Using medication

A drug can take effect either specifically in the area of the body it is applied to - for example on an inflamed area of skin. This is referred to as a “local effect.” Often, it is important that a drug can spread throughout your entire body, though. Doctors call this a “systemic effect.”

Whether the effect is local or systemic depends on the drug itself. The way that the medication is used and how the drug enters the body is a factor as well. When you use cortisone as an ointment, for example, it has a local effect on your skin. When used in tablet form, though, it is transported throughout your body and has a systemic effect.

These are the most common routes of administration (how the medication is used):

• Oral: The most common way to use oral medication is to swallow it in the form of tablets or capsules. But it’s also possible to take this medication as drops, syrup or a dissolved powder.
• Sublingual: Some drugs are absorbed by the lining of the mouth. They dissolve while they are still in your mouth. So they are taken by placing a tablet under your tongue or in your cheek, for instance.
• Nasal: Some medications are available as nasal (nose) sprays or drops. The active ingredient is absorbed by the lining of the nose.
• Aural: Drops that are used in your ear are known as “aural” or “otic” drugs.
• Inhaled: These medications are inhaled (breathed in) as a spray or a fine powder and absorbed by the mucous membranes lining the bronchi in the lungs.
• Rectal: Medication can be used in the rectum (bottom), for example in the form of suppositories and enemas.
• Vaginal: The medication is inserted into the vagina, in the form of an ointment or a suppository.
• Cutaneous: These medications are put on your skin in the form of creams or gels, for instance. Some only have an effect on that area of your skin, while others spread through the bloodstream to the rest of your body. A number of medications can also be applied using patches that slowly release the drug into the skin.
• Subcutaneous (SC): The drug is injected into the fat tissue just under the skin (subcutaneous fat tissue) and slowly absorbed into the blood stream.
• Intravenous (IV): A doctor injects the medication directly into a vein (injection) or attaches a drip (infusion) that slowly releases the medication into the bloodstream over a longer period of time.
• Intramuscular (IM): The medication is injected into a large muscle such as the gluteal muscle (in the bottom) or the biceps muscle (in the upper arm).

For a medication to reach the right place in the body and have the desired effect, the choice of dosage form is also important. The dosage forms include:

• Solid: tablets, capsules, coated tablets
• Liquid: tinctures, drinks, syrups, intravenous solutions, eye and nose drops
• Semisolid: ointments, creams and gels
• Other forms: sprays, patches, inhalation powder, suppositories

The choice of the dosage form and the route of administration determines where the medication will have an effect and how long that effect will last. One example: Some antibiotics are available as tablets to be taken by mouth or as a liquid solution that can be injected into muscle tissue. The tablets are taken daily, whereas the injection is only given once and the drug is then absorbed evenly by the body over a longer period of time.

Different dosage forms may useful for different age groups: Young children, for example, have difficulty swallowing tablets. If the medication they need is available as a drink or suppository, it is easier to use.

Not every active ingredient can be given in different dosage forms – they are determined by its physical and chemical properties.

Taking a tablet as needed for a nagging headache or toothache is usually straightforward. But it can be difficult to keep taking a medication regularly for a long period of time. It can be especially hard if you have to take several medicines because of chronic conditions like diabetes, osteoarthritis and heart disease, for instance. Special containers for medications (dispensers) and a list of the medications can then help you to keep track of things.

In Germany, a standardized medication schedule is available to help people who need to take three or more systemic medications over the long term. It lists all the medicines that you use regularly, and is issued by your doctor. More in-depth information on this medication schedule is provided by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung).

Different medications can affect each other when taken together, resulting in a different effect. That can make one drug less effective – or much more effective – than intended. This also increases the likelihood of side effects.

Certain foods – like grapefruit juice or dairy products – can also interact with some medication.

So it’s important to be aware of the possible interactions of any medicine you use. This is also true for older people who often take several medications to treat various conditions. Information on possible interactions can be found in the package insert.

More specific questions may arise about the use of some medications.

The correct use of antibiotics is an important topic in general. Using antibiotics incorrectly or too frequently is risky – this not only increases the risk of side effects, but it also leads to bacteria becoming resistant and the drugs losing their effectiveness.

Some painkillers are available from the pharmacy without a prescription – these are over-the-counter (OTC) drugs. They are generally well tolerated and easy to use – but there are still a few things to bear in mind, for example to avoid overdosing or to quickly recognize possible side effects.

It is also important to use sleeping pills and tranquilizers with caution, as it’s possible to become dependent on them. It is best to get help from a doctor when you to stop using them.

Many people take dietary supplements, sometimes over long periods of time. They do so in the hope that the vitamins and minerals in the supplements will improve their immune system and prevent illnesses. Some food supplements such as vitamin A, E or beta-carotene may also be harmful to health if they are taken long-term and at high doses without a specific reason.

Sometimes medicines are used to treat medical conditions for which they haven’t been approved by the country's regulatory authorities. This is referred to as off-label use, and may be a good alternative or the only treatment option. But it is also sometimes associated with certain risks. If a doctor prescribes medicine to you off label, they are required to specifically tell you about these risks.

When children need to take medicine, it’s especially important to check that the dose is correct to avoid risks. The doses for children often differ from those for adults. It can be easy to give them too much medication, particularly if the medicine is in liquid form, such as liquid antibiotics, painkillers or cough syrup. You may also need a lot of patience when trying to give medicine to very young children.

Older peoples’ bodies may also be slower to absorb some medications or to break a substance down than when they were younger. This increases the risk of side effects and drug interactions. The use of certain medications might also increase the risk of falls. These include some antihypertensives (blood-pressure-lowering drugs) and antidepressants.