Common medicines given to neurosurgery patients on discharge from hospital

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1 Common medicines given to neurosurgery patients on discharge from hospital

2 This leaflet contains brief information about some of the medicines we commonly supply on discharge to patients who have been admitted for various types of brain or spinal surgery and procedures. You will not receive all these medicines; you should check to see which you have been given and then read the information for those medicines only. General Information For more detailed information about the medicines you have been given, read the information leaflet in the packet with the medicines. If you have a specific question about the medicines you have been prescribed, ring the pharmacy helpline number given at the end of this leaflet. Some of the medicines below may cause drowsiness, and some people may be affected more than others. If you feel drowsy or have difficulty concentrating, you should not drive or operate machinery. Before starting any other new medication, including medicines you buy, you should check with your doctor or a pharmacist. They will make sure the new medicine can safely be taken as well as the medicines you have received from hospital. Pharmacy Medicines Hotline Monday Friday 2-4pm This is a direct line into the pharmacy for advice on medicines supplied to you by this hospital. For queries not related to medicines please phone the hospital switchboard on and ask for the relevant department.

3 Amitriptyline Amitriptyline is usually prescribed at the Walton Centre as a treatment for nerve pain, although it can also be used to treat depression and other conditions. It can also be commonly used for various types of headache. The leaflet from the manufacturer does not mention use for pain because the manufacturer has not applied for formal approval from the government for this use. However amitriptyline has been well recognised as an effective treatment for nerve pain for decades, and is recommended in UK guidelines. It is best taken at night as it may cause drowsiness, which may sometimes persist the following day. Caution needs to be taken with alcohol and particularly with driving. You will usually start on a small dose such as one 10mg tablet at night. If necessary, your doctor will gradually increase the dose. Other common side effects include dry mouth and constipation. These side effects may be worse initially and then lessen as you get used to the medicine. In a very small number of people more serious side effects can occur. You should read the leaflet with the tablets for more information about these. Aspirin / Clopidogrel Aspirin and clopidogrel are used to thin the blood, that is, make it slightly slower to clot. If you are taking these medicines before you come in for planned surgery, you will usually be told to stop them for a number of days before the date of surgery, to reduce the risks of excess bleeding during surgery. Before you leave the hospital you should be told when it is safe to start taking them again. People who have had an aneurysm coiled will often be newly prescribed aspirin and/ or clopidogrel once daily. For some patients these are only required for a short period of time eg between one and six months, while for others they may have to continue indefinitely. It is best to take aspirin and clopidogrel with or after a meal. The most common side effects are indigestion and heartburn, and an increased tendency to bruising and bleeding.

4 Codeine phosphate / Tramadol Codeine and tramadol belong to the same class of medicines; they are stronger painkillers than paracetamol. You may be given either codeine or tramadol, but never both. Paracetamol will often be prescribed as well. It is safe to take codeine or tramadol at the same time as paracetamol. Common side effects include drowsiness, constipation and nausea. Side effects may be less troublesome with lower doses. While you are taking codeine or tramadol, you should not take other products containing codeine, tramadol or related medicines, for example co codamol (eg Solpadol, Zapain, Kapake), co dydramol and some over the counter painkillers. (Ask a pharmacist for advice if unsure.) Usual doses: Codeine: one or two codeine 30mg tablets at a time, every four to six hours, up to a maximum of eight tablets in twenty four hours. Tramadol: one or two tramadol 50mg capsules at a time, every four to six hours, up to a maximum of eight capsules in twenty four hours. Dexamethasone Dexamethasone is a type of corticosteroid (commonly called steroids for short). It is not the same as the anabolic steroids taken by some body builders or athletes. Low levels of corticosteroids are produced naturally by the body. Dexamethasone is prescribed to reduce inflammation and swelling, for example in those with brain tumours, or in some people who have had brain or spinal surgery, or have inflammation. It may be given for a few days only or for longer periods, depending on the situation. Ensure you know how long you need to take it for, and who is going to review this treatment. Often it starts at a higher dose and gradually reduces down. If you have been taking it for three weeks or more, or taking a dose of 6mg daily or more, dexamethasone must be tapered off gradually and not stopped suddenly. You will be given a blue steroid card stating that you are on dexamethasone. You should carry this card with you and show it to anyone you see in relation to your health or medical/dental care. Dexamethasone may increase appetite, and can make some people feel depressed or high. Seek medical advice if you notice any mood changes. It can cause indigestion, and you will usually be given an extra medicine to protect your stomach (see omeprazole / lansoprazole / ranitidine). It may increase blood sugar levels, and this should be monitored in people with diabetes. Steroid treatment can make you more susceptible to catching infections. Try to avoid contact with anyone who has chicken pox or shingles, and if you do come into contact, you should see your doctor.

5 Diclofenac / Ibuprofen / Naproxen These are anti-inflammatory painkillers. You may be prescribed either diclofenac or ibuprofen but never both together. They are safe to take at the same time as paracetamol and codeine or tramadol. They may be taken up to three times daily, and should always be taken with or after food. They do not cause drowsiness, but can sometimes cause indigestion or heartburn. Occasionally they can cause stomach ulcers and bleeding, and you may be given another medicine to take to prevent this (see Omeprazole / Lansoprazole / Ranitidine). This is not always necessary, particularly for short courses. In people with asthma or other breathing problems, they can sometimes make breathing worse. Occasionally they can cause kidney damage; this is less likely when taken for a short time only. Some over the counter painkillers (including gels and creams) contain diclofenac or ibuprofen or similar medicines. You must not take these while you are taking diclofenac or ibuprofen. If you are unsure, ask a pharmacist or your doctor. Gabapentin / Pregabalin These were first developed as medicines for epilepsy, but are now more commonly used as a treatment for nerve pain. You will normally start off on a small dose and gradually build up. Common side effects include drowsiness, dizziness and tiredness. These may be worse initially when starting or increasing the dose. If side effects are troublesome, reducing the dose may help. Often, after a while at the reduced dose, the dose may be increased again without recurrence of the side effects. In general, if you and your doctor decide you should stop taking these medicines, they should be tapered off gradually rather than stopping abruptly.

6 Nimodipine Nimodipine is used for patients who have had a subarachnoid haemorrhage, a specific type of bleed in the head. It must be taken every four hours (six times a day) for a total of 21 days only. In hospital we give this medicine at 6am, 10am, 2pm, 6pm, 10pm and 2am. You will have started this course in hospital, and if you need to complete the course at home you will be given the correct number of tablets to complete the course. Nimodipine may lower blood pressure. If you feel dizzy or lightheaded while taking them, sit or lie down until it passes. If this persists, contact your GP surgery to get your blood pressure checked. If you are on medicines for high blood pressure already, you may be told to stop one or more of them temporarily while you are taking nimodipine. Omeprazole / Lansoprazole / Ranitidine These medicines all reduce the production of stomach acid, and are used as a treatment for indigestion, heartburn or stomach ulcers, or to prevent such problems developing as side effects from other medicines. If you have been prescribed them as a preventative while taking medicines such as diclofenac, ibuprofen or dexamethasone, then when these other medicines are stopped, you should also stop taking the omeprazole / lansoprazole / ranitidine.

7 Ondansetron / Cyclizine / Metoclopramide These are anti-sickness tablets. They are usually taken when required, though if nausea is persistent they may be taken regularly to help keep it at bay. It is best to take them 30 minutes to an hour before meals, to give them time to start working before you eat. Cyclizine may cause drowsiness. Ondansetron may cause headache, constipation and a feeling of flushing or warmth. Paracetamol Most patients requiring pain relief will be prescribed paracetamol. The standard dose is two tablets at a time, taken every four to six hours, up to a maximum of four times in 24 hours. At recommended doses paracetamol does not usually cause side effects. It can be taken just when required, or can be taken regularly for as long as necessary. When pain is particularly bad it is often better to take it regularly to help keep the pain at bay, rather than waiting until the pain is bad before taking it. You must not take any other medicines containing paracetamol while taking paracetamol tablets. Other products containing paracetamol include co codamol (eg Solpadol, Zapain, Kapake), co dydramol and many over the counter painkillers and cough/cold remedies. Check with a pharmacist if you are unsure.

8 Phenytoin / Sodium Valproate / Carbamazepine / Lamotrigine / Levetiracetam (Keppra) These are all medicines used to treat or prevent seizures (fits), although some of them are also used to treat other conditions, such as nerve pain. Seizures can sometimes be caused by brain surgery, brain tumours, bleeds in the brain or brain injuries. One of these medicines will be prescribed if you have had one or more seizures, or if your doctor thinks you may be at risk of having a seizure, or if your doctor thinks it will help reduce your pain. The length of time you will need to keep taking it for varies for different patients, and your doctor will advise on this. The following information applies to patients who are taking these drugs for seizures, nerve pain or any other condition. You may be started on a low dose and gradually increase up to a higher dose, to reduce side effects. Some of the more common side effects are drowsiness, dizziness, nausea, headaches, confusion and difficulty co-ordinating movement. Some of these problems may be worse when starting the medicine or increasing the dose, but then improve as you get used to taking the medicine. If these side effects are causing you problems please speak to your doctor. In a very small number of people more serious side effects can occur, such as allergies or problems with your liver, blood or skin. It is important that you read the leaflet provided with your medicine which warns about the symptoms to watch out for which might indicate these more serious effects. If you develop a rash, fever, flu like symptoms, glands or feeling ill in any other way within the first few weeks of starting it may be an allergic reaction. You should consult your GP immediately in case the drug needs to be discontinued as this is sometimes necessary. In general, if you and your doctor decide you should stop taking these medicines, they should be tapered off gradually rather than stopping abruptly. Some of these medicines may reduce the effectiveness of contraceptive pills ( the pill or the mini-pill ) and contraceptive injections, implants and vaginal rings. This could make the contraceptive fail, leading to unwanted pregnancy. Please discuss this with your doctor if you are unsure whether this applies to you. Women of child bearing age should also be aware that some of these medicines, if taken during pregnancy, can affect the baby, causing various abnormalities. The risk of this happening, and the type of abnormality possible depends on the exact medicine. You should have been informed about this potential problem. If you would like further information please ask your doctor straight away.

9 Senna / Docusate / Macrogols (Laxido) These are all laxatives and should only be taken if required. Constipation is a side effect of some painkillers, and is often made worse when patients are not as mobile as usual. Senna is a stimulant laxative, which works by stimulating the muscles in the bowel to be more active and move stools along. Docusate is a softening laxative, with a little stimulant action also. Macrogols (Laxido) works by drawing water into the bowel to help soften stools.

10 Index of medicines Amitriptyline 3 Aspirin 3 Carbamazepine 8 Clopidogrel 3 Codeine phosphate 4 Cyclizine 7 Dexamethasone 4 Diclofenac 5 Docusate 9 Epanutin see phenytoin 8 Epilim see sodium valproate 8 Gabapentin 5 Ibuprofen 5 Keppra see levetiracetam 8 Lamictal see lamotrigine 8 Lamotrigine 8 Lansoprazole 6 Laxido see Macrogols 9 Levetiracetam 8 Lyrica see pregabalin 5 Macrogols 9 Metoclopramide 7 Naproxen 5 Nimodipine 6 Nimotop - see nimodipine 6 Neurontin see gabapentin 5 Omeprazole 6 Ondansetron 7 Paracetamol 7 Phenytoin 8 Pregabalin 5 Ranitidine 6 Sodium valproate 8 Steroids 4 Tegretol see carbamazepine 8 Tramadol 4

11

12 The Walton Centre NHS Foundation Trust Lower Lane, Fazakerley Liverpool L9 7JL Tel: Fax: For practical advice our Customer Care Team provide a (PALS) service. Contact Customer Care Team on , or visit Alternatively, log on to: or call; for advice and information for people with neurological conditions and their carers. Produced by: Michelle Rackham Version No:1.0 Reviewed: Oct 2012 Review Date: Oct 2014

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