Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 31: Use of Medicines in Women’s Health (introduction...) Deciding to use medicine (introduction...) Harmful uses of medicines How to use medicine safely Using the medicines in this book (introduction...) Generic names and brand names Medicine comes in different forms How much medicine to take When to take medicines Who should not take a certain medicine Side effects Precautions (warnings) Information you should know Taking too much medicine Kinds of medicines (introduction...) Antibiotics Medicines for pain Medicines for heavy bleeding from the vagina after birth or abortion Medicines for allergic reactions Medicines that can save a woman’s life

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 31: Use of Medicines in Women’s Health

In this book we recommend many medicines. This chapter explains how to use them safely. For more information on side effects, warning signs, medicines that need special instructions, and antibiotics, see the “Green Pages”.

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¨ Medicines can be useful, but they cannot replace healthy living, good food, or good health care.

Medicines are drugs that can be used to help the body fight disease or feel better when sick. Medicines can be either modern or traditional. In this book, we mostly talk about how to use modern medicines. This is because traditional remedies vary greatly from one region to another. A remedy that works in one community may not exist or may not work in another community. Ask traditional healers where you live to help you find remedies that may work for your problem. (For more information about using traditional remedies.)

It is important to use medicines safely. Used properly, medicines can save lives. But used improperly, medicines can hurt and even kill you. For example, some medicines can cause health problems for a pregnant or breastfeeding woman and her baby. And some medicines may cause other problems (side effects) that can be annoying, worrisome, or even dangerous to a person’s health. If you take too much of a medicine at once, or if you take it too often, it may harm you.

This chapter talks about how to use safely the medicines mentioned in this book to treat women’s health problems. It also provides information to help you decide when to use medicines to improve women’s health.

Deciding to use medicine

Some people think that you always need medicine to get good health care. But medicines can only treat health problems - not solve the conditions that cause them. And not all health problems are best treated with medicine. For some, drinking lots of liquids and resting are most important. A medicine should be used only if you know what the problem is and that the medicine will work for that problem.

¨ See the chapters called “Solving Health Problems” and “The Medical System” for more information to help you decide if you need to take medicine.

To decide whether or not you need a medicine, think about these things:

· How serious is my illness?
· Can I get better without this medicine?
· Can I get better by changing my living or eating habits?
· Is there a traditional remedy that works?
· Are the benefits of using this medicine greater than the risks and costs?

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To the health worker: When giving medicine, remember these guidelines: 1. Medicine is not a substitute for good health care. Good health care means explaining why people have a health problem, what they can do to get better; and how they can prevent that problem in the future. 2. Medicine is safe and helpful only if you give good instructions about how to take it. Be sure the woman understands your instructions. 3. Medicine will be used correctly only if you understand a woman’s beliefs and fears. If a person believes that taking more medicine will make her heal faster, she may take extra and harm herself. If she is afraid that a medicine will harm her body, she may not take it at all. But if she understands how the medicine works, she will be more eager to take it correctly. 4. Help find the cheapest and best treatment for the people you see. Most people worry about the cost, since buying a medicine can take all the money a family has for a week or month. Figure

Harmful uses of medicines

Medicines are used to fight dangerous illnesses, but medicines have their own dangers. Used improperly, medicines can hurt or even kill you. These are some common examples of ways medicines can be misused in women’s health:

Figure

· Oxytocin and ergometrine are sometimes misused to hurry the birth of the baby or the afterbirth (placenta). This is dangerous. These medicines can kill the woman and her baby. Unless you are a trained health worker, use these medicines only to stop heavy bleeding AFTER childbirth. Also, do not use them to cause abortion. They may burst (rupture) the womb and kill the woman before they cause an abortion. · Women and girls sometimes try using dangerous medicines - such as aspirin, malaria medicines, and ergometrine - to cause abortion. These medicines almost never work. Instead of ending the pregnancy, some medicines can cause serious problems, such as poisoning and death from too much medicine. For more information on new medicines that can be used for safe abortion, read the chapter on “Abortion”. · Some women have died from using bromocriptine to stop the flow of breast milk. Never take it. Your breast milk will dry up naturally when your baby stops suckling. · In many places, women are encouraged to take medicines to calm their fears, to improve their mood, or to help them sleep. But these problems are usually caused by life’s difficulties. Most of the time, medicines will not make these difficulties go away, and the cost can quickly use up a family’s money. If you have difficulty getting through each day, see a trained mental health worker before using a medicine for your nerves or mood. · DES (diethylstilbestrol), a hormone, was used by women in Western Europe and North America from 1941 to 1981 to prevent miscarriage. It is no longer used because it can cause cancer of the cervix and vagina in girls and of the testicles in boys whose mothers used it while pregnant. This medicine may still be used in other places, such as parts of Africa and Latin America, to prevent miscarriage and stop the flow of breast milk. Do not take this medicine. · Some doctors prescribe hormone replacement therapy (HRT) for problems that can happen when your monthly bleeding stops forever (menopause). Sometimes these medicines are helpful. But most women can have a normal and healthy menopause without taking medicines. · Buying vitamins and minerals can be a waste of money, unless you have an illness that will be helped by them. Nutritious food is cheaper and healthier for the whole family. If possible, women who have weak blood (anemia) and who are pregnant should take iron pills and folic acid. But injections of vitamin B12 and liver extract do not help anemia - iron pills and good nutrition will do more good.

How to use medicine safely

Any time you use a medicine, follow these guidelines:

· Be sure it is necessary.

· Get good instructions from the person who told you to take it. You should know:

- how much to take (the dose).

- how often to take it each day and for how many days.

· Take the full amount. If you stop taking the medicine too soon, the problem may come back.

· Know the warning signs for any problems (side effects) the medicine can cause.

· Know if the medicine reacts badly with particular foods and if you should take it on a full or empty stomach.

· Avoid taking many medicines at the same time. Some medicines can stop other medicines from working. Some medicines can combine with other medicines to cause problems that neither would cause by itself.

· Be careful when buying combination medicines (2 or more medicines in 1 tablet). Some combination medicines are necessary, but they usually cost more, and you may be putting medicine in your body that you do not need. For example, some eye drops and eye ointments contain both antibiotics and steroids. The steroids can be harmful. Combination medicines can also cause more side effects.

· Make sure the package is labeled. If there is no label, ask the person to show you the bottle or box the medicine came in, and to write down the name and dose for you.

Keep all medicines in a cool, dry place or they may lose their usefulness before the expiration date. Make sure children cannot reach them. They can be deadly to a child.

Avoid medicines that are too old It is best to use a medicine before its expiration date. This date is written in small print on the package or bottle. For example: If you see ‘exp. 10/29/98’ or ‘exp. 29/10/98’ or ‘exp. Oct. 29, 1998’, this means the medicine should be used before the 29th day of October, 1998. Sometimes expired medicine is better than no medicine. But do not use expired medicines if they are: · pills that are starting to fall apart or change color. · capsules that are stuck together or have changed shape. · clear liquids that are cloudy or have anything floating in them. · injections. · eye drops. · medicines that require mixing. If the powder looks old or caked, or if the medicine does not pour evenly after shaking, do not use it. (These must be used soon after they are mixed.) IMPORTANT Do not use doxycycline or tetracycline after the expiration date has passed. They may be harmful.

Using the medicines in this book

Throughout this book, we have given the names and doses of medicines that can be used to treat some common women’s health problems. But to be able to buy and then use a medicine safely you must also know:

· what the medicine is called where you live (see below).

· in what forms the medicine comes.

· how to take the medicine correctly.

· whether the medicine is safe for you to take.

· if the medicine causes side effects.

· what happens if you take too much (or not enough) of the medicine.

· what to do if you cannot find (or afford) the medicine, or if you should take another medicine because you are pregnant or breastfeeding or have an allergy.

This information for each medicine is presented at the end of this chapter in the “Green Pages”. The rest of this chapter explains more about how to buy and safely use all of the medicines mentioned in this book.

Read the label carefully before you take any medicine.

Generic names and brand names

Most medicines have 2 names - a generic or scientific name, and a brand name. The generic name is the same everywhere in the world. The brand name is given by the company that makes the medicine. When several companies make the same medicine, it will have several brand names but only one generic name. As long as the medicine has the same generic name, it is the same medicine.

In this book, we use the generic or scientific name for medicines. For a few medicines, such as those used in family planning, we also use the most widely available brand name. If you cannot find the first medicine we recommend, try to buy one of the others listed in the same treatment box.

It is OK to substitute one medicine for another if the generic names are the same. Always take the same dose.

For example: Your health worker has told you to take Flagyl. But when you go to the pharmacy, they do not have any. Ask the pharmacist or health worker what the generic name is for Flagyl (metronidazole) and ask for another brand that has the same generic name. The generic name is usually printed on the label, box, or package. If you ask for the medicine by its generic name, you can often buy it more cheaply.

Figure

Medicine comes in different forms

Figure

Figure

Medicines come in many different forms:

· Tablets, capsules and liquids are usually taken by mouth. In some cases (rarely) they may need to be used in the vagina or rectum.

· Inserts (suppositories, pessaries) are made so they can be put into the vagina or the rectum.

· Injections are given with a needle directly into a person’s muscle, under the skin, or into the blood.

· Creams, ointments, or salves that contain medicine are applied directly to the skin or in the vagina. They can be very useful for mild skin infections, sores, rashes, and itching.

Which kind of medicine, and how much of it you take depends on what is available and on the disease you are trying to treat.

How much medicine to take

How to measure medicine Many medicines, especially antibiotics, come in different weights and sizes. To be sure you are taking the right amount, check how many grams, milligrams, micrograms, or Units each pill or capsule contains. If the pharmacy does not have the weight or size you need, you may have to take part of a pill, or more than one. Here are some helpful symbols to know: = means equal to or the same as + means and or plus Figure Fractions. Doses that are less than one whole tablet or pill are sometimes written as fractions: 1 tablet = one whole tablet = ½ tablet = half of a tablet = 1 ½ tablet = one and one-half tablets = ¼ tablet = one quarter or one-fourth of a tablet = If you are not sure you have the right dose, ask someone who is good at numbers to help you. Kinds of measurements Grams and milligrams. Medicine is usually weighed in grams (g) and milligrams (mg): 1000 mg = 1 g (one thousand milligrams makes one gram) 1 mg =.001 g (one milligram is one-thousandth part of a gram) For example:
One aspirin tablet has 325 milligrams of aspirin.			.325 g 0.325 g 325 mg		All of these are different ways to say 325 milligrams.
Micrograms. Some medicines, such as family planning pills, are weighed in milligrams or even smaller amounts called micrograms (mcg or µcg): 1 µcg = 1 mcg = 1/1000 mg (0.001 mg) This means there are 1000 micrograms in a milligram. Units. Some medicines are measured in units (U) or international units (IU). For liquid medicine: Sometimes instructions for syrups or suspensions tell you to take a specific amount, for example, 10 ml or 10 milliliters or 10 cc (cubic centimeters). A cubic centimeter is the same as a milliliter. If the medicine does not come with a special spoon or dropper to measure liquid, you can use household measures: 1 tablespoon = 1 Tb = 15 ml 1 teaspoon = 1 tsp = 5 ml So, for example:
Amoxicillin tablets come in 2 sizes:	250 mg and				500 mg
If you need to take: ‘amoxicillin 500 mg 1 tablet 2 times a day’, but you only have 250 mg tablets, you need to take 2 tablets each time.
	250 mg	+		250 mg		=	500 mg
Dosing by weight In this book we have given dosages for adult women. But for some medicines, especially ones that can be dangerous, it is better to figure out the dosage according to a person’s weight (if you have a scale). For example, if you need to take gentamicin, and the dosage says 5 mg/kg/day, this means that each day you would give 5 milligrams (mg) of the medicine for each kilogram (kg) the person weighs. So a 50 kg woman would receive 250 mg of gentamicin during 24 hours. This amount should be divided up depending on how many times it is given each day. Gentamicin is given 3 times a day so you would give 80 mg in the morning, 80 mg in the afternoon, and 80 mg in the evening.

When to take medicines

Figure

It is important to take medicines at the right time. Some medicines should be taken only once a day, but others must be taken more often. You do not need a clock. If the directions say’ 1 pill every 8 hours’, or ‘3 pills a day’, take one at sunrise, one in the afternoon, and one at night. If they say’ 1 pill every 6 hours’, or ‘4 pills a day’, take one in the morning, one at midday, one in the late afternoon, and one at night. If the directions say ‘1 every 4 hours’, take 6 pills a day, allowing about the same time between pills.

IMPORTANT
· If possible, take medicines while standing or sitting up. Also, try to drink a glass of liquid each time you take a medicine.
· If you vomit and can see the medicine in the vomit, you will need to take the medicine again.
· If you vomit within 3 hours after taking a birth-control pill, take another one to make sure you will not get pregnant.

If you are writing a note for someone who does not read well, draw them a note like this:

Figure

In the blanks at the bottom, draw the amount of medicine to take and carefully explain what it means. For example:

This means they should take 1 tablet 4 times a day: 1 at sunrise, 1 at midday, 1 in the late afternoon, and 1 at night.

This means ½ tablet 4 times a day.

This means 1 capsule 3 times a day.

Who should not take a certain medicine

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CAUTION

= read carefully if you are pregnant

= read carefully if you are breastfeeding

= do not take if pregnant

= do not take if breastfeeding

Some medicines can be dangerous for certain people, or during certain times of their lives. You should be especially careful if:

· you are pregnant or breastfeeding. Many of the medicines that you take during pregnancy and breastfeeding will be passed on to your baby. Before you take any medicine, find out if it will harm your baby. Medicines in this book that are harmful during pregnancy and breastfeeding are marked with a warning.

But if you are sick, it is important that you get treated. Do take medicines to treat serious illnesses and anemia. It is possible to find medicines that will not harm your baby.

· you have long-term liver or kidney disease. Your liver and kidneys clear the medicine from your body. If they are not working well, the medicine may build up and become poisonous.

¨ In the Green Pages, medicines that may be harmful during pregnancy and breastfeeding will be marked with the above signs.

· you have a stomach ulcer or a stomach that upsets easily (heartburn). Medicines such as aspirin and ibuprofen can cause bleeding in the stomach and a painful or burning feeling. If you must take a medicine that bothers your stomach, take it with food.

· you are allergic to the medicine. If you have ever had any of these signs after taking a medicine, you are probably allergic to that medicine:

- a skin rash (raised, red and itchy, usually with swelling)
- swelling
- trouble breathing or swallowing

Being allergic means your body fights against the medicine rather than using it to fight disease. Allergic reactions happen more often with antibiotics from the penicillin and sulfa families. Avoid taking other medicines from the same ‘family’ of medicines as the one you are allergic to. You may also be allergic to them.

IMPORTANT
If you have an allergic reaction to a medicine, never take the medicine again. The next time it may cause a more serious reaction or even death.

Figure

IMPORTANT If you have taken a medicine and then get a severe skin rash, swelling of the mouth or difficulty breathing or swallowing, get medical help immediately.

Side effects

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Medicines fight disease but can also cause other effects to happen in the body. Some are harmless but annoying. Others are harmful. For example, metronidazole makes your mouth taste bad, which is annoying but harmless. Some very strong antibiotics, such as gentamicin and kanamycin, can cause permanent harm to your kidneys and hearing if too much is taken.

Before you take a medicine, find out what the possible side effects are. When using the medicines in this book you can look at the “Green Pages” to learn about possible side effects.

IMPORTANT
If you have unusual signs such as dizziness, ringing in the ears, or fast breathing, and these are not listed as side effects for the drug you are taking, see a health worker trained in giving medicines. These signs can mean that you are taking too much medicine.

Precautions (warnings)

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Some medicines have specific warnings you should learn about. But you should check with a health worker before taking the medicine if:

· you are taking other medicines. Medicines that are safe when taken alone can be harmful when taken with another medicine, or they can be made weaker.

· giving medicine to a child. Children have smaller bodies and may need to take less medicine. Check with a pharmacist or health worker for the right dose for a child.

· you are older. Older people sometimes need smaller doses because medicine will stay in their bodies longer.

· you are very small, thin or poorly nourished. You may need a smaller dose of some medicines, such as medicines for tuberculosis, high blood pressure, and seizures and other problems.

Information you should know

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Food and medicine

With most medicine, you can continue eating the foods you normally eat. Some medicines work better if you take them when your stomach is empty - when it has been more than 2 hours since you last ate.

Medicines that upset the stomach should be taken with food or just after eating.

If you have nausea or vomiting, take the medicine with a dry food that calms the stomach - like rice, bread, or a biscuit.

Taking too much medicine

Figure

Some people think that taking more medicine will heal the body faster. This is not true and can be dangerous! If you take too much medicine at one time or too often, or if you take some medicines for too long, the medicine may harm you.

Never take more medicine than the amount advised.

Some common signs of taking too much of a medicine are:

· nausea
· vomiting
· pain in the stomach
· headache
· dizziness
· ringing in the ears
· fast breathing

But these can also be side effects for some medicines. If you have one or more of these signs and they are not common side effects of the medicine you are taking, then you should talk to a health worker trained in giving medicines.

Poisoning. Taking too much of a medicine (for example, half a bottle or more) can poison a person, especially children. You should do the following:

· try to make the person throw up. She may be able to get the extra medicine out of her body before it harms her more.

· give activated charcoal. Activated charcoal can absorb some kinds of drugs and keep them from acting as poison.

· Get medical help immediately.

Kinds of medicines

Figure

Different medicines are used to treat different problems. Some cure the problem itself and others relieve only the signs of the problem. Sometimes you cannot take the best medicine for your problem because:

· it is not available where you live.

· it is not safe if you are pregnant or breastfeeding.

· you are allergic to it.

· it no longer works where you live, because of drug resistance (see box below).

When this happens, you can substitute one medicine for another, but only if you are sure it will work. The treatments we recommend in this book often give you choices if for some reason you cannot use the best medicine. If you are unsure of what medicines to take, talk to a health worker.

Antibiotics

Antibiotics are important medicines that are used to fight infections caused by bacteria. They do not fight viruses or cure the common cold, But not all kinds of antibiotics will fight all kinds of infections. Antibiotics that share the same chemical make-up are said to be from the same family. It is important to know about the families of antibiotics for 2 reasons: 1) antibiotics from the same family can often treat the same problems. This means you can use a different medicine from the same family. 2) if you are allergic to an antibiotic of one family, you will also be allergic to the other members of the same family of antibiotics. This means you will have to take a medicine from another family instead, The major families of antibiotics used in this book are: Penicillins: amoxicillin, ampicillin, benzathine penicillin, benzyl penicillin, dicloxacillin, procaine penicillin, and others. Medicines of the penicillin family are very effective for a variety of infections. They have very few side effects and are safe to take if pregnant or breastfeeding. They are widely available, cheap, and come in oral and injectable forms, but they cause more problems with allergic reactions than many other medicines. They have been overused and some diseases are now resistant to penicillins. Macrolides: azithromycin, erythromycin, and others Erythromycin is an older, commonly used and widely available antibiotic that works for many of the same infections as penicillin and doxycycline. It is often a good substitute for doxycycline when a woman is pregnant or breastfeeding, or if there is penicillin allergy. Tetracyclines: doxycycline, tetracycline Tetracycline and doxycycline both treat many different infections and are cheap and widely available. Neither drug should be taken by pregnant or breastfeeding women or by children under 8 years of age. Sulfas (sulfonamides): sulfamethoxazole (part of co-trimoxazole), sulfisoxazole These medicines fight many different kinds of infections and they are cheap and widely available. But they are less effective now because some infections are resistant to them. They cause more problems with allergic reactions than other medicines. They can be taken during pregnancy, but it is better to take a different medicine just before you give birth and during the first few weeks of the baby’s life. Stop using sulfonamides immediately if you develop signs of allergy. Aminoglycosides: gentamicin, streptomycin, and others These are effective and strong medicines, but most of them can cause serious side effects and can only be given by injection. They should only be used when infection is severe and no safer drug is available. Cephalosporins: cefixime, ceftriaxone, cephalexin, and others These are a large family of new and powerful drugs that treat many women’s infections that have become resistant to the older antibiotics. They are often safer and have fewer side effects than the older antibiotics but can be quite expensive and hard to find. They are safe to use during pregnancy and breastfeeding. Quinolones: ciprofloxacin, norfloxacin, and others Ciprofloxacin and norfloxacin are new and powerful antibiotics. They are expensive and may be hard to find. They cannot be taken while pregnant and breastfeeding or by children less than 16 years old.

Use antibiotics only when necessary Many antibiotics, especially penicillin, are used too often. Use antibiotics only when necessary because: · while they kill some germs, antibiotics allow others - ones that are normally in the body and usually harmless - to grow out of control. This can cause problems like diarrhea and vaginal yeast infections. · some antibiotics can cause serious side effects and allergic reactions. · using antibiotics when they are not needed or for diseases they cannot cure has made some harmful germs stronger and resistant to the medicine. This means the medicine can no longer cure the disease. For example: In the past it was easy to cure gonorrhea, a sexually transmitted disease, with penicillin. But penicillin has been used incorrectly and too often for many other, less serious problems. Now there are new kinds of gonorrhea that resist penicillin and other antibiotics. These new kinds are harder and more expensive to cure.

Medicines for pain

Pain is a sign of a problem, such as an injury or infection. So it is very important to treat the problem that is causing the pain, and not just the pain. But during the treatment, the pain can be eased with pain medicines. With some illnesses that cannot be cured, like AIDS and cancer, pain can be disabling and last a long time. When treating pain: · try to find and treat the cause of the pain. · try the weakest pain medicines first and use stronger ones only if needed. · treatment for ongoing pain should be given regularly. Don’t wait until the pain returns before the next dose. · think about other ways to relieve pain: relaxation exercises, acupressure, or putting heat or cold where the pain is. Figure For mild to moderate pain, as with monthly bleeding or a headache: Paracetamol is widely available and cheap. It is the safest pain medicine for pregnant and breastfeeding women, and it also works to reduce fever. Do not take it with alcohol or to treat a hangover, or if you have liver or kidney problems. Aspirin is also widely available, cheap, and works well to lower fever and to treat pain and inflammation in muscles and joints, and for pain with monthly bleeding. Breastfeeding women can use aspirin one week after the baby is born, but pregnant women should use paracetamol instead. It is safe when taken in the correct amounts, but it can irritate the stomach, so it should not be taken by people with stomach ulcers. Aspirin keeps blood from clotting normally, so it should not be taken if the person is bleeding or before any surgery, Ibuprofen is widely available but more expensive than aspirin or paracetamol. Like aspirin, it is very effective in lower doses for pain with monthly bleeding, and for muscle and joint pain and inflammation. Ibuprofen is a good medicine for the lasting pain of arthritis. It can also cause irritation of the stomach and bleeding problems, so it should not be taken before surgery or by people with stomach ulcers. Breastfeeding women can use ibuprofen but pregnant women should not use it during the last 3 months of pregnancy. For moderate to severe pain: Ibuprofen in larger doses can be effective (up to 800 mg 3 to 4 times daily). Codeine is a drug of the opiate family which is useful for pain after surgery or an injury. Taking codeine for too long can cause addiction. For severe or ongoing pain: Codeine in higher doses can be used for severe pain. Morphine is a very strong medicine of the opiate family that is good for pain during the last stages of cancer or AIDS. Morphine is usually difficult to get unless you are in a hospital, but it may be available with a doctor’s prescription. It is highly addictive.

Medicines for heavy bleeding from the vagina after birth or abortion

Medicines that contain ergometrine or oxytocin cause contractions of the womb and its blood vessels. They are important medicines to control heavy bleeding after childbirth.

Figure

Ergometrine is used to prevent or control severe bleeding after the placenta has come out. Do not inject ergometrine into the vein (IV). It should be injected into a large muscle. Never give this medicine before the baby is born or the placenta has come out! Do not give this medicine to a woman with high blood pressure.

Oxytocin is used to help stop severe bleeding of the mother after the baby is born. It is very rare for oxytocin to be needed before the baby is born. For this purpose, it should only be given in the vein by a doctor or trained birth attendant. Using oxytocin to speed up labor or give strength to the mother in labor can be dangerous to both mother and child.

Medicines for allergic reactions

A person can be allergic to medicines, foods, or things that are breathed in or touched. Reactions may be mild - with itching, hives or rash, or sneezing - or they can be moderate or severe. Some reactions can worsen and bring on allergic shock. Severe reactions and allergic shock can be life-threatening and must be treated.

Figure

In this book, we talk about how some medicines may cause allergic reactions. Any medicine that causes an allergic reaction should be stopped and never given again - even if the reaction was mild.

Depending on how strong the reaction is, allergic reactions are treated with 1, 2, or 3 kinds of medicines:

1. Antihistamines, like diphenhydramine, hydroxizine, or promethazine. None of these medicines are good for pregnant or breastfeeding women, but promethazine is the least dangerous of them. Otherwise diphenhydramine is usually the cheapest and most widely available.

2. Steroids, like dexamethasone or hydrocortisone. Dexamethasone is a better choice for pregnant or breastfeeding women.

3. Epinephrine or adrenaline. These medicines are safe for pregnant or breastfeeding women.

Medicines that can save a woman’s life

Starting a community emergency medicine kit is one way you can help save the lives of women where you live. The medicines in this chart will help you start treatment until other medical help is available. Make sure these medicines are in your kit or at the nearest health post. If you need to buy them, try meeting with leaders in your community. Explain how these medicines can help, and see if you can find ways together to buy them.

What to include in a medicine kit:

Figure