It’s time for us to have a little chat about how to take your medicine properly. I know that sounds simple, but too often I have patients who come to me who are taking their medicine incorrectly. The confusion seems to stem from the terms “take twice a day,” or “three times a day”, or “as needed.”

Rule of thumb is twice a day means the dose should be separated by 12 hours, for example, 8 a.m. and 8 p.m. Three times a day, means the doses should be separated by eight hours. If the first dose is 8 a.m., the second dose should be 4 p.m. and the final dose at midnight or immediately prior to bed. No, you don’t have to wake up in the middle of the night to take your medication.

“As needed” almost always refers to pain medication. Those instructions do not mean whenever you feel like it. Instead, most pain medicine should not be taken more often than every four hours. It’s dangerous to take too much pain medication. It can lead to extreme drowsiness, stomach bleeding, liver damage and problems breathing.

Whenever you have even slightest hesitation about when or how much medication to take, ask your pharmacist. Remember, it is truly better to be safe than sorry.

Q: I went to get some cold medicine for my two-year-old son, and I couldn’t find any for kids his age. Everything is for kids four and over. What over the counter cold medications do you recommend for infants?

A: Actually, I don’t recommend any over the counter cold medicine for children under four. Based on recent studies, it doesn’t really help, and many parents have been giving children too much medicine and causing them harm. That is why you haven’t been able to find anything recommended for children that age at your local pharmacy. Instead, I recommend a humidifier or vaporizer to make the air moist.

The moist air will soothe your child’s breathings passages and help with a cough. Also, give the child lots of fluids, which will ease coughing and chest congestion. For a stuffy nose, use a saline solution, either spray or mist, and a bulge syringe to remove mucus.

I suggest acetaminophen or ibuprofen for fever or discomfort. Ask your pharmacist for a measuring spoon so you can be sure to give the right dose.

Q: I’m a full-time college student who works full-time. To get through the day, I need lots of coffee and energy drinks to keep me going. Is there a limit to how much caffeine I can drink in a day?

A: Yes. Too much caffeine can lead to rapid heartbeat, nervousness, an inability to focus and prolonged insomnia. Most healthy adults can safely consume up to 400 mg of caffeine per day, about three 8 oz cups of coffee. Most doctors recommend that people with heart conditions and those with high blood pressure eliminate caffeine.

Q: I promised my wife that this was the year I’d stop smoking. I’ve tried a number of times before, usually cold turkey, but it didn’t work. Using nicotine patches or gum just sounds like trading one form of addiction for another. What do you recommend?

A: I understand your hesitation about nicotine patches and gum; however, there is logic to this approach, which has helped hundreds of thousands of former smokers kick the habit. Nicotine addiction is strong. Most people need something to wean them from that addiction. Giving smaller amounts on a scheduled basis–which is what the patches and gum do–slowly reduces your dependence on nicotine, without exposing you to the more toxic cigarette by-products including tar, formaldehyde, and carbon monoxide.

A different, and separate approach, is Chantix, a drug that diminishes your urge to smoke. Until more information is known, it is not recommended that you use nicotine or nicotine replacement products with Chantix.

Q: Can erectile dysfunction drugs like Cialis, Levitra and Viagra cause amnesia?

A: It’s possible, but extremely rare. If it does happen, it will go away. Users are more likely to experience other side effects, like possible blurred vision or dizziness. Do not use these drugs if you are taking medication for chest pain, such as nitroglycerin or related products. The combination can cause a severe drop in your blood pressure, which can be fatal.

Q: The way my family tells it, vinegar is some kind of miracle drug. My grandmother swears that it helps control her diabetes. My aunt claims it helps reduce her high blood pressure. Sounds like a bunch of hooey to me.

A: Actually, those wise women in your family may be onto something. There are studies that suggest adding apple cider vinegar to the diet may help control blood sugar levels between and after meals. As for high blood pressure, some studies say it can lower blood pressure significantly for limited periods of time. The question that remains to be answered is exactly “how” vinegar works to do these miraculous things. Also, be mindful that vinegar is an acid, and large amounts can irritate your stomach.

More importantly, neither of these is a substitute for prescription medication and proper follow-up with a physician for diabetes and high blood pressure.

Dr. Daphne Bernard,Pharm,D.,is a registered pharmacist in Maryland, Virginia and the District of Columbia. She is currently assistant dean at the Howard University School of Pharmacy and a member of numerous boards and associations, including the Association of Boards of Pharmacy, the District of Columbia Board of Pharmacy, the Nonprescription Medicines Academy, Rho Chi Honor Society, American Society of Health-System Pharmacists, American Pharmaceutical Association and the American Association of Colleges of Pharmacy, Please email her at