Certain medications need to be taken with plenty of water. Depending on the medication, there are different reasons for this: -the medication could cause you to become dehydrated (e.g., lithium) -the medication could damage the kidneys or lead to kidney stones if too much of it reached the kidney at the same time (e.g., cotrimoxazole, indinavir) – water helps to “dilute” the extra medication so that too much medication does not go through the kidneys at once In general, medications should be taken with a full glass of water, unless your doctor or pharmacist recommends otherwise. If your medication needs to be taken with “plenty of water,” you may need to drink more than a full glass of water with your medication. This varies with the medication, but can be as much as 1.5 L every day, as is recommended for indinavir. Check with your pharmacist to see how much water you should have with your medication. It is also important to drink enough water throughout the day to avoid dehydration. People’s water needs will vary. If you are producing about 1.5 litres (6 cups) of colourless to pale-yellow urine each day and rarely feel thirsty, you are likely getting enough fluids.

Drowsiness, or feeling abnormally sleepy, is a common side effect of many medications. Drowsiness can affect your ability to drive, operate machinery, or do other things that require alertness. It affects some people more than others. A variety of different medications can cause drowsiness, including: -narcotics used to relieve pain (e.g., codeine, morphine) -certain antianxiety medications (e.g., diazepam, lorazepam, alprazolam) -certain antidepressants (e.g., amitriptyline, fluvoxamine) -certain antihistamines, often found in cold and allergy products (e.g., diphenhydramine, chlorpheniramine) – newer antihistamines (e.g., loratadine, fexofenadine) are much less likely to cause drowsiness, but may still make some people drowsy -certain anti-nausea medications (e.g., dimenhydrinate) Medications other than those listed above may also cause drowsiness. If you are not sure, check with your pharmacist. If you are starting a new medication that may cause drowsiness, it is important to avoid activities that require alertness, such as driving, until you find out how the medication affects you. Alcohol can add to the effects of the medication to make you even drowsier. People who do not get drowsy when taking the medication alone may find that they become drowsy when taking the medication at the same time as consuming alcohol.

Dairy products, antacids, and iron preparations prevent some medications from being properly absorbed into the body. If the medication is not properly absorbed, it may be less effective. Medications that are affected this way include: -certain antibiotics (e.g., tetracycline, ciprofloxacin, norfloxacin) -certain medications used to treat osteoporosis (e.g., alendronate, etidronate, risedronate) Other medications may also interact with dairy products, iron and antacids. Check with your pharmacist to find out whether this is true for your medication. If so, avoid taking or eating the following items within 2 hours of taking your medication (for some medications, a different timeframe may be recommended – check with your pharmacist): -Dairy products (milk, cheese, yogurt, ice cream, butter): These products contain large amounts of calcium, which can react with some medications and prevent them from being absorbed into the body. -Calcium supplements: Calcium can be found in multivitamins, over-the-counter medications and prescription medications (e.g., calcium carbonate, calcium gluconate, calcium citrate). Calcium can react with some medications and prevent them from being absorbed into the body. -Iron-containing products: Iron may be found in multi-vitamins, over-the-counter medications and prescription medications (e.g., ferrous sulfate, ferrous gluconate, ferrous fumarate). Like calcium, it can react with some medications and prevent them from being absorbed into the body. -Antacids: These products usually contain calcium, aluminium or magnesium. Any of these can interact with some medications and prevent them from being absorbed into the body.

Some medications should be taken on an empty stomach. This is usually because food prevents the medication from being fully absorbed into the body. Medications that should be taken on an empty stomach include: -ampicillin -bisacodyl -cloxacillin -didanosine -etidronate -risedronate -sotalol -sucralfate -tetracycline -zafirlukast A number of other medications should also be taken on an empty stomach. If you are not sure, check with your pharmacist. If your medication needs to be taken on an empty stomach, take it 2 hours before meals or 2 hours after your last food with a full glass of liquid (usually water). Some medications that should not be taken with food should also not be taken with milk. Check with the pharmacist to see if this is required for your medication.

Some medications should be taken with food. Depending on the medication, there are different reasons for this: -the medication is absorbed into the body better if there is food in the stomach (e.g., calcium, nelfinavir, sertraline) -the medication can cause stomach upset, and food can help prevent this (e.g., dexamethasone, diclofenac, carbamazepine) -the medication is needed to help the body process the meal (e.g., pancreatic enzymes, lactase) A number of other medications should also be taken with food. If you are not sure, check with your pharmacist. If your medication needs to be taken with food, take it with or just after a meal or a large snack. For some medications, it is enough to take it with a glass of milk. Check with your pharmacist for instructions specific to the medication you are taking.

There are two types of Turbuhaler®: -Medication that is inhaled through the mouth into the lungs (e.g., Bricanyl®, Oxeze®, Pulmicort®). -Medication is inhaled into the nose using a nasal adapter (e.g., Rhinocort®). A. General instructions for a Turbuhaler® where medication is inhaled through the mouth into the lungs. Unscrew the cover and lift it off. Load a dose by holding the inhaler upright. Turn the grip dial (coloured base portion) as far as it will go in one direction, then turn it back to the original position. The “click” you hear means that the inhaler is ready to use. Keep the inhaler upright until you are ready to inhale the dose. If you drop the inhaler or if it falls over before you inhale it, you must repeat step 2. Breathe out normally. Note: Never breathe out through the mouthpiece. Put the mouthpiece between your teeth and close your lips around the mouthpiece. Do not chew or bite down hard on the mouthpiece. Inhale forcefully and deeply through your mouth. You may not feel or taste any medication when you are inhaling – this is common. Talk to your doctor or pharmacist about how to tell whether your medication is working. Remove the inhaler. If your doctor has prescribed more than one dose, repeat steps 2 to 4. Replace the cover. Rinse your mouth with water (applies to a Turbuhaler® containing a steroid medication; check with your pharmacist if you aren’t sure whether your Turbuhaler® contains a steroid medication). B. General instructions for a Turbuhaler® where medication is inhaled into the nose using a nasal adapter. Unscrew the cover and lift it off. Load a dose by holding the inhaler upright. Turn the grip (coloured base portion) as far as it will go in one direction then turn it back to the original position. When you hear a “click,” the inhaler is ready to use. Keep the inhaler upright until you are ready to inhale the dose. If you drop the inhaler or if it falls over before you inhale the dose, you must repeat step 2. Breathe out normally. Note: Never breathe out through the nasal adapter. Place the nasal adapter in the nostril so that it fits tightly. Close the other nostril with a finger. Sniff quickly and forcefully. Remove the inhaler before breathing out. If you are using a dose in each nostril, repeat steps 2 to 4 for the other nostril. If your doctor has prescribed more than one dose, repeat steps 2 to 5. Replace the cover. Rinse your mouth with water. How do I take proper care of the Turbuhaler®? Clean the outside of the mouthpiece or nasal adapter once a week with a dry tissue. Never use water or any other fluid. If fluid enters the inhaler, it may not work properly. What do I do if I drop the Turbuhaler®? If you accidentally drop, shake, or breathe out into the Turbuhaler® after it has been loaded, you will lose your dose. If this happens, you should load a new dose and inhale it. How will I know when the Turbuhaler® is empty? There are 2 types of indictors to show when the Turbuhaler® is running out of doses: -Type 1: The Turbuhaler® has a dose indicator that moves slowly each time you use a dose. A number indicates every 20th dose and a dash indicates every 10th dose. When a “0” appears in the middle of the window, the Turbuhaler® is empty and you should start a new inhaler. You should obtain your next inhaler before the dose indicator reaches “0” to ensure you don’t miss any doses of your medication. The empty Turbuhaler® should be discarded because it cannot be refilled. -Type 2: These types of Turbuhaler® have a dose indicator. When a red mark first appears in the window underneath the mouthpiece, there are about 20 doses left. Now is the time to get your next inhaler so you will be ready when the doses run out. When the red line reaches the bottom, the Turbuhaler® is empty. It should be discarded because it cannot be refilled. *Different medications come in Turbuhaler® form. This information is intended to provide general instructions for the use of a Turbuhaler®. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

Wash your hands well with soap and water. If the suppository feels too soft to insert, hold it under cool water (before removing the wrapper) to harden it. Remove the plastic or foil wrapper completely. If desired, use cool water or KY jelly (or another water-based lubricant) to lubricate the suppository tip and the rectum. Lie on your side with the bottom leg straight and the upper leg bent up towards your chest. Gently push the suppository into the rectum, pointed end first. The suppository should be pushed past the muscular sphincter of the rectum (a few centimetres), so that it does not pop out. Close your legs and remain lying down for approximately 5 minutes. If the medication is for constipation, you should feel the urge for a bowel movement within about 15 to 60 minutes. If not, a suppository should be used at bedtime so that the medication is thoroughly absorbed. There may be some leakage in the morning. Wash your hands well with soap and water. *Many different medications come in suppository form. This information is intended to provide general instructions for the use of a suppository. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

Wash and dry your hands well. Open the sachet and press out a Spincap® through the foil. Hold the Spinhaler® upright with the mouthpiece pointing downwards; then unscrew the body. Check that the propeller is on its spindle, and then firmly push a Spincap® (coloured end downwards) into the cup of the propeller. Make sure that the propeller spins easily and then screw the body tightly back onto the mouthpiece. Still holding the Spinhaler® upright, slide the outer sleeve as far down as it will go and then back up again. This pierces the Spincap® and makes the Spinhaler® ready for use. Make sure the mouthpiece and the body of the Spinhaler® are still tightly screwed together. Breathe out, put the mouthpiece in your mouth and close your lips around it so that they are right up against the lip of the Spinhaler®. Tilt your head well back and breathe in as deeply as you can. Hold your breath for as long as comfortable, then take the Spinhaler® out of your mouth and breathe out. Keep repeating this process until the Spincap® is empty. 2 or 3 breaths should be enough. It does not matter if a little powder is left. Take a drink of water should your throat become irritated afterwards. How to look after the Spinhaler® Always keep your Spinhaler® in its container. This will make ensure that dirt cannot get into it. For best results, the parts of the Spinhaler® must be kept free from any powder residue. At least once a week, it is important that you brush off any powder left sticking to the propeller and wash all parts of the Spinhaler® in warm water. Make certain components of the Spinhaler® are completely dry before putting it back together. *This information is intended to provide general instructions for the use of a Spinhaler®. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product.

Remove the Rotahaler® from its container. Hold the Rotahaler® by the mouthpiece. Twist the barrel in either direction until it stops. Take a Rotacap® from its container. Hold the Rotahaler® vertically and press the Rotacap® firmly, clear end first, into the raised square hole. Make sure that the top of the Rotacap is level with the top of the hole. This will push the used Rotacap® shell, if one is there, into the Rotahaler®. Hold the Rotahaler® level (horizontal) with the white dot upper-most. Twist the barrel until it stops. This separates the 2 halves of the Rotacap®. The Rotahaler® is now ready to use. Breathe out slowly and fully, then immediately… …raise the Rotahaler® to your mouth. Be sure to keep it level. Place the mouthpiece over your tongue and well into your mouth. Close your lips around the mouthpiece and tilt your head slightly backwards. Breathe in through your mouth as deeply and fully as you can. Hold your breath for about 10 seconds or as long as is comfortable and remove the Rotahaler® from your mouth. Hold your breath as long as you comfortably can before breathing out. Pull the 2 halves of the Rotahaler® apart and discard the empty Rotacap® shells. There is no need to remove the shell that is still lodged in the square hole, except before cleaning. Reassemble the Rotahaler®. If your doctor has instructed you to use a second Rotacap®, repeat steps 2 to 10. Rinse mouth with water. How to look after the Rotahaler® Always keep the Rotahaler® in its container to keep it clean. At least every 2 weeks, wash the 2 halves of your Rotahaler® in warm water, making sure beforehand that the empty Rotacap® shell is removed from the raised square hole. Dry the Rotahaler® completely before putting it back together. Get a replacement Rotahaler® after you have used it for 6 months. Make a note of the date on which you got your current Rotahaler® so that you will know when to replace it. Do not swallow the Rotacaps®. Only insert Rotacaps® into the Rotahaler® immediately before using. *Different medications come in Rotahaler® form. This information is intended to provide general instructions for the use of a Rotahaler®. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

A patch is used to deliver medication through your skin into your bloodstream. While you wear a patch it provides a steady flow of medication into your body. Find an appropriate place to put the patch: Choose a dry, unbroken, non-hairy part of your skin. The buttocks, lower abdomen, lower back, and upper arm (outer part) are good choices. If the area you choose has body hair, clip (do not shave) the hair close to the skin with scissors. For women: If you are using a patch containing any type of estrogen (such as estradiol-17β, found in medications such as Climara® or Estraderm®) or nicotine (such as Nicoderm® or Habitrol®), do not apply it to your breasts. Make sure that the area is clean. If there is any oil or powder (from bath products, for example), the patch may not stick properly. Do not put the patch on skin that is burned, broken out, cut, irritated, or damaged in any way. If you need to clean the skin where the patch will be applied, use only clear water. Soaps, oils, lotions, alcohol, or other products may irritate the skin under the patch. Attach the patch to your skin: Remove the patch from its package. Do not do this until right before you are ready to use the patch. A stiff protective liner covers the sticky side of the patch – the side that will be put on your skin. Hold the liner at the edge and pull the patch from the liner. Try not to touch the adhesive side of the patch. Throw away the liner. Attach the adhesive side of the patch to your skin in the chosen area. Press the patch firmly on your skin with the palm of your hand for about 30 seconds. Make sure the patch sticks well to your skin, especially around the edges. If the patch does not stick well or loosens after you put it on, tape the edges down with first aid tape. Wash your hands after applying the patch. Wear the patch for the prescribed amount of time: Check with your doctor or pharmacist to find out how often your patch should be changed. Some patches have special labels to help you remember when to change to a new patch. Contact with water, when you are bathing, swimming, or showering, should not affect the integrity of the patch. Very hot water or steam may loosen the patch. In the unlikely event that a patch should fall off, a new patch must be applied for the remainder of the time you are required to wear the patch (as instructed by your doctor). If you are having patches fall off regularly, this could be happening as a result of using bath oil, using soaps with a high cream content, or using skin moisturizers before applying the patch. Patches may stick better if you avoid using these products. If you would like to use skin moisturizers, apply the patch first, then use the lotion on areas not covered by the patch. Some patches should not be exposed to heat while you are wearing them, as this increases the rate at which the drug enters your body. Check with your doctor or pharmacist to see whether your patch should not be exposed to heat. After wearing the patch for the prescribed period of time, remove the patch and throw it away: Be sure to throw away the patch so that it is safely out of the reach of children or pets (e.g., by folding it in half so that the adhesive side sticks together and flushing it down the toilet). The adhesive and the medication remaining in the patch could seriously harm a child or pet. Any adhesive from the patch that might remain on your skin can be easily rubbed off. Apply a new patch: Repeat steps 1 to 4 for the new patch. The new patch should be placed on a different skin site. Contact your doctor or pharmacist to find out how long you should wait before using the same skin site again. Before applying a new patch, make sure you have removed the old one. How to look after the patch Store the patch in its protective package at temperatures below 30°C. Apply the patch immediately after you remove it from its protective package. Keep out of the reach of children and pets before and after use. Do not cut the patch in half. This will cause the drug to leak out. This would be unsafe (as you could end up receiving too much medication) and prevent the patch from working properly. If for some reason, the patch is punctured and the contents leak onto your hands, rinse them thoroughly with water. *Many different medications come in patch form. This information is intended to provide general instructions for the use of a patch. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication, such as how often the patch needs to be changed, or whether the patch should be removed for certain activities such as exercise.

Blow your nose gently. Wash your hands well with soap and water. Remove the packaging from the nasal spray pump. Some nasal sprays need to be primed before use. As well, some nasal sprays need to be shaken. Check with your pharmacist to see whether your nasal spray needs to be primed or shaken. If your spray needs to be primed before using, spray it a few times into the air and keep it well away from your eyes. Close one nostril and keep your head upright, but not tilted backward. Insert the nasal spray tip into the other nostril. Keep the bottle pointing upright, and point the tip toward the back and outer side of the nose. Administer the required number of sprays into the nostril. Remember to breathe in slowly and deeply through your nose as you depress the applicator, and breathe out through your mouth after each spray. Remove the nasal spray tip from your nose and tilt your head back. If needed, repeat steps 5 to 8 in the other nostril, as directed by your doctor or pharmacist. Put the cap back onto the nasal spray container. Try not to blow your nose for several minutes after using the spray. *Many different medications come as nasal sprays. This information is intended to provide general instructions for the use of a nasal spray. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

A metered dose inhaler (MDI) or aerosol inhaler is designed to help you inhale medication into your lungs. The medication is contained in a metal canister, which is wrapped in a plastic mouthpiece. Remove the cap from the inhaler. Make sure nothing is inside the mouthpiece of the inhaler. Gently shake the inhaler well (although most inhalers should be shaken before use, some do not need to be shaken – check with your pharmacist). Breathe out as completely as possible. Tilt your head back slightly. Place the mouthpiece into your mouth between your teeth and close your lips around it (do not bite it). To allow the medication to enter your lungs, keep your teeth apart and your tongue flat on the floor of your mouth. Breathe in slowly and deeply through your mouth as you press the canister into the mouthpiece. Hold your breath for 10 seconds or as long as is comfortable, then breathe out slowly through your nose. If you are using more than one puff, wait for about half a minute and then repeat steps 2 to 6. Put the cap back on the inhaler. Rinse your mouth with water for all corticosteroid inhalers. This is not necessary for bronchodilator inhalers. If you are unsure whether the medication in your inhaler is a corticosteroid or a bronchodilator, ask your pharmacist. How to care for your inhaler For most inhalers, wash the mouthpiece twice a week. Remove the plastic mouthpiece from the metal canister and wash the plastic mouthpiece in warm water. Allow the mouthpiece to air dry overnight, then reinsert the canister back into the plastic mouthpiece. Please note that some products recommend that you clean the mouthpiece every week with a dry piece of tissue and avoid washing your inhaler with water or any other type of liquid. Check with your pharmacist to find out which instructions apply to your inhaler. How to make sure you are using the inhaler properly From time to time, check your technique in front of a mirror. Watch for white mist escaping into the air as you use the inhaler. This means that some medication is being lost into the air. Check to make sure that you are closing your lips fully around the mouthpiece, and that you are inhaling as you press down the canister. Do not hesitate to ask your pharmacist for tips on how to use your inhaler properly. * Many different medications come in aerosol inhalers. This information is intended to provide general instructions for the use of an aerosol inhaler. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

Wash and dry your hands well. Open the Handihaler® by pressing the button on the side and pulling the cover away from the mouthpiece. Open the mouthpiece by lifting the ridge away from the base. Remove one capsule of medication from the blister. The capsules should only be removed from the blister just prior to use. Do not swallow capsules that are meant to be used with the Handihaler®. Place the capsule of medication in the hole in the centre of the chamber of the Handihaler®. It doesn’t matter which end goes in first. Close the mouthpiece – you will hear a click. Press the button on the side once for as far as it will go. This will pierce the capsule so that the medication is ready for you to inhale. Remember to keep the device upright when pressing the button. Breathe out, put the mouthpiece in your mouth, and close your lips tightly around it. Make sure you are not breathing into the mouthpiece. Keeping your head in an upright position and the Handihaler® in a horizontal position, breathe in slowly and as deeply as you can. You should hear or feel the capsule in the device vibrate. Take the Handihaler® out of your mouth and hold your breath for as long as is comfortable. Then breathe out as you normally do. If you’re not sure if you received the full dose of the medication, you may repeat steps 7 to 9. Do not press the button on the side again. After you’ve taken your dose, open the mouthpiece again and throw away the empty capsule. Close the mouthpiece and cover. Take a drink of water if your throat becomes irritated afterwards. How to look after the Handihaler®: To clean, open the cover and mouthpiece. Open the base by lifting the button on the side. Remove any powder buildup or capsule fragments from the device, especially in the capsule chamber. Rinse the Handihaler® with warm water only. Allow 24 hours to air dry. Clean the Handihaler® at least once a month, more often if needed. When you decide to clean your Handihaler®, do it immediately after you use it so that there will be enough time for it to air dry before your next dose. Do not store capsules in the device. Only insert the capsule into the Handihaler® immediately before using. *This information is intended to provide general instructions for the use of a Handihaler®. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

The Diskus® is a plastic inhaler device designed to help you inhale your medication. It contains a foil strip with medication blisters. Each blister holds one dose of the medication. It can be used in 4 easy steps: Open: To open your Diskus®, hold the outer case in one hand and put the thumb of your other hand on the thumb grip. Push your thumb away from you as far as it will go. When you take your Diskus® out of the box for the first time, it will be in the closed position. Slide: Hold your Diskus® with the mouthpiece towards you. Slide the lever away from you as far as it will go – until it clicks. Your Diskus® is now ready to use. Every time the lever is pushed back, a dose is made available for inhaling. This is shown by the dose counter. Do not play with the lever – this releases doses that will be wasted. Inhale: Before you start to inhale the dose, read through this section carefully. Hold the Diskus® away from your mouth. Breathe out as far as is comfortable, and remember to never breathe into your Diskus®. Put the mouthpiece to your lips. Breathe in steadily and deeply through the Diskus® and not through your nose. Remove the Diskus® from your mouth. Hold your breath for about 10 seconds or for as long as is comfortable. Breathe out slowly. Close: To close your Diskus®, put your thumb on the thumb grip and slide the thumb grip back towards you as far as it will go. When you close the Diskus®, it clicks shut. The lever automatically returns to its original position and is reset. Your Diskus® is now ready for you to use again. Rinse your mouth: If you are using a Diskus® that contains a corticosteroid medication, rinse your mouth and gargle with water, then spit out the water. This step is not necessary if you are using a Diskus® that contains a bronchodilator. If you are unsure whether the medication in your Diskus® is a corticosteroid or a bronchodilator, ask your pharmacist. Second dose (only if instructed by doctor): If your doctor has instructed you to take 2 inhalations (doses), close the Diskus® and repeat stages 1 to 5. If you are using a Diskus® that contains a corticosteroid medication, you only need to rinse your mouth after the second dose. The Diskus® has a dose counter that tells you the number of doses remaining. It counts down from 28 or 60 to 1. The last 5 doses will appear in red. How to look after the Diskus® -Keep the Diskus® dry. -Keep the Diskus® closed when not in use. -Never breathe into the Diskus®. -Only slide the lever when you are ready to take a dose. -When the red number 5 appears in the dose counter, it is time to get a new Diskus® so you will be ready when the doses run out. *Different medications come in Diskus® form. This information is intended to provide general instructions for the use of a Diskus®. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

If you wear glasses or contact lenses, remove them. Warm the ointment tube in your hand for a few minutes. This will make the ointment flow better and more comfortable to apply. Wash your hands well with soap and water for at least 30 seconds to remove any bacteria that may be on your hands. Open the ointment tube. Do not touch anything with the tip of the tube. Many tubes have a metal skin on the opening that must be pierced using the spike on the lid of the tube. When the tube is opened for the first time, the first 0.25 cm (0.1 inch) of ointment should be thrown away, as it may have become too dry. Lie down or tilt your head back. With eyes open, pull the lower lid down to form a pouch. Hold the ointment tube nearly horizontally and bring it towards your eye from the side until the tube is about 2.5 cm (1 inch) away from your eye. Look at the ceiling by moving your eyes but not your head. Apply a ribbon of ointment along the lower lid. The ribbon should be about 1 cm (0.4 inches) long. Avoid touching the tip of the ointment tube to any surface, including your eyelids, lashes, or fingers. You do not need to apply the ointment all of the way across the lower lid. Follow your doctor’s or pharmacist’s instructions. Twist your wrist to break off the ribbon of ointment from the tube. Gently release the lower lid. Close the eyes gently for 1 to 2 minutes. Roll eyeball in all directions so that the ointment coats the eye. If you are taking more than one ointment, wait about 10 minutes between applications. If you are using both eye drops and ointment, use the drops first, wait 5 minutes, then apply the ointment. Use a clean, soft tissue to wipe away any excess ointment from around your eye. Use another tissue to wipe the cap of the ointment tube. Tightly replace the cap on the ointment tube to prevent it from drying out. Wash your hands thoroughly. Your vision may be blurred for a few minutes after you use the eye ointment. Do not drive or operate machinery until your vision has returned to normal. *Different medications come as eye ointments. This information is intended to provide general instructions for the use of an eye ointment. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

For adults Wash your hands well with soap and water for at least 30 seconds to remove any dirt or bacteria that may be on your hands. If you wear glasses or contact lenses, remove them. If your eye drops need to be shaken before using, shake the bottle now. (Check with your pharmacist to see whether your eye drops need to be shaken.) Remove the cover from the eye drop container. Do not touch anything with the tip of the container. Tilt the head back or lie down. With your eyes open, gently pull the lower lid (holding it below the eyelashes) away from the eye to form a pouch. Hold the eye drop container near the eyelid. Be sure not to touch the tip of the container to the eye, or to any other surfaces. Touching the tip of the container could contaminate it with bacteria. This is also true for the cover of the container. Look toward the ceiling. This helps prevent blinking. Squeeze the bottle gently to instill one drop into the pouch. Look down for several seconds to bring the eye into contact with the drop. Then slowly release the lower lid. Close the eyes gently for at least 30 seconds and up to 5 minutes. Do not squeeze the eyelids together or rub the eyes – this could push the drops out of the eye. Try not to blink. Apply gentle pressure to the corners of the eyes at the bridge of the nose to prevent the medication from draining into your tear duct. If you have had recent eye surgery, ask your eye doctor whether you should apply this pressure or not. Use a clean tissue to blot away excess medication. Do notrub the eyes. If you are using more than one drop, wait about 3 to 5 minutes between drops. This keeps the drops from diluting each other or flushing each other out. For children Wash your hands well with soap and water. Have the child sit facing you, with their head tilted backward and eyes closed. Remove the cover from the eye drop container. Rest the hand holding the container on the child’s cheek. Approach the child’s eye slowly from the side. This helps to prevent eye injury in case the child moves suddenly. Pull the lower lid down. Instill the drop through the eyelashes. Remember not to touch the tip of the container to the eyelashes. Or, place the drop on the eyelid in the inner corner of the eye. Then, have the child open the eye, and the drop will fall in. Take care not to touch the tip of the eye drop container to the eye, eyelid, eyelash, or any other surface. This could contaminate the eye drop container with bacteria. For infants or very young children Wash your hands well with soap and water. Have the child sit on your lap, facing you. Slowly lower the child down into a lying position (support the child’s head and back as you do this). Hold the child’s head with one hand and instill drops with the other on the same side as you are holding the head. In cases where the child is not cooperating, you can wedge the feet under your arms, and hold the head gently between your legs. You can also get a third person to help. Pull the lower lid down and instill the drop through the eyelashes. Remember not to touch the tip of the container to the eyelashes. Take care not to touch the tip of the eye drop container to the eye, eyelid, eyelash, or any other surface. This could contaminate the eye drop container with bacteria. If you are having a hard time getting an entire drop into the eye, remember that it is better to get some liquid into the eyelids or lashes (this will allow at least some of the medication to reach the eye) than not to give the eye drops at all. For people with hand tremors or arthritis Using eye drops may be hard for you because it requires a steady hand and good dexterity. Here are some options: Have someone instill the drops for you, using the first method described above. Ask your doctor or pharmacist about devices to help you give yourself eye drops. These include plastic supports to rest the dropper on, a system of mirrors, or a squeezing device for the bottle. *Many different medications come as eye drops. This information is intended to provide general instructions for the use of eye drops. Specific instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information.

There are two positions that you may use for using an enema: -Lie on your side with the bottom leg straight and the upper leg bent up towards your chest. -Kneel with the head and chest lowered to rest on the bed. Once you have found a comfortable position, follow these steps: Remove the protective tip from the enema bottle. Gently insert the enema nozzle into the rectum, with the tip pointing towards the navel. If this causes pain, or if you are having trouble inserting the enema tip, stop. Do not force the enema tip into the rectum – this could cause injury. Pull out the nozzle and try inserting again. Some enema nozzles are pre-lubricated. If the nozzle is not pre-lubricated, you may wish to lubricate it before inserting. Once the nozzle is comfortably inserted into the rectum, empty the enema container slowly. Squeeze the container from the end, until almost all of the liquid is gone. Don’t worry about emptying the container completely because it is designed to contain extra liquid. Remove the enema tip from the rectum. Wait, then evacuate your bowels by having a bowel movement. The amount of time that you should wait before having a bowel movement depends on the product being used. Check with your doctor or pharmacist to find out how long to wait before having a bowel movement. If you do not have a bowel movement after using the enema, or if you have bleeding from the rectum, stop using the enema and consult your doctor. *This information is intended to provide general instructions for the use of an enema. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

Warm the eardrop tube in your hand for a few minutes. This will make the eardrops more comfortable to instill. Wash your hands well with soap and water. Gently shake the bottle if instructed to do so by your pharmacist or doctor. Open the eardrop bottle or tube. Tilt your head to one side, or lie down with the affected ear facing towards the ceiling. Pull the auricle (the top of the outer ear) upward and backward in adults and children over 3 years of age, or downward and backward in children under 3 years of age. This will straighten out the ear canal. Instill the required number eardrops into the ear canal. Do not allow the dropper to touch the ear or other surfaces, as this could contaminate the dropper. Remain in position for 3 to 5 minutes to allow the eardrops to act. This period of time depends on the medication being used. Check with your doctor or pharmacist about how long you should remain in position after the eardrops have been instilled. After using certain medications, such as Cerumenex®(triethanolamine polypeptide oleate-condensate), the ear must be gently flushed out with water after the drops have been used. If you are giving drops in both ears, wait 5 to 10 minutes between ears to allow the ear drops to run into the ear canal. *Many different medications come as eardrops. This information is intended to provide general instructions for the use of eardrops. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

Load the Diskhaler®: Remove the cover. Pull out the white tray by grasping the corners, pulling out until you see the ribbed sides, then squeezing the ribbed sides as you gently ease the tray out of the Diskhaler®. Place the disk on the wheel of the tray with the numbers face up. Slide the tray back into the Diskhaler®. Get ready for the dose: Gently push in and pull out the cartridge until the number “4” appears in the side indicator window. This number tells you how many doses are left in the cartridge. When the number “1” appears, you have one dose left. After taking this dose, you will need to replace the disk by repeating step 1. Get ready to inhale: Hold the Diskhaler® level. Lift up the rear edge of the lid as far as it will go. This will allow the plastic needle to pierce the blister package. Both the upper and lower surfaces of the blister must be pierced. You may feel some resistance when this happens. Once both surfaces of the blister have been pierced, close the lid again. Do not lift the lid unless the cartridge is completely inside the Diskhaler® body or completely removed, as this could break the needle. Inhale: Keep the Diskhaler® level. Breathe out fully, then place the Diskhaler® mouthpiece in your mouth, between your teeth. Do not bite the mouthpiece or cover up the air intake holes on the side. Breathe in as steadily and deeply as you can. Then, hold your breath if you can and remove the Diskhaler® from your mouth. Keep holding your breath for as long as it is comfortable. Breathe out slowly. Get ready for the next inhalation: Push in and pull out the cartridge as described in step 2. Do not pierce the blister until just before your next inhalation. After you are finished with the Diskhaler®, put the cap back on. How to look after the Diskhaler® -To clean, remove the cartridge and use the brush provided to clear away any remaining powder. Do this before inserting a new disk. When you clean the Diskhaler®, the tray and wheel should be removed from the Diskhaler® body. -Replace the Diskhaler® after 6 months of use. *Different medications come in Diskhaler® form. This information is intended to provide general instructions for the use of a Diskhaler®. Instructions may vary for different products. If these instructions are different from those given by your doctor or pharmacist, check with your doctor or pharmacist to confirm how you should be using the product. Consult your doctor or pharmacist for specific information about your particular medication.

Try these tips for easier swallowing* -Check to see if you can break, split, or crush your medication into smaller pieces that are easier to swallow. Not all medications can be crushed or broken, so check with your pharmacist before you try this. -For capsules, pull the capsule apart by holding on to both ends and twisting it to empty the medication into a small amount of food. For slow-release capsules, this may still be done as long as the contents are swallowed without chewing. Check with your pharmacist, or look at the prescription label or information sheet from your pharmacy to make sure you can take your medication with food. -Check to see if the medication comes in a smaller tablet, as a liquid, or if your pharmacist can make the medication in liquid form for you. -Place medication in a small amount of food. Some medications can’t be taken with food, so check before trying this. -Place medication at the back of the tongue, tilt your head back slightly then take a drink of water to wash it down. *If you have medical problems that make it hard for you to swallow (such as partial muscle paralysis after a stroke), talk to your doctor before trying these tips. Your doctor may offer special instructions depending on your condition.