Tips to better understand the leaflet

Tip: Consult with your doctor beforehand
The package leaflet focuses on the general effect and side effects of a medicine, but provides little practical and personal information. 30 percent of the Dutch are therefore looking for additional information, according to research by market research agency InSites Consulting. However, the understanding of the use of a medicine already starts in the doctor’s office, says scientist Jantien van Berkel. She conducts research into package leaflets at the VU Medical Center in Amsterdam. “As soon as possible, ask the doctor as much information as possible when prescribing a medicine. What exactly does this drug do? What happens if I don’t take it or stop taking it? What side effects can I expect? Can the medicines be used in combination with my other medicines?” The more thoroughly you review your personal health and medication use with the doctor, the better. Van Berkel: “The package leaflet is a reference book: how was it again?”

Tip: Expose the side effects
Manufacturers are legally obliged to list all side effects that have ever occurred in the package leaflet. That can produce a list of side effects that takes up more than half of the package insert. Some people are so frightened by this that they stop taking the drug prematurely or don’t even start taking it, according to research by the Pharmo Institute. As many as 50 to 70 percent of people who regularly have to take medication because of a chronic condition, stop within one year; half within three months. Sometimes because the drug does not work (well), sometimes because it has unpleasant side effects. But the fear of side effects is also an important reason to stop. Keep in mind, however, that everyone reacts differently to medicines, and that many of the side effects will never affect you. Do you want to know how often a side effect really occurs? Then go to the website of the Dutch Side Effects Center Lareb: www.lareb.nl. Here you can see which side effects of a substance have been reported and how often.
You can view the experiences of other patients with a certain drug at www.meldpuntmedicijnen.nl or on the new website www.mijnmedicine.nl.

Tip: Understand the package leaflet
For 60 percent of the Dutch population, the package leaflet is incomprehensible, according to a recent study by communication consultancy BureauTaal. Wendela Wessels, pharmacist and initiator of www.mijnmedicine.nl doesn’t mind: “The package leaflet is a short summary of complex matter. Moreover, medical terms are often difficult to translate into simple words.”
Many pharmacies therefore provide a sheet with their own medicine information for new medicines, as a supplement to the manufacturer’s leaflet. The information is printed on A4 paper, the letters are easy to read and the content is usually clearer and more extensive than in the package leaflet.
If you do not understand the information sheet or have additional questions, you can always ask your doctor or pharmacist. But there are also other ways to ask your question:

• Do you have an urgent question? Then call the Medicines Info Line: 0900-999 88 00 (€0.20 pm). You will be assisted by a pharmacist and you will receive an immediate answer.
• Ask your question to the web pharmacist www.apotheek.nl. You will receive an e-mail from a pharmacist within a few days.
• If you are taking medication for a specific condition, there is often a patient organization that can provide you with more information about your medication. Would you like to know whether there is a patient organization for your condition? View on www.npcf.nl, click on ‘Service’ in the navigation bar and go to the ‘Address Directory’.

Tip: Listen to the package leaflet
Do you have trouble reading the package leaflet because of the fine print? Then call the National Information Leaflet Telephone: 0900-0125 (on working days from 9 a.m. to 5 p.m.). Here you can listen to spoken package leaflet texts of all registered medicines at a local rate. Have the registration number (RVG, RVH or EU number) of the medicine handy.
Check the website for more information www.nationalebijsluitertelefoon.nl.

Tip: Report all your prescriptions to the pharmacist
The package insert states with which other medicines the medicine does not go well together. However, many things go wrong when prescribing medicines to people who are already taking other medicines. 30 percent are given medicines that they should not actually take in combination, according to recent research by the UMC St. Radboud in Nijmegen. Even more shocking is the outcome of a new study by the Erasmus Medical Center in Rotterdam: 3 percent of the over-70s are prescribed drugs that can be fatal in combination. For example, the combination of the water pill spironolactone (brand name Aldactone) with blood pressure lowering RAAS inhibitors can lead to a life-threatening increase in potassium in the blood.
How can you avoid taking wrong combinations of drugs? Pharmacist Wendela Wessels: “Always take all your prescriptions, from GP and specialist, to your own pharmacy. Pharmacies have an automated system that warns you if you take medicines that do not go together. And also report the non-prescription medicines used. Whether it is a cough medicine, a painkiller or a natural product such as St. John’s wort. It can all cause side effects when interacting with other drugs.”

Tip: Listen to your body
A leaflet with a long list of side effects, but yours is not even there? That too happens! “So always keep a close eye on how your body reacts to new medicines,” says pharmacist Wendela Wessels. “Do you have any side effects that are not listed in the package leaflet? Then contact the pharmacy. They can find out whether the side effect can come from the drug, or from an interaction with other drugs.”
You can also report side effects that are not in the package leaflet on the website of the Dutch Side Effects Center Lareb: www.lareb.nl. After submitting your report, you will receive a personal, substantive response.

Tip: Don’t have any doubts
Research by the Consumers’ Association shows that a quarter of the respondents cannot find important information in the package leaflet. This mainly concerns information about contraindications (situations in which the substance may not be used), side effects and interactions with other substances.
Pharmacist Wendela Wessels: “What often happens is that you cannot find your own health problems in the package leaflet. In that case, the doctor has probably prescribed the drug for an ailment for which it is not officially registered.”
It is also common that a higher dosage is stated in the package leaflet than on the label. “The reason is often that you can manage with a lower dose at an older age: the kidneys break down medicines more slowly, so that they stay in the body longer.”
Can’t find the information you’re looking for? Wondering if you’re getting the right drug or dose? Or are you concerned whether the effectiveness of the drug outweighs the possible side effects? Please contact your doctor or pharmacy. Wendela Wessels: “The doctor and pharmacist will consult each other if necessary. Perhaps a different drug can be prescribed or the dose or dosage adjusted.”