Medicines, vitamines & minerals
* Medicines, vitamins and minerals generally
* A stoma and medicines, vitamins and minerals
Medicines, vitamins and minerals generally
Medication is best stored at room temperature (no warmer than 25°C). Preferably in a dry area. There are drugs that should be stored in the fridge or in the dark.
Drugs have a limited shelf life after first usage:
Tablets 2 years
Capsules 1 year
Powders 1 year
Drinks 6 months
Drip liquids 6 months
Steam liquids 3 months
Nose drops 3 months
Nose spray 3 months
Eye drops 1 month
Eye ointment 6 months
Eye wash 1 month
Ear drops (non sterile) 6 months
Ear drops (sterile) 1 month
Ointment in tube 1 year
Ointment in pot (with spatula) 6 months
Cream in a tube 1 year
cream in a pot (with spatula) 3 months
Paste in a pot (with spatula) 6 months
Sprinkle powder 1 year
Skin gel in tube 3 months
Liquids for use on the skin 6 months
Suppository in foil 1 year
It is best to take your medicines with water. Other liquids such as juice, milk, yoghurt etc can affect the absorption and working of the medicine. For example in milk there is a lot of calcium and some medicines form an insoluble calcium compound. This means the medicine cannot be absorbed in the blood and cannot do its work. It is also known that fruit juices (orange, grapefruit, lemon and apple juice) can cause only half of the medicine to be absorbed or even increase the working of the medicine. Naringin is responsible for this.
for tips about medicines and holidays.
Read more about probiotica
If you are in hospital you are given your medicines by them. They are responsible for you at that time, but insurance comes into play then. It can be that you are given a similar medicine but with a different name. It can also look different than you are accustomed. Take a list with you of which medicines you use, and make sure it is correctly noted during your admission. Do not be afraid to ask what sort of medicine the pink or yellow tablet is.
After an operation sufficient protein is very important, this helps new tissue to grow and is a support of the immune system. Extra vitamins such as A, C, E, K and B vitamins, zinc, calcium and iron are also important for recovery after an operation. Discuss this with a dietician.
Picture source: ANP
Return to top
A stoma and medicines, vitamins and minerals
You must always tell your doctor or pharmacist that you have a stoma, if new medication is being prescribed or if you buy over the counter medication. Certain things can be different with a stoma, such as the absorption or colouring of urine or stools.
For people who are missing a large part (especially small) of intestine the absorption of certain medicines can be disrupted. Some medicines which are taken orally are absorbed in the empty intestine. Most medicines however, are absorbed in the last piece of the small intestine (ileum). If you are missing this then the absorption can be disrupted. Other factors also play a part, such as the speed of the production of stool, type of medicine etc. A large pill or a pill with a sugar coating can sometimes come out of your stoma whole without any of it being absorbed. Capsules dissolve easier, as do soluble medicines and chew tablets, and these are absorbed well. The anti-conception pill is not 100% reliable for people with a stoma, and especially not with people who have an ileostomy. Click
for other possibilities of contraception. For medicines which are not correctly absorbed an alternative should be sought. Sometimes there is also the option of grinding the pill (this is not possible with tablets with a sugar coating). After a few months it can happen that the remaining intestine takes over the function and the absorption (partly) is restored.
People who are missing the last piece of the small intestine can be seriously affected by lack of absorption of vitamin B12. It is important that you regularly are tested for this by your doctor. If you do have a shortage of this it can give annoying symptoms. If your blood shows that the B12 content is too low, you will be given injections. You can also learn to do this yourself so that you can do it at home. In time the rest of your small intestine can (partially) take over the absorption whereby you need less (or none) injections further.
Some medicines and vitamins can colour the stool or urine. For example iron tablets (black stool), antibiotics (green stool or red-brown urine) and some antidepressants (blue-green urine).
If you still have a piece of the rectum, you can use a suppository. This can sometimes be an alternative to oral usage, so that it can be better absorbed. The medicine is then absorbed via the bloodstream. If you no longer have an anus, you can also put a suppository in your stoma. Discuss this with your doctor! To prevent it being shoved out by peristalsis you must insert the pill lying down and close of the stoma with a finger, tampon or stoma plug.
Salt (Sodium) and potassium are lost if you have diarreah, it is hot weather or if you are participating in sport. Therefore it is important (especially with an ileostomy) to watch out for this. It is best to use around 15grams salt per day. The average Dutch person uses 9 grams of salt, meaning that you should use an extra 6 grams of salt daily. You can get the following symptoms with a salt deficiency: tiredness, irritability, dizziness, sleep disturbances, quick weight loss and muscle cramps.
Salt is a natural product. It is taken from the ground and from the sea (sea salt). The chemical name of normal cooking salt is sodium chloride. In 1 gram of salt (1000mg) is 400mg salt and 600mg chloride. It also has an anti caking agent. Sea salt also has other minerals and also trace elements. In the
food list you can find examples of salt enriched products. You can also use extra salt with your hot food. Take care that you do not just take fatty foods if you need to have salt, such as cheese and salted herring. Salted liquorice does not help, because it contains no cooking salt (sodium chloride) but ammonium chloride. There are also salt tablets and salt capsules that you can use if you cannot get enough salt inside. Mineral waters often have salt added and there are also sports drinks which contain extra salt. Do not forget that the people around you do not need extra salt.
Together with fluids and salt (sodium), you also lose (especially with an ileostomy) a lot of potassium, 2 essential electrolytes. The amount of potassium in your body in influenced by the amount of sodium, these two must be in balance with each other. Together they play a role in the fluid balance in the body, the transmission of stimuli in the nervous system and they make a significant influence in the regulation of the blood pressure. A shortage of potassium causes nerve and muscle disturbances. You can also have problems with fluid retention (oedema), tinnitus and sleep problems. If you have a large deficiency you can get a potassium chloride infusion in hospital. If you have a small deficiency you can try to supplement your diet, in the
food list you can find examples of potassium rich products. There are also vitamin preparations with potassium, for example that from Orthica.
With prolonged, persistent diarreah it is necessary to use ORS (oral rehydration salts), in order to make sure that the body holds onto as much fluid, salt and sugars as possible. These are sachets with a salt solution which you mix in water, available from the pharmacist and chemists. If you do not have this to hand, you can make it yourself with 8 lumps of sugar and 1 teaspoon of kitchen salt mixed in 1 litre of drinking water. A diarreah inhibitor (loperamide) can also be handy.
If you have a stoma and use a water tablet (diuretic), then you will lose salt and potassium even faster. A water tablet promotes the excretion of water from the kidneys meaning you have a higher urine output. It is then advisable to use potassium saving diuretic, or you will quickly have a shortage of this.
Iron can be absorbed less well if (a part of) the intestine is removed. This is also possible after blood loss from an operation or inflammation in the intestines. This can lead to a shortage of iron and eventually anaemia. An iron rich diet can prevent or reduce the shortage but a real shortage of iron you must see your doctor. They can prescribe you iron preparations, or an iron infusion. With an iron shortage you can amongst other things feel tired, be dizzy, have headaches and appear pale. A grown man requires 9mg iron daily; a woman needs 15mg. The iron requirement of a woman is higher because of the blood loss through menstruation. After the menopause the requirement is 8mg iron daily. Iron tablets can cause constipation. Modern iron tablets contain organic iron such as for example irongluconate, which is absorbed better and cause less stool problems. Anaemia can also be caused, apart from iron deficiency, by a shortage of vitamin B12. If this is the case the iron content can raise if you take or inject extra vitamin B12.
If you need an enema, this can be inserted in the (intestinal) stoma. Use a sleeve with this so that the fast ejection of the liquid and/or stool makes no mess. Even if you no longer have (a part of) the large intestine, you can still use laxatives.
The flu jab makes the chance of getting flu much smaller. If you do get flu, then the illness is normally less serious. People with a stoma do not automatically belong to the at risk group whereby you have the right to a flu jab. It is about the reduced resistance in combination with a stoma which makes you a part of the group. This includes people who have Crohn’s, colitis Ulcerosa, whereby a large part of the intestines have been removed and who use medicines such as prednisone, but those who have diverticulitis or who are cleared of cancer, do not belong to this group. Discuss this with your doctor.