Buying medicines safely in Nepal

Check the expiry date first, and check it in the shop rather than at home. This sounds obvious and it is the check most often skipped, because the buyer is unwell, the shop is busy and the box goes straight into a bag. A pharmacy that has sold you an expired pack will usually exchange it; a pharmacy you return to a week later with an opened strip is a much harder conversation.

Check the batch number and the manufacturing date are printed and legible. These are what make a recall possible. When the Department of Drug Administration issues a recall it identifies the affected product by batch, not by brand, so a pack whose batch number is smudged or missing is a pack you cannot check against a recall notice later.

Check the seal and the strip. Blister strips should be intact, with no punctured or resealed cells and no loose tablets rattling in a box. Liquids should have an unbroken tamper ring under the cap. Loose tablets counted out of a jar into a paper envelope — still common for cheap generics — leave you with no batch number, no expiry date and no way to identify what you were given.

Check the printed maximum retail price and compare it with what you are being charged. Nepal operates a maximum retail price system for medicines and the Department publishes MRP lists. The price on the pack is a ceiling, not a suggestion, and being charged above it is a straightforward complaint rather than a negotiation.

Check the name on the pack against the name on the prescription — both of them. Nepali prescriptions frequently carry a brand name, and brand names across manufacturers are close enough to each other that substitutions are easy to make and hard to notice. If the pharmacy has substituted a different brand, ask them to confirm the generic ingredient and the strength are identical, and have them write it on the pack.

Check the strength. This is where the most dangerous quiet errors happen, because the ingredient is right and only the number is wrong. A prescription written for one strength and dispensed at another looks correct on every check except the one that matters. Read the milligram figure out loud at the counter if you have to.

Ask for the bill. A dated receipt naming the pharmacy and the products is what turns any later problem — a reaction, a substandard batch, an overcharge — from your word against theirs into a documented purchase. Pharmacies that will not give a bill are telling you something about how they operate.

A prescription has five pieces of information and you need all five: what the medicine is, how much of it, how often, by what route, and for how long. Nepali prescriptions are frequently written at speed in a mixture of English, abbreviation and handwriting, and a patient who leaves without those five pieces confirmed is taking medicine on trust.

Learn to spot the generic name. Every medicine has one internationally recognised ingredient name and any number of brand names. The generic name is what lets you check a medicine against the essential medicines list, the national formulary, a recall notice or an interaction warning — none of which are indexed by brand. If your prescription carries only a brand name, ask the prescriber or the pharmacist to write the generic name beside it. This one habit does more for medicine safety than any other.

Understand the duration, and understand that it is a separate instruction from the frequency. 'Twice a day' without 'for five days' is an incomplete instruction, and it is the gap into which most incorrect antibiotic use falls. Ask specifically: how many days, and what should happen at the end of them.

Ask what the medicine is for, in plain words, and write it on the pack yourself. Households accumulate strips of unidentified tablets, and six months later nobody remembers whether the small white one was for blood pressure or for acidity. A pen mark on the box at the moment of purchase prevents an entire category of later error.

Ask what to do about a missed dose before you need to know. The correct answer differs by medicine — for some, take it when you remember; for others, skip it entirely; for a few, doubling up is genuinely dangerous. This is a thirty-second question at the counter and an anxious guess at eleven at night.

Tell the prescriber and the pharmacist everything you are already taking, including medicines bought without a prescription, herbal and ayurvedic preparations, and anything a relative gave you. Interactions are the failure mode that patients almost never report on, because the individual medicines each seem harmless. Painkillers are the classic case: two products bought separately can contain the same active ingredient, and the combined dose is what causes the harm.

Keep the prescription. Photograph it if the original goes to the pharmacy. A repeat purchase, a second opinion, an emergency admission and an insurance claim all go faster when someone can see what was actually prescribed, by whom and when.

Antibiotics are the clearest example of a medicine that is genuine, correctly made and routinely misused. They work on bacterial infections and do nothing at all for the viral illnesses that cause most coughs, colds, sore throats and short fevers. Taking them anyway does not shorten the illness; it kills off susceptible bacteria and leaves the resistant ones with less competition.

That consequence is not personal, which is why it is hard to act on. The individual who takes an unnecessary course of antibiotics usually suffers nothing worse than an upset stomach. The cost lands later and on someone else — often a child, an elderly relative or a patient after surgery — when a common infection stops responding to the medicines that used to treat it. Antimicrobial resistance is one of the more serious health problems Nepal faces and it is generated one unnecessary course at a time.

The second failure is stopping early. A course prescribed for a set number of days is calculated to clear the infection, not to relieve the symptom. Symptom relief comes first and the tempting move — stopping when you feel better and saving the remaining tablets for next time — is precisely the pattern that breeds resistance and produces the relapse that then needs a stronger drug.

The third failure is sharing. Leftover antibiotics passed to a family member with a similar-sounding complaint are being given without a diagnosis, at whatever dose is left, for whatever duration the strip happens to allow. Every element of that is wrong even when the medicine itself is fine.

The Department of Drug Administration publishes notices and guidance about the sale and control of medicines, including antibiotics, alongside the national formulary and the essential medicines list. The practical point for a buyer is simpler than the policy: if a pharmacy offers you antibiotics for a cough without a prescription and without asking a single question, that is a shop optimising for a sale, not a health professional managing an infection.

If you are prescribed antibiotics, ask two questions. Why do you think this is bacterial? And what should change, by when, if this is working? A prescriber who can answer both is treating an infection. Those answers also tell you when to go back, which matters more than the tablets.

Pharmacies in Nepal are required to be registered and to be run by people registered with the Nepal Pharmacy Council under its own Act. This is worth knowing not because you will inspect a certificate, but because it establishes that there is a standard and someone to complain to when it is not met. A shop displaying its registration is telling you it expects to be checked.

A good pharmacy counter is genuinely useful, and this guide is not an argument for avoiding it. Pharmacists correctly handle minor, self-limiting complaints, explain how to take something, spot an interaction with what you are already on, recognise a symptom that needs a doctor, and refuse a sale that should not be made. The refusal is the mark of a good one.

The counter stops being enough at fairly predictable points. Anything lasting longer than a few days without improvement, anything recurring, anything in a baby or a very old person, anything in pregnancy, any new medicine taken alongside existing long-term medication, and any symptom that is severe rather than merely uncomfortable, all need a diagnosis rather than a product.

Long-term conditions are the biggest single category where counter buying quietly fails. Blood pressure, diabetes and thyroid medicines all need periodic review against test results, and a patient who simply repeats the same purchase for years is being treated to a snapshot that may be several years out of date. The medicine keeps being dispensed; the condition keeps changing.

Be alert to the sales pitch dressed as care. Vitamin and supplement upselling attached to an ordinary purchase, tonics promising energy or immunity, and anything described as a guaranteed cure are commerce rather than treatment. A pharmacy that adds three products to a prescription for one is not managing your health.

Steroids deserve a specific warning because they are widely available, genuinely effective for the right condition, and actively harmful for several conditions they resemble. Skin creams containing potent steroids applied to fungal infections make the infection considerably worse while briefly reducing the itch, which is exactly the feedback loop that keeps people applying them. Do not buy or continue a steroid product without a diagnosis.

Most Nepali homes store medicine badly, and the climate makes it consequential. Heat and humidity degrade many medicines faster than the expiry date on the pack assumes, because that date presumes storage in the conditions printed on the box. A strip kept in a kitchen through a Terai summer or a Kathmandu monsoon has not necessarily lasted as long as the printed date suggests.

Keep medicines dry, out of direct sun and away from the two places households habitually use — the bathroom shelf and the top of the fridge. Bathrooms are the most humid room in the house and the fridge top is warm. A closed box in a cool interior cupboard is better than either, and free.

Anything labelled for refrigeration means it, and means a working fridge rather than a cool corner. Insulin, some eye preparations, certain liquid antibiotics after mixing and most vaccines lose potency when the cold chain breaks. In areas with long power cuts this is a real planning problem rather than a theoretical one, and it is worth asking the pharmacy how a particular product should be handled if the power goes.

Keep the original packaging. Transferring tablets into a single unlabelled container destroys the batch number, the expiry date and the identification all at once, and it is how households end up with tablets nobody can name.

Do a clear-out twice a year, and pick fixed dates you will remember — the start and end of the monsoon works. Discard anything expired, anything unidentifiable, anything whose strip is broken and anything left over from a course that should have been completed. Leftover antibiotics in particular should not be kept, because keeping them is what makes sharing and self-prescribing possible.

Store medicines out of the reach of children, and treat that as a physical problem rather than an instruction. Children swallow things that are colourful, sweet-coated and within arm's reach, and paracetamol syrup and iron tablets are among the most common serious childhood poisonings worldwide precisely because they are in every house.

Keep a single written list of what everyone in the household takes regularly, with generic names and strengths, and keep it where it can be picked up quickly. In an emergency admission this list saves time that nobody has, and it is the one piece of medicine documentation that is useful to a stranger.

Stop taking it. This sounds automatic and frequently is not, because people reason that a suspicious pack is probably fine and finishing the course matters. If you have real doubt about a product's identity, condition or origin, stop and get advice before continuing.

Keep everything — the pack, the strip including empty cells, the remaining tablets, the bill and the prescription. The batch number is the single most useful thing you hold, because it is how the regulator identifies a product. Throwing away the box and keeping the tablets is the most common way people destroy their own evidence.

Check the Department of Drug Administration's published recall and drug-alert notices, and its banned-drug list. Recalls are issued by batch, so match the batch number rather than the brand. If your batch appears, the notice will say what action is expected.

Take it back to the pharmacy first, with the bill. Most problems — an expired pack, a wrong strength dispensed, a substitution nobody explained, a charge above the printed price — are resolved at the counter by a shop that would rather not have a complaint on record.

Escalate to the Department of Drug Administration where the problem is the product rather than the shop: suspected counterfeit or substandard medicine, a product you cannot find any registration for, a serious unexpected reaction, or a pharmacy selling something on the banned list. The Department is the enforcement authority under the Drugs Act and it publishes its own contact and service information.

Treat overcharging as a consumer matter as well as a medicine one. Selling above the printed maximum retail price is a consumer protection issue and Nepal has a separate complaint route for that, which is worth using because it produces a record in a different system.

Report a serious adverse reaction even if you are not sure the medicine caused it. Safety monitoring works on accumulated reports, and the individual reporter is rarely in a position to know whether their case is one of one or one of two hundred. Tell the prescriber, tell the pharmacy, and where the reaction is serious, make sure it reaches the Department.