Medicine safety and side effects

Two things are worth separating. One is what to do when a medicine is doing something you did not expect. The other is where that information has to go so that it counts for more than your own order. This page covers both, and neither depends on us.

When to stop reading and get help

Call emergency services — 911 in the United States, 112 across the European Union — and do not wait for a reply to an email, if any of the following happens after taking a medicine from this catalogue:

• chest pain, pressure or tightness, a sudden irregular heartbeat, or fainting;
• swelling of the lips, tongue or throat, a spreading rash, or difficulty breathing or swallowing — the signs of a severe allergic reaction;
• sudden loss or marked dimming of vision in one or both eyes, or sudden loss of hearing with ringing and dizziness;
• an erection that is painful and has lasted more than four hours. Priapism is not an inconvenience to sleep off: untreated it damages the tissue permanently, and the window in which that can be prevented is measured in hours;
• a skin reaction with blistering or peeling, or a fever with mouth ulcers, after starting a new tablet;
• thoughts of harming yourself. If they have arrived or intensified since starting a medicine, treat them as a medical event and not as a character flaw. In Italy, Telefono Amico answers on 02 2327 2327 from 9 in the morning until midnight; in the United States the 988 Suicide and Crisis Lifeline answers by call or text, day and night.

Antidepressants carry a boxed warning about suicidal thinking in people under 25 in the first weeks of treatment, and that warning is in the label precisely because the risk is real and short-lived. It is a reason to be watched closely at the start, not a reason to stop a tablet abruptly on your own.

The interactions that actually kill people

Most interaction warnings on a label describe a dose adjustment. A few describe a collapse, and in this catalogue they concentrate in one place. A PDE5 inhibitor — sildenafil, tadalafil, vardenafil, avanafil, in any brand, chewable, jelly or combination form — taken with a nitrate drops blood pressure to a level the heart cannot work against. Nitrates are not only the tablet under the tongue: isosorbide in any form, nitroglycerin patches and sprays, and the recreational alkyl nitrites sold as poppers all count. The same applies to riociguat. There is no safe interval, no half dose and no “just this once”.

The next tier matters almost as much and is easier to miss: alpha blockers taken for blood pressure or for prostate symptoms, azole antifungals, macrolide antibiotics, and HIV protease inhibitors all change what a standard dose of a PDE5 inhibitor does in the body. Each product page lists its own, taken from the label. Read that section before ordering, not after a dose has been taken.

Reporting a side effect, and why it is worth the ten minutes

Regulators detect new risks almost entirely from reports sent in by patients and clinicians. You do not need to be certain the medicine caused what happened; suspicion is the threshold, and reports are read whether or not the reaction appears in the label.

• United States — the FDA’s MedWatch programme takes reports directly from the public through its online form, or by telephone on 1-800-332-1088. Keep the pack: the lot number and the manufacturer are the two details that make a report traceable.
• Italy — the national pharmacovigilance network run by AIFA accepts patient reports through its online reporting form; the background and the paper route are set out on the agency’s page on adverse reactions. The older VigiFarmaco portal was retired in 2022 and its address no longer works.
• Elsewhere in Europe — each national agency has its own channel, and the resulting reports are pooled in the EMA’s EudraVigilance database.

Tell us too, at [email protected]. Our part is narrow and worth stating exactly: we cannot assess your reaction and we are not a substitute for the report above. What we can do is check whether the page you ordered from described the risk correctly, correct it if it did not, and keep the pack details on file if a batch turns out to be involved.

Storage, disposal and the pack itself

Tablets keep in a dry place at room temperature unless the label says otherwise; a bathroom cabinet is the one place in most homes that is neither. The injectable and the topical products in this catalogue have their own storage instructions printed on the carton, and those override general advice. Check the expiry date when the parcel arrives rather than when you need the medicine.

Leftover prescription medicine does not belong in household waste or down a drain. Pharmacies in Italy and in most of Europe take it back; in the United States, pharmacy and law-enforcement take-back programmes do the same, and the FDA publishes the short list of medicines that may be flushed when no take-back is available. Never pass a prescription medicine to someone else, however similar the problem looks: the prescription names one person because the checks behind it were done for that person.

If a parcel looks wrong

Do not take anything from a pack that arrives damaged, unsealed, with a different name or strength on the carton than the one you ordered, or with printing that does not match the label photographs on the product page. Photograph it as it arrived, keep it, and write to us the same day: it is replaced or refunded in full under the returns and refunds terms, and a suspected falsified medicine is reported onwards to the regulator. Where our pages take their facts from, and how a wrong page gets corrected, is set out in how we source our information.