Anti- dyspeptic Carminatives

Simethicone is an effective antiflatulent. It is used for relief of the painful symptoms o excess gas in the digestive tract. Such gas is frequency caused by excessive swallowing of ar Or Dy eating foods that disagree, or leading to indigestion. Mode of action: Simethicone acts n the stomach and intestines to change the surface tension of gas bubbles. enabling them to coalesce, thus gas is freed and eliminated more easily by belching or passing flatus. Its defoaming action relieves flatulence by dispersing and preventing the formation of mucous surrounded gas pockets in the G.I tract.

Ind: 1. Flatulence, abdominal distention, fullness, gas, and windy colic. Simethicone drop is specially used in infants.

2. Postoperative gas pains- Simethicone aids in the elimination of gas from the G.I tract and can be used to reduce postoperative gas pains.

2. Large bowel preparation- the addition of simethicone to a polyethylene glycol bowel preparation produces symptomatic improvement prior to investigation in patients undergoing colonoscopy.

3. Treatment of poisoning- Simethicone has an anecdotal use as an antifoaming agent in the management of accidental ingestion of foaming detergents.

C/I: Contra-indicated in renal failure, severely debilitated patients, Ist trimester of pregnancy.

S/E: Simethicone is physiologically inert and no adverse effect has been noted after oral ingestion.=

Precaution: Do not exceed 12 doses per day except under the advice and supervision of a physician Keep the medicine out of the reach of children.

Pregnancy &Lactation: No data are available to suggest any harmful effect in pregnancy, still it is not advised to give in the 1st trimester. Excretion of simethicone in breast milk has not been established and is also unlikely.

Dosage & Admin: Children less than 2 years of age- 20mg (0.3ml or 5 drops) 4 times daily up to 240mg (3.6ml or 55 drops)/day.

Children 2-12 years of age- 40mg (0.6ml or 10 drops) 4 times daily.

Adults- 40-80mg (0.6ml-1.2ml or 10-20 drops) 4 times daily, up to 500mg (7.5m)/day.

Take all the dosages after meals and at bedtime.

In the case of infants, can be given with feeds. Shake the bottle well before each use.

Drug interaction: There is no evidence that simethicone modifies the effect of other drugs. The defoaming effect of simethicone is reduced by antacids such as aluminum hydroxide and magnesium carbonate, which absorb the silicone.

METOCLOPRAMIDE HCl: Tablet/syrup/drop/injection

It is an effective anti-emetic drug. It has got a central anti-emetic effect & a peripheral action on the gut as a dopamine antagonist, as a result, it enhances the motility of the upper gastrointestinal tract & thus hastens gastric emptying.

Indications: Non-ulcer dyspepsia, for speeding the transit of barium during intestinal follow-through examination.reflux oesophagitis and also in non-specific or cytotoxic nausea and vomiting.

Side Effects: Extrapyramidal reactions, drowsiness, constipation, gynecomastia, galactorrhoea.

Cautions: Renal impairment, immediately after abdominal surgery, Parkinsonism & children.

Adult: 15 to 20 years 5-10mg; others, 10mg. Both 3 times daily.

Child: Under 1 yr, 1 mg twice daily; 1-3 yrs. Img 2 or 3 times daily; 3-5 yrs. 2mg 2 or 3 times daily;5-14 yrs. 2.5-5mg 3 times daily. All orally, i.m or i.v. Usual max. doses, all ages 0.5mg/kg body-daily

Preparations: See under anti-vomiting drugs in the chapter of CNS products.

MOTILITY STIMULANTS/DOPAMINE ANTAGONISTS

Tablet/Suspension/-Suppositories Introduction & mode of action: Domperidone is a dopamine antagonist. It acts peripherally rather than central action; since it can't readily enter the central nervous system due to the blood-brain barrier, its effects are confined to the periphery and acts principally at the receptor site in the chemoreceptor trigger zone.

Ind: In the adult-

i. prevention and symptomatic relief of acute nausea and vomiting from any cause including cytotoxic therapy, radiotherapy, and anti-parkinsonism therapy: 

ii. functional dyspepsia: not recommended for routine prophylaxis of postoperative vomiting or for chronic administration. In children- the use of domperidone is restricted to nausea and vomiting following cytotoxic or radiotherapy only, not recommended for other causes

C: The known case of hypersensitivity to this drug: neonates.

Use in pregnancy & lactation: In pregnancy, the safety of domperidone has not been proven and hence it is not recommended during pregnancy. In lactating mother, domperidone may precipitate galactorrhoea & improve postnatal lactation; it is also secreted in breast milk but in very small quantities insufficient to be considered harmful, but its use in lactating mother should be very cautiously observed

S/E: Domperidone may cause increased prolactin production (1.3%), which may result in galactorrhoea gynaecomastia; soreness and reduced libido. Other gynecomastia; soreness and reduced libido. Other side-effects may include- dry mouth, nervousness, drowsiness, skin rash, and itching. Extra-pyramidal reactions are also reported very rarely in some clinical studies.

Cautions: Domperidone should be used with absolute caution in case of young children, because there may be an increased risk of extrapyramidal reactions, since the drug may enter into the central nervous system due to an incompletely developed blood-brain barrier.

Dosage &Admin: Adults- acute nausea and vomiting (including drug-induced), 10-20 mg every 4-8 hours daily orally; maximum period of treatment is 12 weeks. Functional dyspepsia, 10- 20mg 3 times daily orally before foods & at night: the maximum period of treatment is 12 weeks. 

Children- nausea and vomiting following cytotoxic or radiotherapy only, 0.2-0.4mg/kg every 4-8 hours daily. Functional dyspepsia- not recommended.

Note: Domperidone oral preparations should be taken15-30 minutes before a meal.

Drug interactions: Domperidone may reduce the hyperprolactinemic effect of bromocriptine. The action of domperidone on g.i function may be antagonized by antimuscarinics and opioid analgesics.

MAGNESIUM HYDROXIDE OR MILK OF MAGNESIA: Suspension

Antacids with Laxative action

Composition & action: An aqueous suspension of magnesium hydroxide containing about 8% hydrated magnesium oxide, also known as milk of magnesia is an effective osmotic laxative. This magnesium salt is useful where rapid bowel evacuation is required & acts as an osmotic laxative by retaining water within the gut. This is also an effective antacid and bowel disturbances are minimized when combined with a potentially constipating aluminum salt.

Ind: Constipation, heartburn. gas & nausea. Acute & chronic constipation due to hyperacidity & peptic ulcer.

C/I: Do not use where use fo laxative is contra-indicated; acute gastro-intestinal conditions; renal failure (risk of magnesium accumulation).

S/E: Diarrhoea; abdominal colic.

Caution: Hepatic impairment elderly and debilitated; heart block, myocardial disease; pregnancy.

Doses: Adults & older children- 5 to 10 tsp in a single dose or in divided doses with a glass of water.

Children: 6-11 years, 3 to 5 tsp in a single dose or in divided doses with water; 2-5 years, 1 to 3 tsp in a single dose or in divided doses with water.

Ind: Duodenal, benign gastric and postoperative ulceration, reflux oesophagitis, Zollinger- Ellison syndrome, and other conditions where a reduction of gastric acid is beneficial.

S/E: No serious adverse effects have been reported to date. But rare and transient nausea, headache, dizziness, and diarrhoea may occur. Anaphylactoid reactions & skin rashes have been reported rarely.

Caution: Caution should be taken in case of renal impairment, pregnancy, lactation; exclude malignantly diseases before treatment. Carry out periodic examinations of patients on prolonged therapy

Dose: Adult- benign gastric and duodenal ulcer, 150mg (1 tab or 2 ts) b.id. in the morning and at bedtime; or 300mg at bedtime for 4 weeks; maintenance therapy, at bedtime.

Reflux oesophagitis, 150mg b.i.d.for up to 8 weeks. Zollinger-Ellison syndrome, the starting dose is 150 mg t.d.s. and maybe increased as necessary to 900mg (six tablets).

Child- Under 8 yrs. not recommended; over 8 yrs. up to 150mg twice daily. By injection: adult- 50mg. 1.m. or by slow  IV.  Inj. or infusion, repeated 6 to 8 hourly.

Child- not recommended.

Ind: Peptic ulceration, recurrent and stomal ulceration, Zollinger-Ellison syndrome; Reflux oesophagitis and other conditions where a reductation of gastric acid is beneficial, erosive gastritis with bleeding.

Cautions: Impaired renal functions (reduce dosage), exclude malignant disease, as cimetidine may mask symptoms and delay treatment; long-term treatment should be avoided (if possible) otherwise the patient should be kept under observation or monitored; avoid abrupt withdrawal of treatment, concurrent admin. of anticoagulants or phenytoin.

S/E: Occasional diarrhoea, dizziness, rashes, rarely mental confusion, and gynecomastia.

Dose: Adult- by mouth, duodenal & benign gastric ulcer, 400mg, 2 times daily with breakfast & at bedtime or 800 mg at bedtime for a minimum 4 weeks, then 400mg. once or twice daily as a maintenance dose. Reflux oesophagitis- 400mg 4 times a day after meals.

By injection- 200mg i.m. or slow i.v.( 100-150mg/hour) 4 to 6 hourly, max. dose 2 gm. daily. 

Child- not recommended.

*G-CIMETIDINE Inj. Gonoshastho.

Cimetidine 200mg/2ml ampoule: injection 25 amps pack: 107.25 MRP

Ind: Lansoprazole is indicated in the treatment of conditions where a reduction of gastric acid secretion is required, such as- duodenal ulcer, gastric ulcer, peptic ulcer associated with Helicobacter pylori, NSAID associated peptic ulcer, gastro-oesophageal reflux disease, acid-related dyspepsia & Zollinger-Ellison syndrome.

C/l: Hypersensitivity to the ingredients of this drug.

S/E: These include- headache, diarrhea, rashes, pruritus, dizziness, urticaria, nausea and vomiting, constipation, flatulence & abdominal pain.

Precaution &warnings: Lansoprazole should be administered with care in the following patients-

•  patients with a history of drug hypersensitivity,
•  patients with hepatic dysfunction, 
• in pregnant women or women having possibilities of being pregnant only if the expected therapeutic benefit is thought to outweigh any possible risk, 
• it is advisable to avoid in nursing mothers, 
• the safety of lansoprazole in children has not been established.

Dosage & Admin: Benign gastric ulcer- 30mg daily in the morning for 8 weeks. Duodenal ulcer- 30mg daily in the morning for 4 weeks; maintenance 15mg daily. NSAID associated duodenal or gastric ulcer- 15mg to 30mg once daily for 4 weeks, followed by a further 4 weeks if not healed completely. Zollinger-Ellison syndrome (and other hypersecretory conditions)- initially 60mg once daily adjusted according to response; daily doses of 120mg or more are given in two divided doses. Gastro-oesophageal reflux disease- 30mg daily in the morning for 4 weeks, followed by a further 4 weeks if not fully healed; maintenance therapy may be required, 15-30mg daily. Acid- related dyspepsia- 15mg to 30mg daily in the morning for 2-4 weeks.

Interactions: In clinical studies, lansoprazole does not show any significant interactions with warfarin, indomethacin, aspirin, ibuprofen, phenytoin, prednisolone, antacids, or diazepam in healthy subjects; but when administered concomitantly with theophylline, a minor increase (10%) in the clearance of theophylline was seen, which is unlikely to be of clinical importance.

General Information

Toothache" usually refers to pain around the teeth or jaws. Common dental causes of toothache include dental cavities, dental abscess, gum disease irritation of the tooth root, cracked tooth syndrome, temporomandibular disease, impaction, and eruption. Most commonly toothache is the result of dental decay caused by acid-producing bacteria in the mouth.

Bacteria that live in our mouth thrive on the sugars and starches in the food we eat and form a sticky plaque that clings to the surface of our teeth. Acids produced by the bacteria in plaque can eat through the hard, white coating on the outside of our teeth (enamel), creating a cavity.

Pain is caused by the corrosion of the tooth enamel and the exposure of the nerve endings of the tooth. The severity of a toothache can range from chronic and mild to sharp and excruciating. A sensitive tooth is used to define painful teeth due to exposure to extreme temperatures.

Sometimes, a toothache may bee caused by a problem not originating from a tooth or the jaw. Pain around the teeth and the jaws can be symptoms of diseases of the heart (such as angina or heart attack), ears (such as inner or external ear infections), and sinuses (air passages of the cheekbones).

A thorough oral examination, which includes dental X-rays, can help determine the cause, whether the toothache is coming from a tooth or jaw problem.

Signs and Symptoms

• Pain with chewing
• Hot or cold sensitivity
• Bleeding or discharge from around a tooth or gums
• Swelling around a tooth or swelling of your jaw
• Injury or trauma to the area

Advice to the Customers

• Consult a dentist in case of severe pain. The dentist may call for tooth extraction, root canal ora simple pulp filling.
• Chew on sugarless gum to stimulate salivation
• Mouthwash may decrease bacteria in the oral cavity but only on a short term basis.
• Avoid hot, cold, and sweet foods and beverages to avoid the aggravation of the pain.
• Flossing prevents the formation of plaque and lodged food debris, thereby lessening the chances for a toothache to occur.
• Brush the teeth three times daily regularly to prevent plaque formation.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, 1.e. name of the medication, frequency of dosage, etc.
• In cases where the toothache is severe or persistent, instruct the patient to consult a physician.
• Discuss advice to the customers thoroughly for more information on the prevention and management of toothache.

General Information

A sore throat is the result of a very common infection by any one of a large number of bacteria or viruses. It is a part of a collection of illnesses ranging from the common cold to glandular fever. 

The sore throat may be accompanied by sniffles, cough, and feeling generally weak and feverish. Bacteria and viruses infect the tissues at the back and sides of the throat. The body makes antibodies to the infection, and this may cause the glands (lymph nodes) in the neck to swell and become tender Often a sore throat is associated with enlarged, tender glands in the neck that causes difficulty in swallowing. 

There is often dryness, redness, and a raspy feeling when a person has a sore throat. Most commonly sore throats are caused by viruses e.g. adenoviruses, influenza, and sometimes glandular fever (infectious mononucleosis). Many other viruses may cause sore throats as well as bacteria e.g. streptococcus. The untreated streptococcal throat infection may later pose a risk of rheumatic fever, which may later lead to a fatal condition called rheumatic heart disease.

Signs and Symptoms

Symptoms of sore throat include:

• Fever
• Headache
• Nausea
• Malaise
• Pus on the surface of the tonsils
• Redness of the oropharynx
• Tender neck glands (inflamed lymph nodes)
• Drooling or spitting (swallowing becomes too painful)
• Difficulty breathing (inhaling can be especially difficult when the passage through the pharynx or larynx becomes too narrow for a normal stream of air)

Advice to the Customers

• Sore throats usually clear up in a few days, even without medication.
• An antibiotic is of no benefit if the infection is caused by a virus.
• Sucking ice may help relieve the Soreness of the throat.
• Taking sugar-containing preparations to relieve sore throat may cause tooth decay, especially when given to children. Diabetics should also be warned of the sugar content of these products
• Drink more of clear liquids (cold sodas, Popsicles, and mild juices) as these are most soothing and help to thin out the mucus at the back of the throat.
• Add 1/2 teaspoon of table salt to 1 Cup of warm tap water and gargle with this solution at least 4 times a day as it helps to soothe and heal.
• Practice good hygiene like washing hands, covering the nose, and mouth when sneezing, and proper disposal of used facial tissues.
• Avoid smoking as it irritates and dries the mucous membranes that line the nose and throat.
• Applying moist heat compresses (wash-cloths moistened with warm tap water) to the neck helps swollen glands feel better

Prescription Advice

Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.

In cases where the sore throat is severe, instruct the patient to consult a physician.

Discuss Advice to the Customers thoroughly for more information on the prevention and management of Sore throat.

General Information

Difficulty in sleeping or insomnia is not a disease inset may be a symptom of underlying problems, eg. stress. anxiety, pain, or prostate problems it may be a temporary problem of unknown causes. Sleep difficulty is often temporary but may become chronic in Some people. The length of sleep varies in many people and nones really ideal. Some people need very little sleep and sit function well during the day while others need a lot more sleep. It is important to know whether the patient has difficulty getting to sleep or saying as sleep. People generally require less sleep, as they get older. Elderly people oñen get to sleep fast but wake up after a few hours.

Possible reasons for sleeplessness include pain, getting up to go to the toilet, snoring. going to bed too early and not sleeping through to normal morning hours, and difficulty in breathing. which could be caused by respiratory or cardiovascular disease. Many people who have to snore the problem may be experiencing sleep apnea, a condition where the person's breathing stops tor a very short time every few minutes during sleep because their airway is blocked by the tongue and throat. The brain wakes up the person every time this happens to start breathing again. However, they are unaware of the constant sleep-wake pattern during the night; hence, they wake up feeling tired and remain sleepy throughout the day

Signs and Symptoms

• Chronic, loud snoring, gasping, or choking episodes during sleep. Excessive daytime sleepiness (EDS)
• Morning headache
• Cognitive difficulties poor memory concentration
• Personality changes depression
• Gastro-esophageal reflux
• Frequent nocturnal urination
• Morning sore throat
• Dry mouth in the morning
• Restlessness
• Chest and limb pain
• Obesity
• A thick neck

Advice to the Customers

• Avoid drinking coffee or tea a few hours before sleeping, since these drinks contain caffeine, a stimulant. Herbal teas may be used as an alternative.
• Alcohol, nicotine, and other stimulants should also be avoided late in the evening. Alcohol may appear to help some people get to sleep initially but may cause waking after a few hours.
• Avoid taking a meal or large snack just before bedtime.
• Sleep in a regular routine by going to bed and getting up at the same time each day.
• Avoid daytime naps. If a nap Is taken, go to bed much later.
• Do some exercise during the day or late in the noon.
• Practice relaxation techniques, especially before going to bed

Prescription Advice

• Instruct the patient on the medication and how to use it properly, I.e. name of the medication, frequency
• of dosage etc
• In cases where the sleep difficulty is severe and long-standing, instruct the patient to consult a physician
• Inform the patient of the possibility of interactions of some antacids with other medications, and the side effects associated with some of these agents
• Discuss Advice to Customers for more information on the prevention and management of sleep difficulties.

General Information

Pre-menstrual tension or syndrome (PMT or PMS) is a collection of physical and emotional (mood) changes related to menstruation.PMS usually starts at the beginning of the menstrual cycle and lasts until a few days after menstruation. The cause of PMS is still unknown. The condition commonly occurs in many women, although the symptoms are normally mild. Less than 10% of this population experience severe symptoms and these women should seek medical advice.

Signs and Symptoms

Physical:-

• Fluid retention-swollen ankles, fingers, legs, bloated feeling in the stomach, puffy face.
• Tender, swollen or painful breasts
• Dull aches and pains often beginning in the back, knees, or ankles
• A headache like a band around the forehead
• Gaining weight.
• Stomach cramps, constipation.
• Tiredness/no energy.
• Increased thirst or appetite.
• Difficulty in sleeping
• Skin breaks out.
• Being clumsy or uncoordinated.

• Tension, anxiety.
• Depression
• Being irritable, aggressive angry.
• Sudden mood swings
• Decreased interest in work, study friends and hobbies.
• Difficulty concentrating

Advice to the Customers

• Practice stress management and relaxation techniques
• Cut down on salt to help prevent bloating, and avoid caffeine to lessen anxiety.
• Because the symptoms are numerous, trying different products may be necessary, with each product tried for approximately 3-4 months to determine effectiveness. However, if two to three products fail to provide symptomatic relief, the patient should see a physician who may prescribe medicines that may be helpful.
• If PMS interferes significantly with a normal lifestyle, refer the patient to a physician.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• In cases where PMT is severe and causing much discomfort, instruct the patient to consult a physician.
• Discuss advice to the customers thoroughly for more information on the prevention and management of pre-menstrual tension.

General Information

Conjunctivitis, commonly known as "Red-eye", is an inflammation of the membrane (conjunctiva) that covers the eye and lines the inner surface of the eyelid. The consistency of possible discharge may range from watery to purulent (pus-like), depending on the specific cause of conjunctivitis. The common cause involves the introduction of either bacterial or viral microorganisms into the eye. These may be transmitted to the eye by contaminated hands, washcloths or towels, cosmetics (particularly eye makeup), false eyelashes, or extended wear contacts. It is not uncommon tor minor conjunctivitis to accompany a viral cold or flu. Although bacterial and some of the viral infections (particularly herpes) are not very common, they are potentially serious. Both types of infection are contagious irritants are another cause of conjunctivitis. Offenders of this type include air pollutants, smoke, soap, hairspray, makeup, chlorine, cleaning fluids, etc. Lastly, some individuals acquire conjunctivitis due to a seasonal allergic response to grass and other pollens. It usually takes from a few days to 2 weeks for most types of conjunctivitis to clear. Conjunctivitis due to an allergy may continue as long as the offending pollen is present.

Signs and Symptoms

• Itching
• Redness
• Photophobia (sensitivity to light)
• Swelling of the lids and/or discharge from the eyes
• Reduced visual acuity
• Ciliary flush
• Conjunctival hyperemia
• Corneal opacification
• Corneal epithelial disruption
• Pupillary abnormalities

Advice to the Customers

• Stay away from substances that irritate the eye, such as smoke, dust, cosmetics, and chlorine in Swimming pools, especially if these are factors known to aggravate the condition
• Wash your hands frequently and keep them away from your eyes in order to reduce or prevent decontamination 
• Avoid rubbing of the eyes to decrease irritation of the area
• Throw away or carefully wash items that touch your eyes
• Rubbing can cause a more severe infection or prolongation of the condition. Use a clean tissue paper if rubbing is necessary
• Avoid touching other people's eyes Do not share eye makeup or other items used on their eyes (for example, towels, or tissues)
• Apply cool compresses to the infected eye(s) 34 times per day for 1015 minutes using a clean washcloth each time. This should help reduce itching and swelling and provide some comfort.
• Contact lens should be removed before applying eye drops
• Do not wear contact lens if an eye infection is present
• Wear goggles when working in an area where metal is cut or where the work area has wood shavings or splinters

Prèscription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency
• of dosage etc.
• In cases where the red-eye is severe, instruct the patient to consult a physician
• Discuss advice to the customers thoroughly for more information on the prevention and management of red-eye.

General Information

Dysmenorrhea ls declined as a menstrual condition oharacterz0d by severe and frequent menstrual cramps and pain associated with menstruation. It is typically a cramping spasmodic pain occasionally lasting tor several days and is a Common monthly experience for many women, with more than 50% being affected and as many as 10% being incapacitated for 1-3 days each month, Dysmenorrhea is classified into primary and secondary dysmenorrhea Primary dysmenorrhea begins in adolescence and usually occurs only in ovulatory cycles, which generally appear within the first year of menarche. Childbirth and advancing age often improve the problem. Primary dysmenorrhea occurs mainly in young women, particularly in their late teens or early twenties. he severity depends on factors such as the age at which periods began, length of periods, degree of bleeding, and practices such as smoking. Period pain is not determined by body weight, length of the menstrual cycle, and level of physical activity. Secondary dysmenorrhea usually begins in the third decade and underlying pathology such as endometriosis or pelvic congestion may be present. It usually occurs in older women, i.e., those in their thirties and forties. Secondary dysmenorrhea is often due to other pelvic medical problems such as pelvic inflammatory disease (PID), uterine fibroids, abnormal pregnancy (i.e., miscarriage, ectopic), infection tumors, or polyps In the pelvic cavity.

Signs and Symptoms

The symptoms of primary dysmenorrhea are:

• Cramping
• Central and low abdominal pain
• Sharp and severe exacerbations
• Pain that often radiates to the back and upper thighs
• Systemic symptoms such as nausea, vomiting, diarrhea, headache, fatigue and rarely, syncope and collapse and pain that usually precedes the onset of bleeding by several hours, and is most severe on the first day of menstruation, pain that usually lasts from a few hours to 1 day and seldom exceeds 2 to 3 days.

The symptoms of secondary dysmenorrhea are:

• Pain that occurs several days prior to the onset of menses and lasts throughout menses.
• A sensation of abdominal bloating.
• Dyspareunia
• Menorrhagia

Advice to the Customers

• Apply heating pads on the lower abdomen to help relieve the pain.
• To prevent water retention and bloating drink plenty of water avoiding salt and caffeine.
• Doing exercises regularly increases pelvic circulation and lessens the intensity of period pains.
• Consume a healthy diet, rich in iron, calcium, and vitamin B complex
• Rest and relaxation may alleviate the pain during menstrual periods

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc
• In cases where period pains are severe and causing much discomfort, instruct the patient to consult a physician.
• Discuss Advice to the Customers thoroughly for more information on the prevention and management of period pain.

General Information

Osteoporosis is the thinning and weakening of the bones, resulting in brittle bones that fracture easily. All people suffer some degree of the condition, although women are affected by it more than men and at an earlier age. The condition progresses with age and is common in people over 60 years old, particularly in women after menopause, when the ovaries stop producing estrogen Hip, wrist and spinal bones are the most susceptible. Many people do not discover that they have osteoporosis until it is well established and at this stage, the condition is irreversible. Lack of dietary calcium and exercise smoking, caffeine, excessive alcohoł, nutritional deficiency, and intestinal and kidney dysfunction are some of the factors causing this bone disorder.

Signs and Symptoms

• Osteoporosis is sometimes called the silent thief because it quietly eats away at skeletal strength over time. For some women, the first sign of osteoporosis is a broken bone - the result of a tall, minor bump, or simply getting up or bending over Other, less traumatic signs include.
• Backache
• Loss of height - A loss of 2 or more inches may mean you're experiencing spinal crush fractures brought on by osteoporosis. it's not unusual tor you to miss these fractures because the pain may not be severe or last for long periods.
• Dowager's hump-a protrusion in the upper back. The thinner front sides of the vertebrae collapse, pushing the head forward, shortening the chest area, and reducing lung capacity.
• Tooth loss.

Advice to the Customers

• Exercise regularly
• Maintain a healthy weight and an active lifestyle.
• Eat food rich in calcium, e.g., milk, cheese, yogurt, sardines, shellfish, and green leafy vegetables.
• Take calcium supplements 
• Quit smoking, cut down on caffeine, salt, or alcohol intake.
• Advise the patient to undergo a bone examination such as a densitometry test to determine the extent of the disorder.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e name of the medication, frequency of dosage, etc.
• In cases of exacerbation despite treatment, instruct the patient to consult a physician.
• Discuss advice to the customers thoroughly for more information on the prevention and management of Osteoporosis.

General Information

Menopause is a state of physiologic cessation of menstrual bleeding as a result of decreasing ovarían function, which is a transition from fertile and menstrual years to a stage when a woman can no longer conceive. Menopause occurs when women runOut of viable ova or have their ovaries removed or damaged at the surgery. in either case, the production of oestrOgen, progesterone and androgens from the ovary is reduced below the level necessary to maintain good cellular responses. Menopause can be natural, artificial, or premature. Menopause is a natural stage in a woman's life occurring in the 40-55 year age group. The dramatic depletion of estrogen in the body is basically responsible for the symptoms.

Signs and Symptoms

The common symptoms involve:

• Vasovagal symptoms such as hot flu (80%% of patients), sweats(70%), formication (17%), and palpitation (30%)
• Irritability
• Nervousness
• Depression
• Insomnia
• Amenorrhoea
• Pain Back pain, bone and joint pain, muscle pain
• Osteoporosis
• Dry skin
• Poor memory
• Vaginal dryness
• Dyspareunia
• Dysuria
• Decreased libido

Advice to the Customers

• To prevent osteoporosis do weight-bearing exercises e.g. brisk walking regularly.
• To help to prevent heart disease eat a balanced low-fat diet.
• Take calcium-rich food and drinks eg, milk, cheese, etc.
• Wear loose clothing
• To prevent discomfort due to hot flushes occasionally douse your face with a moist towel.
• Avoid alcoholic beverages and coffee
• Drink plenty of water at least 8 glasses of water per day regularly.
• Have regular sleep. 
• Examine your breasts regularly.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, 1.e. name of the medication, frequency of dosage, etc.
• In cases where menopause causes much distress and discomfort, instruct the patient to consult a physician.
• Discuss Advice to the Customers thoroughly for more information on the prevention and management of menopause.

General Information

Urticaria or an itchy rash may occur anywhere on the body. It is usually temporary and disappears within 24-48 hours. The rash may be characterized by red welts (hard raised patches of skin) and is usually itchy, sometimes producing skin eruptions. Itchy rash is often due to an allergy to certain drugs, food, or preservatives There are also times when it is due to fever, heat, or physical pressure. The cause of urticaria is often unknown. Itchy rash in children may be caused by other childhood conditions such as chickenpox.

Signs and Symptoms

Urticaria is characterized by:

Blanching raised palpable wheels which can be linear, annular (circular), or arcuate (serpiginous). These lesions occur on any skin area and are usually transient and migratory

Advice to the Customers

• In cases where the cause of urticaria is known the trigger should be avoided.
• If aspirin causes the urticaria, see a physician before using any other NSAID
• A lukewarm shower may provide temporary soothing effect. Using hot water may worsen the itch.
• Avoid wearing tight clothing and clothing with tight bands. Pressure from straps and waistbands may worsen the welts and itch.
• If the condition does not respond to an antihistamine, the person should see a physician.
• Avoid scratching. Scratching will only make the urticaria worse.

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• In cases where urticaria persists for more than one week or is exacerbated, instruct the patient to consult a physician.
• Inform the patient of the side effects associated with antihistamines
• Discuss Advice to the Customers thoroughly for more information on the prevention and management of itchy rash.

General Information

Influenza, or flu, is an infection due to a virus. It can be very debilitating and serious, especially in the weak and/or the elderly. People often make the mistake of saying that they have the flu when it is just actually a cold. The symptoms of these persons are quite different Secondary infections such as bronchitis or pneumonia may be the result of influenza.

Signs and Symptoms

• A person with flu is likely to experience:
• A high-grade fever (38.8-40°C) 
• Muscle and joint aches 
• Severe, unexplained tiredness and weakness
• Headache that many range from mild to severe
• Pain and burning sensation of the eyes
• Cough that is usually non-productive
• Sore throat
• Nasal symptoms such as sneezing.a stuffed nose and /or a runny nose are rarely seen with influenza.

Advice to the Customers

• Measure the temperature regularly every 6 hours, making sure the manner of taking temperature is correct and properly carried out.
• Maintain a high fluid intake.
• Take an adequate amount of bed rest for 1-3 days to let the body rest.
• Influenza may be transmitted and contagious. Avoid areas that are populated such as the workplace.
• Vaccination against influenza is available. Consult your doctor about this.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• In cases where flu persists for more than one week or is exacerbated, instruct the patient to consult a physician.
•  Inform the patient of the side effects associated with NSAIDs, and some cough suppressants and decongestants
• Discuss Advice to the Customers thoroughly for more information on the prevention and management of influenza.

General Information

Indigestion is also called dyspepsia or heartburn. Indigestion may be caused by gastric disorders such as peptic ulcer, reflux esophagitis, gastritis, or gastric discomfort. Some symptoms of indigestion may signal the presence of a more serious underlying disease like cancer

Signs and Symptoms

• Symptoms of Indigestion include A feeling of discomfort or pain between the ribs and the navel during or after eating.
• A burning sensation felt in the chest that rises towards the throat, often occurring after eating, exercising, or lying down. This is 'reflux and is referred to as 'heartburn'.
• A bloated feeling, excess gas, and Wind.
• A lump in the throat or difficulty in swallowing.
• An ill-feeling or upset stomach.
• Feeling full after eating very little
• Pain and discomfort after a heavy fatty meal.

Advice to the Customers

• Walk and avoid bending over and lying down after eating. This helps the stomach to digest its contents easily, preventing them from being pushed upwards and cause heartburn.
• Stay away from foods that are known to upset your stomach. It is not necessary to have a bland diet, but foods that are tatty or spicy, coffee, or most alcoholic beverages may cause indigestion.
• Avoid wearing belts that are too tight.
• Seek medical advice when the pain is frequent and persistent to get a better diagnosis of your condition.
• Antacids are used only for the relief of the symptoms and not for treating the condition itself, unless otherwise instructed by the physician.
• In cases where an antacid in used for more than 3-4 times weekly, visit a physician so that a diagnosis can be confirmed.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• In cases where indigestion persists for more than two weeks or present exacerbation, instruct the patient to consult a physician.
• Inform the patient of the possibility of interactions of some antacids With other medications, and the side effects associated with some of these agents
• Discuss advice to the customers thoroughly for more information on the prevention and management of indigestion.

General Information

Hyperacidity is the excessive production of gastric fluids (e.g., hydrochloric acid, pepsin) in the stomach causing stomach upset. The excessive secretion of acid overwhelms the defenses, decreases the protective forces of the mucosal a layer of the stomach, ultimately damaging the inner lining, leading to a condition known as gastritis. The condition is generally influenced by chronic alcohol consumption, spicy food, irregular eating habits, carbonated drinks, stress, excessive smoking, certain medications (e.g. NSAIDs), and may also be brought about by surgery, burns, or severe bacterial infections Hyperacidity may lead to severe gastric ulceration leading to complication like perforation. This condition requires medical attention.

Signs and Symptoms

• Symptoms include Steady pain of short duration in the upper abdomen.
• Nausea
• Loss of appetite persisting for 1-2 days
• Heartburn or sour belching
• Vomiting of blood

Advice to the Customers

• Avoid foods and drinks that regularly bring discomfort, eg onions, and fried, tomato-based, spicy and highly acidic foods, etc.
• Eat three meals at regular times every day, avoiding snacks as much as possible so as not to suppress the appetite during mealtime
• Avoid cigarettes and alcohol to prevent the production of excessive gastric juice.
• Relax and get enough sleep. Stress induces the production of gastric juice.
• Chew gum or suck on hard candy to increase saliva production thereby neutralizing the acid that enters the esophagus.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• In cases where the hyperacidity has not cleared up after two days or present exacerbation, instruct the patient to consult a physician.
• Inform the patient of the possibility of interactions of some antacids with other medications, and the side effects associated with some of these agents.
• Discuss advice to the customers thoroughly for more information on the prevention and management of hyperacidity.

General Information

Hemorrhoids, or piles, are swollen tissues containing veins that are located in the walls of the rectum and the anus. Hemorrhoids are often characterized by itching and pain, which may be accompanied by rectal bleeding, soft lumps felt around the anus and a|slimy discharge from the anus in some cases Piles may become inflamed, bleed, develop a clot or become enlarged and eventually protrude (external Hemorrhoids) Repeated straining during bowel movements, constipation, pregnancy portal hypertension due to obesity or underlying liver disease may cause hemorrhoids.

Signs and Symptoms

• Pain around the anus and lower bowel (rectum)
• Itching around the anus is common with external hemorrhoids
• Thrombosed external hemorrhoids (blood clots within hemorrhoidal veins) may appear as painful lumps outside the anus. Pain is constant and aggravated by sítting or bowel movement. Bleeding may occur from a ruptured clot.
• Prolapsed (protrusion) of a small lump (hemorrhoid) may be telt or seen during a bowel movement.
• Bright painless rectal bleeding on the surface of stool is the first symptom of internal hemorrhoids.

• Soak in a warm bath for 10-15 minutes, three times daily. Soaking helps ease the pain and clean the affected area
• Control constipation with a high-fiber diet. Constipation is one of the major causes of hemorrhoids.
• Drink at least 8 glasses of water regularly.
• Avoid alcoholic beverages these beverages cause dehydration making defecation dry and difficult.
• Avoid scrubbing the affected area. Doing so would only irritate the hemorrhoids more.
• Exercise regularly.
• Do not resist the urge to defecate. However, do not try to move your bowel unless there is an urge to really do so.

• Instruct the patient on the medication and how to use it properly, i.e.name of the medication, frequency of dosage, etc.
• In cases where the hemorrhoids have not cleared up after a week or are exacerbated, instruct the patient to consult a physician immediately.
• Discus advises the customers thoroughly for more information on the prevention and management of hemorrhoids.

General Information

An ulcer is a general term that refers to a break in the skin or the lining of the gut or mouth that does not heal but is commonly related to the types involving the gastrointestinal tract. Hyperacidity or the presence of micro-organisms such as helicobacter pylori normally causes ulceration of the gastrointestinal tract. Also see separate articles on hyperacidity. Factors such as smoking and stress, irregular meal times, and improper diet or skipping meals, excessive alcohol consumption, and certain medications also influence the development of this condition. Peptic ulcers afflict men, women, and children.

Signs and Symptoms

• Gnawing or burning within 1%-3 hours after eating
• Frequent pain-causing sleeplessness but pain relief within minutes with food or antacids
• Recurring pain normally lasting from several days to several months
• Feeling of indigestion
• Heartburn or hunger pains
• Nausea
• Weight loss
• Anemia

Advice to the Customers

• Avoid or do not use caffeinated beverages. These drink also promote ulcers
• Reduce stress by taking time out to relax
• Avoid alcoholic beverages. Alcohol consumption may slow down the stomach's ulcer-repair mechanism
• Stop smoking
• Avoid medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) that can result in gastrointestinal bleeding and can cause and/or aggravate ulcers

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i e name of the medication, frequency of dosage, etc.
• In cases where the ulcer is severe or persistent, instruct the patient to consult a physician.
• DiscusS advice to the customers thoroughly for more information on the prevention and management o ulcer.

General Information

Headache is a common disorder occurring in 3 Out of 4 persons. It is seldom a symptom of underlying brain disease. Tension headache is the most common type, affecting people of all ages It can Occur frequently and is not associated with vomiting or aggravated by movement. A feeling of stiffness or tightness Over the top of the head or at the back of the neck often accompanies this condition. Migraine is a painful headache that occurs on one side of the head. It is characterized by throbbing pain, visual disturbances, and dislike of light, nausea, and vomiting Hormonal and stress factors, certain food, beverages or food additives, e.g. chocolate, alcohol, monosodium glutamate, sensory stimulation e.g bright light or blaring sounds, hunger, and Overexertion can trigger a migraine.

Signs and Symptoms

• Moderate to severe pain
• Pain on just one side of the head
• Throbbing or pulsing aches
• Feel sick or nauseous

• Identify the factors that trigger the headache and avoid them
• Take a pain killer; lie down and rest or sleep in a dark, quiet room
• Drink plenty of water and maintain a healthy diet
• An ice pack may help relieve the pain
• Take a cold shower
• Avoid the glare of strong sunlight; wear sunglasses outdoors
• Exercise regularly
• Relax; do stretching exercises in between extended periods of work or sitting

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e.name of the medication, frequency of dosage, etc.
• In the case of exacerbation despite treatment, instruct the patient to consult a physician immediately.
• Discuss Advice to the customers thoroughly for more information on the prevention and management of headaches.

General Information

Some of the most common types of fungal infections are tinea, pityriasis, and candida.

Signs and Symptoms

Athlete's foot (Tinea pedis)

• Occurs in moist and warm areas of the feet, particularly between the undersides of the toes.
• The skin in this area becomes soft and whitish with cracks and a red eruption
• The condition is usually accompanied by itching, burning, or stinging

The genital area (groin, inner thigh) becomes red and itchy when infected with fungi.

Ringworm (Tinea corporis)

• These are circular (rings) itchy red lesions that may have a raised edge but the clear area of unaffected skin in the center of the ring.
• Ringworm often occurs in body folds i.e. the armpits

Thrush (Candida albicans)

• Thrush can be associated with a nappy rash, especially in children. The rash will extend into the area of the groin and red pustules may appear.
• Sites where thrush commonly appears in adults include the area under the breasts, in the armpits, in the genital area, and in the mouth.
• Women may also experience vaginitis producing thick white, yellow, or green discharges that sometimes smell like fish. There may also be tenderness and irritation around the vagina, pain on sexual intercourse or on urination, itchiness, and a burning sensation in the area.
• When left untreated, fungal vaginitis may lead to infertility or may be transmitted to a newborn by an infected mother.

White spots(Pityriasis Versicolor)

• White spots are superficial fungal infections characterized by fine. scaly, white patches on the skin. 
• Some cases result in itching after sweating.
• This condition commonly appears on the face, neck, shoulders, and arms.

Advice to the Customers

• Shower or bathe at least once daily. Wash the feet twice daily and dry in a patting motion. Do not rub.
• Keep and use your own towels and face cloths to prevent contamination, especially in communal areas.
• Wear cotton and underwear changing them regularly (at least once daily)
• Use antifungal powders in shoes and socks to prevent the proliferation of the remaining spores.
• For most antifungal products, treatment should be carried out for two weeks after the skin has been cleared of the infection.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e.name of the medication, frequency of dosage etc
• In cases where the fungal infection has not improved or is exacerbated, instruct the patient to consult a physician
• Discuss Advice to the customers thoroughly for more information on the prevention and management of fungal infections.

General Information

Fever is a generalized condition where the body temperature is higher than the normal 37°C (100°F) as measured by an oral thermometer or 37.7°C as measured rectally. Pain and/or mild fever may accompany a viral infection such as the common cold, and influenza. Other symptoms of a viral infection include aching muscles and feeling generally unwell. Fever may be a symptom of another condition, especially in cases where it occurs with another symptom, i.e. sinusitis (with headache and nasal congestion), measles (with a rash), etc. Aside from bacterial and viral infection, other causes of fever include cancer, allergies, hormonal disorders, autoimmune diseases, or hypothalamic damage. Fever can have a positive role as part of the body's defense against some infections. Most mild fevers are self-limiting and will clear up on their own accord. Some medications may cause fever, e.g. certain antibiotics, antihistamines, quinine.

Signs and Symptoms

• Slight shivering
• Pain in the head and various parts of the body
• Thirst and great lassitude.
• Scanty urine flow
• As the fever rises, the pulse and respiration become faster. Finally, there is profuse sweating, a copious flow of concentrated urine, and general relief of symptoms.

Advice to the Customers

• Be aware of the warning signs, e.g. delirium, vomiting., diarrhea, etc.
• A cold bath or cold compress will often provide comfort and bring down the temperature of the patient.
• Wear light clothing and keep bedding light. Warm clothing may only hold the heat and make the patient more uncomfortable.
• Drink plenty of water (at least 8 glasses) or rehydration fluid as fever can cause dehydration.
• Check that the person knows how to use a thermometer

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• In cases where fever has not improved or is exacerbated, instruct the patient to consult a physician.
• Inform the patient of the side effects accompanying the use of NSAIDs, e.g., gastric irritation and ulcers.
• Discuss Advice to the customers thoroughly for more information on the prevention and management of fever.

General Information

Fatigue is an overwhelming feeling of tiredness due to physical, emotional, or mental factors. Most cases result from hard work or overexertion. This is the kind of fatigue that can be relieved by adequate sleep and nutrition. Other causes of fatigue include anxiety, depression, and lack of sleep and rest. The condition can also be brought about certain factors such as an underlying disease (e.g. anemia, lupus erythematosus), menopause, or some medications Feelings of inadequacy, low motivation, and decreased libido can also be symptoms of fatigue

Signs and Symptoms

• The least physical and mental effort causes exhaustion and weakness.
• The body aches with joint and muscle pain. Migrating joint pain without swelling or redness
• Muscle soreness and weakness Persistent low-grade fever 
• Sleep disorders (insomnia or oversleeping)
• Headaches
• Long-lasting malaise following physical exertion
• Memory loss or forgetfulness
• Mental confusion and poor concentration
• Digestive problems
• Loss of appetite
• Intestinal problems
• Food and environmental allergies/sensitivities
• Recurrent upper respiratory tract infections
• Depression
• Autoimmune reactions
• Dizziness
• Mood swings
• Anxiety attacks

Advice to the Customers

• Get enough rest, at least for 8 hours.
• Eat nutritious foods.
• Get more exercise.
• Avoid too much alcohol and caffeine.
• Rest and relax in a cool place with a dry atmosphere every once in a while.
• Change your routine every now and then to avoid the monotony that may lead to mental fatigue.
• Lose weight if you are overweight, eating well-balanced meals and avoiding crash diets.
• Quit smoking, smoking decreases the body's oxygen supply, thus decreasing the energy of the individual

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e name of the medication, frequency of dosage, etc.
• In cases where fatigue has not improved in one week or is exacerbated, instruct the patient to consult a physician.
• Discuss Advice to the customers thoroughly for more information on the prevention and management of fatigue.

General Information

The causes of diarrhea vary and may include a change in diet, food intolerance (e.g., lactose), inflammatory bowel disorder, drug-induced (anti-biotics, magnesium-containing antacids), a bacterial infection (food poisoning), or a viral infection (rotavirus in children).

Diarrhea may be accompanied by abdominal cramps, vomiting, or fever People with diarrhea, especially the very young and the elderly, are at risk of becoming rapidly dehydrated, which may be fatal at times. This requires immediate medical attention.

Signs and Symptoms

• Stools are watery, green, foul-smelling, explosive, and are Occasionally tinged with blood or mucus.
• Stomach pain
• Cramps
• Vomiting
• Headache
• Red rash around the anus

Advice to the Customers

• Avoid sodas or other drinks high in glucose since its sugar content may draw fluid into the gut thereby worsening the condition.
• Do not give only clear fluids you can also add electrolyte and fluid rehydration solutions.
• After 24 hours, eat only bland, dry foods. Avoid grains and uncooked fruit and vegetables. Fatty food and dairy products may only be eaten after 48 hours seek medical advice.
• Children may experience lactose intolerance (unable to digest milk sugars) for some time after diarrhea has settled. In this case, reintroduce milk products gradually.
• Avoid spreading the condition. Wash hands after each bowel movement, before eating, or during the preparation of food.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e. name of the medication, frequency of dosage, etc.
• Inform the patient about the possibility of side effects caused by certain anti-diarrhoeal agents.
• In cases where diarrhea has not improved in two days, instruct the patient to consult a physician
• Discuss advice to the customers thoroughly for more information on the prevention and management of diarrhea.

General Information

The terms eczema, dermatitis, and rash are often used interchangeably to describe the same condition. The most common forms of this condition are contact and atopic. Other forms include seborrheic, nummular, generalized exfoliative, status, and localized scratch dermatitis.

Contact dermatitis

• Results from direct contact with irritants.
• Is restricted to the area of contact.
• Develops slowly from chronic exposure.
• Is often due to skin contact with chemical irritants such as hair dye, nickel in jewelry, sticking plasters, perfumes, plants
• Is often very itchy, red, and has raised welts.

Atopic dermatitis

• Is common in the elbows or behind the knees.
• Often occurs with a history of allergy and/or asthma.
• Develops in early childhood.
• Looks like dry, flaking skin, especially before scratching starts
• Is usually symmetrical
• There is often a family history of allergy or eczema.

Signs and Symptoms

• Slight to marked redness.
• Itching.
• Drying, scaling and cracking, weeping, and thickening of some areas of the skin.
• There may be some swelling and blistering.

Advice to the Customers

• People with dry skin or those who are prone to dermatitis should use hypoallergenic cosmetics
• Use alternative products when possible to avoid the cause of contact dermatitis.
• After bathing or shower, dry the skin by patting with a towel, not by rubbing.
• Use a mild soap or soap substitute, even when the skin is healthy. Soap substitutes are the cornerstone of therapy
• Avoid taking too many showers or baths, as these dry the skin out One or two short showers or baths daily are enough.
• Applying moisturizers helps prevent excessive drying of the skin throughout the day.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, 1.8 names of the medication, frequency of dosage, etc.
• Inform the patient about the possibility of side effects caused by certain agents for dermatitis.
• In cases where dermatitis has not improved in 5-10 days, instruct the patient to contact the dermatologist immediately.
• Discuss Advice to the Customers thoroughly for more information on the prevention and management of dermatitis.

General Information

Dandruff is a natural metabolic condition characterized by excessive shedding of dead skin cells in the scalp. It is common and harmless. The scales, or scruff, are thin, dry, and white to off-white and often fall on the collar or shoulders of the shirt. Contrary to what is believed, dandruff is non-infectious and is not a sign of bad hygiene. Although the real cause of dandruff exacerbation is unknown, many conditions eg heredity, pathological diseases, and fungi have been cited Other causes include stress, obesity, and chemicals from hair cosmetics, eg., hair sprays, styling gels, mousse, etc.

Signs and Symptoms

• White or gray flakes on hair and clothing 
• itchy scalp.
• Irritating scalp
• Oily scalp.
• The affected area on the skin becomes red and greasy

Advice to the Customers

• Shampoo every day using a mild antidandruff shampoo.
• Switch shampoos if the regular anti-dandruff shampoo does not work.
• Rotate shampoo brands to avoid resistance.
• Avoid excessive use of hair
• Cosmetics, e.g., gel, mousse, hair spray
• Avoid scratching and itchy scalp.
• An infusion of rosemary or lavender or a few drops of essential oil of these herbs rubbed into the scalp may prove to be an alternative home remedy.

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e.name of the medication, frequency of dosage, etc.
• In the case of exacerbation despite treatment, instruct the patient to consult a physician immediately.
• Inform the patient that adverse events may occur eg., photosensitivity (especially with the use of coal tar products). In these instances, instruct the patient to contact the physician.
• Discuss advice to the customers thoroughly for more information on the prevention and management of dandruff.

General Information

A productive cough may be characterized by a rattly or tight chest. The patient may experience a feeling of congestion and breathlessness, which are often distressing The cough is accompanied by expulsion of mucus or phlegm Symptoms are usually heightened during waking and when talking.

Signs and Symptoms

Expulsion of mucus or phlegm Feeling of congestion and breathlessness 

Advice to the Customers

• Drink at least 8 to 10 glasses of water or other liquids regularly.
• Hot steamy showers ill help break down the mucus (phlegm) and make it easier to cough up.
• Keep warm.
• Refrain from smoking, being in cold, dusty, or dry environments.
• Avoid alcohol or caffeine to avoid fluid loss. Fluids are essential in keeping the mucus thin.
• Have plenty of bed rest.
• Paracetamol may be taken for fever and pain that accompanies the cough. However, some cold remedies already contain paracetamol so read the label to avoid an overdose.
• Do not take antihistamines, as these tend to dry up the secretions and leave them in the lung

Prescription Advice

• Instruct the patient on the medication and how to use it properly, i.e.name of the medication, frequency of dosage, etc
• Inform the patient about the possibility of side effects such as dependence and drowsiness caused by some cough preparations.
• In cases where productive cough persists for a long time or is exacerbated, instruct the patient to consult a physician immediately.
• Discuss advice to the customers thoroughly for more information on the prevention and management of productive cough.