
Hay Fever or Other Allergic Rhinitis
Nosebleeds or Epistaxis
Dry Mouth or Xerostomia
Dry Eyes
Spasmophilia
Pregnancy Tests
Stiff Neck and Neck Pain
Cough
Menopausal Disorders and Hot Flashes
Warts
Intestinal Worms
Vertigo

CHILDREN'S SYMPTOMS AND ILLNESSES


Constipation in Children
Acute Diarrhea in Children Over 3 Years Old
Pain in Children
Ear Pain and Otitis in Children
Infant Diaper Rash (Erythema)
Fever in Children
Sore Throat and Tonsillitis in Children
Motion Sickness in Children
Abdominal Pain in Children
Teething
Head Lice and Nits in Children
Infant Regurgitation and Vomiting
Rhinopharyngitis in Children
Cough in Children