Not even doctors know everything

Back to the roots: You can read here why disinfecting is good for the hands, why ASS Protect does not protect the stomach and what “taking three times a day” really means.

Doctors know quite a lot – but their knowledge can also be refreshed at one point or another in between. This can also help when communicating with patients. You already know all this and communicate it that way? All the better.

Warm or cold water – or should it be disinfected?

Washing hands with cold water is better for the skin than washing with warm water. Disinfecting hands with hand sanitizer is better for the skin than washing with cold water. Why? Washing your hands degreases your skin. Water and soap will LIPID washed out of the skin and they go down the drain. They’re gone forever – bye bye.

The higher the temperature of the water, the more lipids are washed out of the skin in combination with the soap. If the temperature of a solvent is increased, more of the substance in question can be dissolved in it – up to a certain concentration. However, if you use a disinfectant instead of water, lipids are also dissolved from the skin, but after the disinfectant has evaporated, the lipids remain on the skin. That’s called replenishing. So, compared to hand washing, hand sanitizing is better. Unless your hands are dirty, in which case it would of course be advisable to use water.

ASA and stomach problems

Gastric juice resistant ASS 100 (Protect) should not dissolve in the stomach. This also works if you take them on an empty stomach, because the pH value of the stomach is low on an empty stomach – the tablet does not dissolve. However, food increases the pH value and the tablet then dissolves in the stomach. So note: The PH value of the stomach is acidic, but food intake makes it rise.

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Enteric-coated tablets have a coating that ensures that the tablets do not dissolve at low pH values ​​in the stomach, but only at higher pH values ​​in the intestine. However, if the pH value in the stomach is increased by food intake, the tablets will already dissolve in the stomach.

Will be low-dose ASS absorbed through the blood, it inhibits platelet aggregation. The platelets cannot accumulate and thus cannot clog vessels. The likelihood of a heart attack or stroke is reduced. But: Even in low doses, ASA ensures that the production of protective gastric mucus is reduced and thus acid secretion increases. These effects occur when taking “normal” ASS-100 tablets as well as when taking enteric-coated tablets.

The difference is that non-enteric-coated ASA-100 tablets disintegrate in the stomach and cause additional local damage to the gastric mucosa (Ion-Trapping), which is omitted in the enteric-coated version. Enteric-coated ASS-100 tablets are not stomach-friendly, but only more stomach-friendly than normal ASS-100 tablets.

Say “every 8 hours” instead of “three times a day”.

From the category “No one has ever told me that”: If a tablet is to be taken three times a day, that does NOT mean morning, noon, evening (e.g. 8 a.m., 12 p.m., 8 p.m.) but every 8 hours ( e.g. 8 a.m., 4 p.m., midnight). Unfortunately, this is often not sufficiently explained when prescribing the medication.

Because when you swallow a tablet, the active ingredient is released and usually absorbed into the blood via the small intestine. One would like to have a concentration of the active substance in the blood that is as constant as possible and not achieve fluctuating plasma levels. A medicine that has to be taken three times a day should therefore be taken at equal intervals if possible: every eight hours, for example at 6 a.m., at 2 p.m. and at 10 p.m. Accordingly, four times a day means every six hours and twice a day every twelve.

The evil grapefruit

Grapefruit should not be eaten with certain medicines because it increases the effect. Examples: Simvastatin, Atorvastatin, Amlodipine, Nifedipine, Sildenafil … and yes, oranges are ok!

Why? An ingredient in grapefruit called Naringin inhibits CYP3A4-Enzyme, which are responsible for breaking down some medicines. As a result, plasma concentrations of these drugs are then increased. It increases the effect and also the side effects. Grapefruit and grapefruit products should be avoided completely while these drugs are being taken. A time interval is not sufficient.

Using the example of simvastatin: Taking simvastatin and consuming grapefruit can lead to a Rhabdomyolysis lead – a dissolution of the striated muscle fibers. The released myoglobin from the muscle can lead to a blockage of the renal corpuscles and lead to acute renal failure and in the worst case to death.

Image source: Terry Vlisidis, Unsplash

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