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[NB - Check renal function before starting an oral aminosalicylate, then at 3 months,  then annually (more frequently in renal impairment].

Advice This medication can rarely affect blood-making cells [which are used for carrying oxygen, fighting infection and controlling bleeding].
So if you develop a sore throat, mouth ulcers, unexplained bruising or bleeding, a rash, fever or any other signs of infection, report this to your doctor immediately.

Further information from patient.co.uk

[when taken for CVD - suddenly stopping aspirin  increases risk of  MI]
Suddenly stopping aspirin can be dangerous. Do not stop taking aspirin [unless you develop side effects like bleeding] without advice from the doctor.

B12 foods


Tablets should be swallowed whole with at least 200 ml of water on an empty stomach immediately after getting up in the morning.
Stay fully upright for at least 30 minutes or one hour.
Avoid any food, drink or other medicines during this time.

Stop taking the tablets and get advice from the doctor if you develop any symptoms of the oesophagus [food pipe] such as difficulty or pain on swallowing, chest pain, or new or worsening heartburn.

Maintain good oral hygiene and have regular dental check-ups.
Please report any mouth symptoms such as loose teeth, pain, or swelling.
Report any thigh pains as this can rarely be due to fracture of the femur [thigh bone].


Inform the  doctor immediately if you develop a sore throat, mouth ulcers,
bruising, fever, malaise, or any non-specific illness.

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Crisis response 0161 716 3806
Crisis team CMHT [home treatment] 0161 778 2094
Mile Lane pharmacy 0161 764 5054
Netpharm 0161 764 4401

Bury Coroner's Office 01706 924815

Hope Hospital 0161 789 7373


Avoid excess water intake (including water swallowed during swimming).
Stop  desmopressin if you develop vomiting or diarrhoea (until you are back to normal).

If you are taking this for night wetting, drink as little as possible from one hour before you take it, to eight hours afterwards.
Guidelines recommend that you try stopping desmopressin for at least 1 week, once you have been on it for 3 months, to see whether the symptoms have improved.

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Notes: Cases of male breast cancer have been reported. Patients or their carers should be told to promptly report to their doctor any changes in breast tissue such as lumps, pain, or nipple discharge.

Advice Report any changes in breast tissue, breast lumps, breast pain or nipple discharge.


Advice  report any possible side effects to the doctor. If you develop a blistering skin rash, or jaundice (yellowing of your skin or the whites of your eyes), you should speak with your doctor straightaway. These are rare but possibly serious side-effects of terbinafine.

More information [printable]


The following may help
losing weight (if overweight)
a balanced, healthy diet
avoid excessive red meat, seafood , alcohol or sugar-sweetened soft drinks [oily fish reduces the risk of heart disease so do not cut it out completely]
Vitamin C supplements [1000mg-1500mg a day] and/or allopurinol could  prevent reapeat attacks.

Maintain adequate hydration [drink up to 2 litres of water a day unless medical reasons not to e.g. heart failure]. This is especially important with fluid loss e.g. due to exercise or  hot weather.

elevation [eg if gout is in the foot, lie on a settee with feet  on a cushion]
try ice packs in a towel for up to 20 minutes about 4 times a day
over the counter painkillers can help but gout often needs stronger painkillers from the doctor
medications like anti-inflammatories, colchicine or opiates like tramadol [discuss options with doctor or pharmacist]

There is an increased risk of  high blood pressure, pre-diabetes [insulin resistance] and heart disease with gout.
It is therefore a good idea to have a BP check at least annually and address any lifestyle changes [diet, exercise, weight loss etc].
You should also have a cholesterol and glucose test at least once.

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If you GAIN 2kg [about 4 pounds] in weight
in 2 days
then let the doctor know straight away
You may also be able to double your water tablets
if that happens.


This drug can sometimes affect the eyes.
Please report any worsening vision or visual symptoms like blurred vision to the doctor.


Blue inhalers are usually 'relievers'.
They open the airways and should work within a few minutes.

Use as needed for cough or wheezing, usually up to 2 puffs 4 times a day.
In emergencies you can use 10 puffs in a spacer but then speak to a health professional soon
especially if the symptoms are not improving.
If  you need to use it more frequently, talk to the doctor or practice nurse soon.

Brown/beige/white/red/orange inhalers are usually 'preventers'.
They are usually  used regularly to prevent shortness of breath and wheezing.

If you have a preventer inhaler that contains a steroid (eg beclometasone, fluticasone) you should rinse your mouth with water after using it.
This  prevent thrush that can be a side effect.

If you are using both preventer and reliever inhalers, use the reliever a few minutes before the preventer if possible.
This is because the reliever opens the airways  and allows the preventer to get down into the lungs easier.

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Drinking orange juice or taking other vitamin C-containing foods with 
iron tablets can help you absorb them better.
Avoid taking tea until 2 hours after a meal containing iron, where possible.

You should take iron for a few months.
This will build up your stores of iron in your body.
You may need a blood test after having had iron for a few months.

Some people have side-effects like nausea,constipation, or diarrhoea.
Speak to the doctor if these are troublesome.
To try and reduce side-effects try:
- taking the tablets with meals. [Food reduces iron absorption so a longer
course will then be needed]
- taking a lower dose or miss some days out [a longer course will then be
- drinking plenty of fluids.

Iron tablets may make your stools black. This is sometimes confused with blood
in the stools from internal bleeding, which can also make your stools black.
If you suspect a bleed speak to the doctor

IMPORTANT - Iron tablets are dangerous for children. Store them safely.

Foods that contain iron include:
  • Red meat
  • Egg yolks
  • Dark, leafy greens 
  • Dried fruit (prunes, apricots,  raisins)
  • nuts
  • Iron-fortified cereals and 
  • wholegrains e.g. brown rice
  • Molluscs (oysters, clams, scallops)
  • Beans, lentils, chick peas and soybeans
  • Liver
  • Artichokes
Info from webmd and the NHS website
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Caution: susceptibility to osteoporosis.
Assess bone mineral density before treatment and at regular intervals.

Start malarone 1or 2 days before entering endemic area and continue until 1
week after leaving,
Remember the importance of avoiding mosquito bites and taking your
prophylaxis regularly
See a doctor immediately if you fall ill within 1 year and especially within
3 months of return.
Ultrasound scan referral form
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[Reports of blood dyscrasias (including fatalities) and liver cirrhosis with low-dose methotrexate]

Check full blood count and renal and liver function tests [FBC, U+E, LFT]
before starting treatment and
every 1 to 2 weeks until therapy stabilised,
then every 2 to 3 months

Advice to patients from patient.co.uk -
Important: If you develop any of the following, let your doctor know straight away:

* Sore throat, unusual bruising, mouth ulcers
* Sickness, abdominal pain, dark urine
* Shortness of breath, cough

Safe prescribing of methotrexate [bury]

There is a temporary supply problem with some isosorbide mononitrate tablets.
We will be prescribing an alternative but the total daily dose may change.
If you get symptoms, we may need to alter the dose, so please let us know.
If you are unsure about any of this, please check with the pharmacist or doctor.
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These drugs slightly increase the risk of heart, stomach or kidney problems
so try to limit usage when possible.
Diclofenac may have the highest risk and ibupofen may be the safest.
Paracetamol, though 
sometimes less effective , is much safer.

Patients or their carers should be told how to recognise signs and symptoms of blood or skin disorders
and advised to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers , bruising or bleeding develop.
Severe, progressive or symptomatic leucopenia may occur [withdraw the drug].
Advice Seek immediate medical advice if the following symptoms occur:-
a RASH , sore throat, mouth ulcers, unexplained bruising or bleeding, fever or any other signs of infection.


Suddenly stopping these can be dangerous. Do not stop taking these without advice from the doctor.

Advice for a patient on oral corticosteroids? From CKS

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Phone a local private hospital.
Ask for a consultant in the speciality you need.
Make an appointment.
Then inform our receptionists to get them to run off the letter to this consultant/specialist.
Collect letter to take along to your appointment.
You may need to check with your medical insurance to see what they will/won't cover.

BMI - The Beaumont Hospital, Old Hall Clough, Chorley New Road, Bolton
01204 404404

BMI The Highfield Hospital,  Manchester Road, Rochdale, OL11 4LZ
0808 101 0337

BMI The Alexandra Hospital, Mill Ln, Cheadle
0161 428 3656

Spire Hospital Russell Road, Manchester, Lancashire M16 8AJ
0161 226 0112

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Take this tablet as soon as possible. 
Please inform a clinician if you vomit within 2 hours of this tablet [this
doesn't happen often].
Your next period may be late.
Use a barrier method till your next period.
Contact a clinician if you get any lower abdominal pain [ectopic pregnancies
can occur infrequently].
See a clinician in 3-4 weeks if your next period is unusual [lighter,
heavier, short, missed or if there is any doubt about your period - in this
case a pregnancy test may be needed].
Please consider a long acting reversible method of contraception such as the
pill, injection, implant or coil.

For further guidance click here.


Contact a health professional immediately if you get symptoms such as nausea, vomiting, abdominal pain, fatigue or  dark urine. Also  report promptly any blood in the urine, painful urination, or a sense of urgency when needing to pass urine.

[NB- Before initiating treatment with pioglitazone, patients should be assessed for risk factors of bladder cancer (including age, smoking status, exposure to certain occupational or chemotherapy agents, or previous radiation therapy to the pelvic region) and any macroscopic haematuria should be investigated. The safety and efficacy of pioglitazone should be reviewed after 3–6 months and pioglitazone should be stopped in patients who do not respond adequately to treatment.

Patients already receiving treatment with pioglitazone should be assessed for risk factors of bladder cancer and treatment should be reviewed after 3–6 months, as above.]

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Latest guidelines recommend that patients reduce or stop medications like omeprazole if their condition allows it.
This is due to data which shows an slight  risk of osteoporosis when they are taken longterm.
Please speak to, or see the GP to discuss this,if this has not been dealt with and you think your condition will allow a trial of a lower dosage or stopping as appropriate.

Pre PSA counselling
 As well as a blood test, he will also need to have a rectal examination.
Screening can fail to detect some prostate cancers.
If test positive
will need a biopsy [can be painful and risk of infection and bleeding in approx 11-5%].
A repeat biopsy may be required (e.g. if PIN is identified).
Only one third of patients with a positive test turn out to have cancer.
We do not yet know if early treatment actually saves lives.
The treatments that would be offered can have unpleasant side effects.
The stress and anguish of knowing that you have cancer is severe and
a positive diagnosis may adversely affect applications for certain types of insurance (e.g. health, life, travel).
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Guidelines recommend that longterm treatment with quinine should be avoided if possible. 
You can try calf stretching exercises which can be very helpful for cramps.
Quinine can be toxic and can have side effects on the heart.
It is recommended to have a trial of stopping quinine, after every 3 months,
to see if the symptoms are acceptable without it.


apply the liquid to dry hair and rub it into your scalp. Let your hair dry naturally.
LEAVE IT ON FOR 8-12 hours (or overnight) and then shampoo it out.
Comb through your hair, using a 'nit comb', while it is still wet to remove the dead lice and eggs (nits).
REPEAT the process 7 DAYS LATER.

Apply the liquid all over including your face, neck, scalp and ears. but DO NOT get any into EYES.
Include awkward places such as your back, the soles of your feet, between your fingers and toes,
under your fingernails, and your genitals.
Pay special attention to the areas where mite burrows most commonly occur
- the front of your wrists and elbows, beneath your breasts, your armpits, and around the nipples in women.
Apply when your SKIN IS COOL and DRY, so after a bath/shower, wait for your skin to cool before applying.
Let it dry naturally.
Leave it on for 24 HOURS, and then wash it off.
If you wash your hands with soap during the 24 hours, reapply the liquid to your hands afterwards.
REPEAT the process 7 DAYS LATER.


Please report promptly any persistent, severe abdominal pain when on sitagliptin
[pancreatitis is a rare side effect].

Please report promptly any unexplained muscle pain tenderness or weakness
whilst on statins.

cautions for statins
notes on statins
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VALPROATE [e.g. Epilim , Depakote]

[monitor liver VITAMIN Dfunction before therapy and during first 6 month. Measure full blood count and ensure no undue potential for bleeding before starting and before surgery.
Patients or their carers should be told how to recognise signs and symptoms of blood or liver disorders and pancreatitis. Withdraw treatment immediately if persistent vomiting and abdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or loss of seizure control].
Advice Seek immediate medical advice if the following symptoms occur:-
- abdominal pain, nausea, vomiting,
fatigue, dark urine,sore throat, mouth ulcers, unexplained bruising or bleeding, a rash, fever or any other signs of infection.
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Please ensure taht every prescription you get for vitamin D has been hand-written
as 'dekristol'.

Take two dekristol [colecalciferol 20,000unit] capsules once a day for a week.

In 1 months time
Get a blood test to check calcium levels.
[Vitamin D treatment can sometimes cause Calcium levels to go too high].
If your calcium remains normal then you can continue on dekristol
2 capsules once a month.
[these are a high strength and 2 capsules once a month are usually enough].

In 3 months time
Get a blood test to check vitamin D levels and see the doctor for a review
and to see if treatment needs to continue.
Please report if your symptoms have improved.

NOTE - vitamin D medications MAY CONTAIN PEANUT OIL.
Speak to the doctor if you have a peanut allergy.

Guidelines from Kirklees with a useful management flowchart

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