22.14 — The Household Medicine Box

Most home medicine cabinets contain about thirty items, of which perhaps eight are in date, six are duplicates nobody realised were duplicates, and four are antibiotics left over from a course somebody stopped early.

This chapter is the list of what to actually keep, why each item is there, and what it is for.

It assumes nothing. Everything on it is available without a prescription in most countries, and everything on it earns its place.

The medicines

Paracetamol

Tablets for adults, and liquid for any children in the house.

For pain and fever. The first choice for most everyday pain, because it is safe at the correct dose and does not upset the stomach or affect the kidneys (Chapter 22.5).

Adult: 500 mg to 1 g every 4 to 6 hours, maximum 4 g in 24 hours.

Children: dosed by weight, using the syringe supplied with the bottle, never a kitchen spoon.

And the rule that prevents the commonest overdose in the world: check every other product for paracetamol before taking more. Cold remedies, "night" preparations and combination painkillers all contain it.

Ibuprofen

For pain with inflammation — injuries, sprains, toothache, period pain, joint pain, and fever where paracetamol is not enough.

Adult: 200 to 400 mg up to three times daily, with or after food.

And it can be combined with paracetamol, since the mechanisms differ.

Do not keep or use it if you have: kidney disease, heart failure, a history of stomach ulcers, or asthma that has ever been worsened by it. And not in the last third of pregnancy.

Topical ibuprofen or diclofenac gel is a genuinely useful addition for localised joint and muscle pain, with far less systemic exposure.

An antihistamine

A non-drowsy one — cetirizine or loratadine — for hay fever, hives and allergic reactions.

And a sedating one — chlorphenamine — which is the one to have available for a significant allergic reaction, because it acts faster.

Neither treats anaphylaxis. Anaphylaxis is treated with adrenaline (Chapter 23.5), and antihistamines are for the skin symptoms afterwards.

Oral rehydration salts

The most underrated item in the box.

For diarrhoea and vomiting, particularly in children and older people, where dehydration is the actual danger rather than the diarrhoea (Chapter 22.9).

Sachets are cheap, keep for years, and dissolve in a measured amount of water.

An antacid or alginate

For occasional heartburn and indigestion.

Alginate preparations are more effective for reflux, because they form a barrier on top of the stomach contents.

A laxative

Macrogol sachets — the best general-purpose choice for constipation (Chapter 22.9).

And glycerol suppositories for when something is stuck and needs help at the far end.

Loperamide

For diarrhoea where symptom control is needed — a long journey, a day that cannot be missed.

Not with fever or blood in the stool, and rehydration matters more.

Something for nausea

Hyoscine or cyclizine for travel sickness, taken before travelling rather than after symptoms start, since they work far better preventively.

Antiseptic

Chlorhexidine or povidone-iodine solution for cleaning wounds.

Though the most effective wound cleaning is running tap water for several minutes, and antiseptic is a supplement to that rather than a substitute.

Hydrocortisone 1% cream

For insect bites, mild eczema and irritant rashes.

Not on the face for more than a few days, not on broken skin, and not on anything that might be infected.

An antifungal cream

Clotrimazole or terbinafine — for athlete's foot, ringworm and fungal rashes in skin folds.

Antihistamine or crotamiton cream

For itch from bites and stings.

Emollient

A plain moisturiser in a large tub, which is useful for dry skin, mild eczema and after sun exposure.

Sunscreen

SPF 30 or higher, broad spectrum, and in date — sunscreen degrades, and an old bottle is not doing what the label says.

The equipment

Thermometer

Digital, and the type matters by age. Under 4 weeks, an underarm digital thermometer is recommended; over that, a tympanic or forehead thermometer is convenient.

Fever in a baby under 3 months is always urgent, regardless of how well they seem.

Dressings and bandages

Assorted plasters, including waterproof.

Sterile gauze pads in several sizes — for covering wounds and applying pressure.

A crepe bandage for support and for holding dressings.

A triangular bandage for a sling.

Micropore tape.

Non-adherent dressings for burns and grazes, which will not stick to the wound and tear it open on removal.

Tweezers and scissors

Fine-pointed tweezers for splinters, and a tick remover if you live anywhere with ticks (Chapter 17.4).

Blunt-ended scissors for cutting dressings and clothing.

Disposable gloves

For anyone else's blood, and for your own protection.

A cold pack

The kind kept in the freezer, or an instant chemical pack for a kit that travels.

Wrapped in a cloth, never applied directly to skin.

A torch

Useful for looking at throats, into ears, and for checking pupils.

The emergency items

And these are the ones that turn a household kit into something that can save a life.

Adrenaline auto-injector

For anyone in the household with a diagnosed severe allergy.

Two of them, not one, because a second dose is needed in a proportion of anaphylaxis cases and because one can fail or be used incorrectly.

Everyone in the household should know where they are and how to use them, and the training device supplied with them should actually be practised with (Chapter 23.5).

Aspirin 300 mg

Kept specifically for suspected heart attack, where chewing a 300 mg tablet is one of the few things a bystander can do that measurably helps (Chapter 23.4).

Dispersible or chewable, in date, and kept somewhere findable in a hurry.

Glyceryl trinitrate spray

For anyone with known angina. And the tablets lose potency within weeks of opening the bottle, which is why the spray is preferred.

Reliever inhaler and spacer

For anyone with asthma. A spacer transforms the effectiveness of an inhaler in an attack (Chapter 22.10), and a spare inhaler that has not been half-used matters.

Naloxone

For any household where opioids are present, whether prescribed or not.

It reverses opioid overdose within minutes, it is available as a nasal spray in many countries, it cannot harm someone who has not taken opioids, and take-home programmes have saved a large number of lives (Chapter 23.6).

Glucose gel or tablets

For anyone on insulin or a sulfonylurea (Chapter 23.11).

Rescue medication for seizures

Buccal midazolam, for anyone with prolonged seizures and a plan from their specialist (Chapter 20.2).

What not to keep

Leftover antibiotics. Never take them for a later illness, never give them to someone else, and return them to a pharmacy.

Anything out of date. Most medicines lose potency rather than becoming toxic — and losing potency is the whole problem when the item is aspirin for a heart attack or an adrenaline injector.

Anything unlabelled. A loose tablet with no packet is unidentifiable and gets thrown away.

Cough and cold medicines for children under 6.

And the cabinet should not be in the bathroom. Heat and humidity degrade medicines, which makes the single most traditional storage location the worst one. A cool dry cupboard, high up or locked, away from children.

Two practical habits

Once a year, take everything out, check the dates, and put back only what you would actually use. It takes fifteen minutes and it is the difference between a box of useful things and a box of history.

And keep a written list of what everyone in the household takes, including doses and allergies, somewhere an ambulance crew could find it. In an emergency, that list answers the first three questions anyone will ask.

Travelling

Add: your regular medication in original labelled packaging with enough for the trip plus several days; a copy of the prescription; rehydration salts; loperamide; antiseptic and dressings; insect repellent containing DEET; sunscreen; and any vaccinations or malaria prevention the destination requires (Chapter 17.7).

Carry essential medication in hand luggage, because checked bags get lost and pharmacies abroad may not stock the same things.

And check the legal status of what you carry. Some ordinary medicines — certain painkillers, sleeping tablets and even some cold remedies — are controlled or banned in particular countries, and the consequences of arriving with them can be serious.

What the next page fixes

Chapter 22.15 covers how a drug gets from an idea to a pharmacy shelf — the trials, the approval, and why it takes a decade and costs so much.