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Sasaki T, Shinozaki M, Nemoto A, Nagao Y, Yasuda M, Shimoda K, Suda S, Yasui‐Furukori N. Effects of age on suicide attempts by medication in patients transferred to the emergency rooms of two advanced medical centers: A retrospective chart review of the DJ project. Neuropsychopharmacol Rep 2023; 43:453-456. [PMID: 37433639 PMCID: PMC10496036 DOI: 10.1002/npr2.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/13/2023] Open
Abstract
AIMS The means of suicide vary, but in cases of impaired consciousness, it is often difficult to determine the initial treatment because it is not known whether a patient has overdosed or used pesticides or poisons. Therefore, we investigated the clinical characteristics of suicide by medication in patients with suicide attempts who were brought to the emergency department, especially the influence of age. METHODS Patients with suicide attempts were transported to the two hospitals. There were 96 males (38.4%) and 154 females (61.6%). The mean age was 43.5 ± 20 years, and both males and females were most often in their 20s. Data on sex, age, motive for suicide, means of suicide attempt, psychiatric diagnosis, length of hospital stay, and place of discharge were retrospectively analyzed. RESULTS The average age of the patients by means of suicide attempt was 40.5 years for "prescription drugs," 30.2 years for "over-the-counter drugs," and 63.5 years for "pesticide/poison." For each means of suicide attempt, there was a significant difference in age among patients with suicide attempts using "prescription drugs," "over-the-counter drugs" and "pesticides/poisons." There was a statistical bias in the means and reasons for each suicide attempt. CONCLUSION The results showed that the age of patients who used over-the-counter medicines and pesticides and poisons varied significantly. It was thought that pesticide use should be considered first, especially when patients aged 50 years and over are brought to the hospital with impaired consciousness due to suicide attempts.
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Affiliation(s)
- Taro Sasaki
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Masataka Shinozaki
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Aki Nemoto
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Yukiko Nagao
- Department of PsychiatryJichi Medical UniversityShimotukeJapan
| | - Manabu Yasuda
- Department of PsychiatryJichi Medical UniversityShimotukeJapan
| | - Kazutaka Shimoda
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Shiro Suda
- Department of PsychiatryJichi Medical UniversityShimotukeJapan
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Thenmozhi B, Sharmil SH. Self-medication Practices of the Rural Community People: A Cross-Sectional Study. Indian J Community Med 2023; 48:619-622. [PMID: 37662137 PMCID: PMC10470567 DOI: 10.4103/ijcm.ijcm_842_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/03/2023] [Indexed: 09/05/2023] Open
Abstract
Background Self-medication is the practice of taking medicines without a physician's advice, and it has become more common in developing nations. The root cause could be anything from a shortage of physicians to financial factors. However, most people are not aware of the ill effects and drug reactions brought on by self-medication. This research aimed to find out the prevalence, frequency, common complaints, primary sources, and regular medicines utilized for self-medication, which are the goal of this study. Materials and Methods A cross-sectional study was conducted among the rural community people in Keezhur, Chengalpattu District, Tamil Nadu, India. A group of 253 participants were selected using a random sampling technique. A self-structured questionnaire was used to collect the data. The gathered information was coded and examined. Results Self-medication was common in 60.5% of people, and 46.6% of them frequently utilize analgesics. The most frequent condition for which people used self-medication was headache (30.4%). The practice was significantly correlated with the younger age group and the level of education. Conclusion Self-medication is harmful to one's health and is widespread in the research group's region. To reduce the practice of self-medication, general people should get sufficient health education.
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Affiliation(s)
- B Thenmozhi
- Department of Medical-Surgical Nursing, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - S Hepsibah Sharmil
- Chettinad College of Nursing, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
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Zaidi SF, Hakami AY, Khan MA, Khalid AA, Haneef AK, Natto SS, Mastour MA, Alghamdi RF. The Awareness and Practice of Self-Medication Among the General Public in Jeddah and Makkah. Cureus 2023; 15:e39706. [PMID: 37398702 PMCID: PMC10309079 DOI: 10.7759/cureus.39706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 07/04/2023] Open
Abstract
Background Self-medication (SM) can be defined as the improper practice of obtaining and consuming a pharmaceutical drug without the consultation or prescription of a licensed physician. This includes evaluating the intensity of signs and symptoms which could lead to treating oneself with a medicine or seeking urgent medical care. Although SM can be deemed as safe for one's health, drug accessibility accounts for an irrational choice of medicines and thus exposes oneself to the adverse effects of these medicines. Several regional studies have provided sufficient evidence about how SM has commonly been practiced and held in some settings, such as pharmacies. Aim In this study, we aimed to assess the practice and awareness of SM in the general public. Thus, we utilized a questionnaire-based survey to analyze SM awareness and practice among the general population in Jeddah and Makkah. In addition, we examined the impact of demographic variables, such as educational level, economic status, age, etc. on SM practice. Methods A cross-sectional survey was distributed via social media platforms in June 2020. The study included Jeddah and Makkah's general public, all different nationalities, and both genders, and it excluded participants below the age 18-year-old and with mental and cognitive instability. After extrapolating the sample size at a 95% confidence level with an estimated 50% response distribution, a margin of error ±5%, and accounting for a 5% non-response rate, the estimated sample size was determined to be 404. Results A total of 642 participants completed the online-based survey, but only 472 responses fit the study criteria. Most of the participants (64.6%) did not consult with a physician, i.e., practiced SM, whereas (34.5%) have visited a doctor. Furthermore, people who did not visit a doctor had the commonest belief (26.1%) that they did not need a doctor to investigate their symptoms. The awareness of SM among the general public in Makkah and Jeddah was assessed by asking whether they deem this practice harmful, harmless, or beneficial. 65.9% of the participants deemed the practice of SM as harmful, and 17.6% regarded the act as harmless. Conclusion This study revealed that 64.6% of the general public of Jeddah and Makkah practice self-medication, even though 65.9% deemed this act harmful. The contradiction between the public's opinion and the actual behavior towards self-medication implies the need for more awareness of self-medication and the importance of exploring the incentives of such behavior.
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Affiliation(s)
- Syed F Zaidi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Faculty of Eastern Medicine, Hamdard University Islamabad Campus, Islamabad, PAK
| | - Alqassem Y Hakami
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Muhammad A Khan
- Medical Education, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Adil A Khalid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ahmed K Haneef
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Safwan S Natto
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed A Mastour
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Rayan F Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
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Hamad M Alomaim L, Faleh Alnefaie A, Abdullah Alowaymir N, Saleh Alahedb NA, Omar A Alomair H, Saud M Alanazi R, Dakheel Alanazi LZ, Naif Alshalawi HA, Albrahim T. Prevalence of Self-Medication Among Female University Students During Examinations: A Cross-Sectional Study in Saudi Arabia. Cureus 2023; 15:e37269. [PMID: 37162782 PMCID: PMC10164448 DOI: 10.7759/cureus.37269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
Introduction Those who practice self-care using over-the-counter (OTC) products believe that these medications are relatively safe. They can be used to treat mild illnesses that do not require medical consultation. However, improper self-medication using OTC medicines because of inadequate knowledge of their side effects and interactions can result in drug-related issues and even death. The current study was performed using the foundation year students of Princess Nourah Bint Abdul Rahman University (PNU) as subjects, to examine the use of OTC medicines during examination times. Methods This cross-sectional study was done on 213 (response rates 87.7%) foundation-year female students in the Health Colleges at PNU in Riyadh. Using a 26-item, self-administered, online questionnaire, data were collected. Results It was found that more than 50% of the students used OTC medicines habitually during exam periods. A majority (90.6%; p< 0.0001) of the students mentioned that the overuse of Panadol Extra was very safe while 67.6% (p< 0.0001) of them declared that nonsteroidal anti-inflammatory drugs (NSAIDs) would not induce stomach ulcer formation. A higher percentage (67.6%; p<0.0001) of the students confirmed using OTC medicines during exam time for headache relief. A higher percentage (72.8%; p< 0.0001) of the students indicated that because the OTC medications were readily available and they believed these drugs were safe, they used sizable quantities during the time of the examinations. Furthermore, 69% (p< 0.0001) of the students confessed that because of a friend's recommendations, they started trying OTC medicine. Above 67% (p< 0.0001) stated that OTC medications are inexpensive and easily available in Saudi Arabia. Conclusion To conclude, the findings of this study reiterated the high usage of OTC medicines by female students during the time of examination, and the highest used were painkillers.
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Affiliation(s)
- Lama Hamad M Alomaim
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Ameera Faleh Alnefaie
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Norah Abdullah Alowaymir
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Nouf Abdulrahman Saleh Alahedb
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Hailah Omar A Alomair
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Rana Saud M Alanazi
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Lamya Zaid Dakheel Alanazi
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Haya Abdullah Naif Alshalawi
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | - Tarfa Albrahim
- College of Health and Rehabilitation Sciences, Department of Health Sciences, Clinical Nutrition, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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Ge P, Zhang ZW, Zhang JZ, Lyu K, Niu YY, Tong YT, Xiong P, Ling R, Li QY, Yu WL, Min HW, Deng YQ, Wang YJ, Sun XN, Sun XY, Yu L, Wu YB. The self-medication behaviors of residents and the factors related to the consideration of drug efficacy and safety-A cross-sectional study in China. Front Pharmacol 2023; 14:1072917. [PMID: 36925637 PMCID: PMC10011170 DOI: 10.3389/fphar.2023.1072917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background: Over-the-counter (OTC) drugs facilitates residents self-medication. However, inappropriate self-medications have become a serious problem in China and even all over the world. Objectives: To make an investigation on the current status of Chinese residents' self-medication behaviors and important considerations, and to explore the factors related to the considerations of drug efficacy and safety. Design: A quantitative, cross-sectional study. Methods: Multi-stage sampling was used to conduct a cross-sectional investigation in China 22 provinces, 5 autonomous regions and 4 municipalities directly under the Central Government. State that an interviewer-administrated questionnaire, was used for data collection. The questionnaire that was used in the investigation included demographic sociological characteristics, health literacy scale-short form (HLS-SF), the 10-item Big Five Inventory (BFI-10), the EuroQol-5D visual analogue scale (EQ-5D VAS), self-medication status and important considerations when self-medicating. Descriptive statistics were performed, and the Chi-square test was used for univariate analysis. Log-binomial regression was used for multivariate analysis on whether residents regard drug efficacy or safety as an important consideration. Results: 9256 respondents were included in the data analysis. The self-medication rate of Chinese adults was as high as 99.1%. Paracetamol and other analgesics were the most common types of OTC medication that respondents purchased, followed by vitamins/minerals. Medical staff recommendations, drug safety and efficacy were the top three important considerations. The residents in the east, central and western regions who consider safety is 63.5%, 61.5%, and 66.8% respectively. The proportion of curative effect was 60.2%, 55.7%, and 61.4% respectively. Log-binomial regression showed that western respondents, retired people, those who mainly used ways including basic medical insurance for employees, commercial medical insurance, free medical treatment to cover their medical cost, respondents with high neuroticism, high health literacy were more likely to consider drug safety as an important factor (p < 0.05). Eastern respondents, employed, main way of medical expenses borne was Out-of-pocket Payment, those with chronic disease were more likely to consider drug efficacy as an important factor (p < 0.05). Female, respondents with high levels of agreeableness, conscientiousness, openness, and self-rated health status were more likely to regard both drug safety and efficacy as important considerations (p < 0.05). Conclusion: Self-medication is practiced by most Chinese adults. Whether Chinese adults take drug efficacy or safety as an important consideration is related to their demographic and sociological characteristics, Big Five personality characteristics, health literacy and self-assessed health status. There is a need to strengthen the management of OTC drugs and public education about self-medication.
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Affiliation(s)
- Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Zi-Wei Zhang
- School of Public Health, Peking University, Beijing, China
| | - Jin-Zi Zhang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Ke Lyu
- China Medical University, Liaoning, China
| | - Yu-Yao Niu
- Department of English, Faculty of Arts and Humanities, University of Macau, Macao, China
| | - Yu-Ting Tong
- School of Public Health, Shandong University, Jinan, China
| | - Ping Xiong
- Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Rong Ling
- Jilin University School of Pharmaceutical Sciences, Jilin University, Changchun, China
| | - Qi-Yu Li
- School of Humanities and management, Jinzhou Medical University, Jinzhou, China
| | - Wen-Li Yu
- School of Foreign Languages, Weifang University of Science and Technology, Weifang, China
| | - He-Wei Min
- School of Public Health, Peking University, Beijing, China
| | - Yu-Qian Deng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yu-Jia Wang
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Xiao-Nan Sun
- School of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Xin-Ying Sun
- School of Public Health, Peking University, Beijing, China
| | - Lian Yu
- Health Care system Reform and Development Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yi-Bo Wu
- School of Public Health, Peking University, Beijing, China
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Lasota D, Mirowska-Guzel D, Goniewicz M. The Over-the-Counter Medicines Market in Poland. Int J Environ Res Public Health 2022; 19:17022. [PMID: 36554903 PMCID: PMC9779608 DOI: 10.3390/ijerph192417022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
The market of over-the-counter drugs, so-called OTC drugs, is a dynamically developing market driven primarily by self-medication. Their use does not require consultation with a physician, and the patients themselves decide to take them. The distribution of OTC medications in the pharmaceutical market in Poland is diversified. These drugs could be purchased at a pharmacy but also at a supermarket, gas station, or via the internet. The low involvement of public funds in spending on drugs, a relatively small percentage of pharmacy sales of reimbursable prescription drugs, and the difficult access to physicians or general consent to drug advertising all create ideal conditions for creating demand for these drugs. Among the European countries, Poland also has the largest share of OTC drugs in the entire pharmaceutical market, and the percentage of OTCs (without supplements) in the whole drug market in Poland continues to grow. Unfortunately, the non-pharmacy market for the sale of OTC drugs is not adequately controlled in practice, and Polish legal regulations regarding the sale of medicines outside pharmacies are among the most liberal in the European Union. However, this does not change the general attitude of consumers toward purchasing OTC drugs. In fact, further growth of the OTC drug market is forecast. Self-medication will undoubtedly play an important role in the trends which may shape this market in the coming years.
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Affiliation(s)
- Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland
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Woroń J, Chrobak AA, Ślęzak D, Siwek M. Unprescribed and unnoticed: Retrospective chart review of adverse events of interactions between antidepressants and over-the-counter drugs. Front Pharmacol 2022; 13:965432. [PMID: 36133817 PMCID: PMC9483551 DOI: 10.3389/fphar.2022.965432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Aim: To systematically evaluate prevalence and clinical characteristics of adverse effects of antidepressants and OTC drugs interactions in a retrospective chart review. Methodology: Dataset of 1,145 registered adverse events were evaluated. Reports were selected for further analysis if pharmacoepidemiological avaluation indicated the presence of high probability of a causal relationship between antidepressants and OTC interaction and the occurrence of side effect. Following variables were extracted from the records: sex, age, medical comorbidities, antidepressant and other concomitant medications, clinical consequences ant the possible interaction mechanisms. Results: 368 showed causal relationship with the simultaneous use of antidepressant with another drug. 15 adverse events (4%) were related to the use of OTC medicine, particularly omeprazole, diphenhydramine, Japanese ginkgo biloba, ibuprofen, diclofenac and sildenafil. All of the analysed side effects were categorized as the result of pharmacokinetic interactions. Here we report identified OTC drugs with corresponding antidepressants and clinical manifestations of DDI. Omeprazole: agomelatine (nausea, abnormal dreams), fluoxetine (extrapyramidal symptoms, paresthesias), sertraline (vertigo, yawning), escitalopram (oral vesiculation). Diphenhydramine: sertraline (diaphoresis, insomnia, vertigo), paroxetine (pruritus, headache), duloxetine (oropharyngeal pain). Japanese ginkgo biloba: citalopram (bradycardia), trazodone (vertigo, taste pervesion), mianserine (restless legs syndrome). Diclofenac: escitalopram (oral vesiculation), and fluoxetine (restless legs syndrome). Ibuprofen: agomelatine (anxiety and nausea), sertraline and omeprazole (QTc prolongation). Sildenafil: fluoxetine (genital oedema) and sertraline (myocardial infarction). Conclusion: The use of OTC drugs by the patients should be monitored. Pharmacokinetic interactions between nonprescribed medicines and antidepressants may increase concentration and severity of side effects of latter ones.
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Affiliation(s)
- Jarosław Woroń
- Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Department of Anesthesiology and Intensive Care No. 1, Department of Internal Medicine and Geriatrics, University Hospital in Cracow, Kraków, Poland.,University Center for Monitoring and Research on Adverse Drug Effects in Krakow, Kraków, Poland
| | - Adrian Andrzej Chrobak
- Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Daniel Ślęzak
- Division of Medical Rescue, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
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Debus JL, Bachmann P, Frahm N, Mashhadiakbar P, Langhorst SE, Streckenbach B, Baldt J, Heidler F, Hecker M, Zettl UK. Associated factors of potential drug-drug interactions and drug-food interactions in patients with multiple sclerosis. Ther Adv Chronic Dis 2022; 13:20406223221108391. [PMID: 35959503 PMCID: PMC9358348 DOI: 10.1177/20406223221108391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the most common immune-mediated demyelinating
disease in younger adults. Patients with MS (PwMS) are vulnerable to the
presence of potential drug–drug interactions (pDDIs) and potential drug–food
interactions (pDFIs) as they take numerous medications to treat MS,
associated symptoms and comorbidities. Knowledge about pDDIs and pDFIs can
increase treatment success and reduce side effects. Objective: We aimed at determining the frequency and severity of pDDIs and pDFIs in
PwMS, with regard to polypharmacy. Methods: In the cross-sectional study, we analysed pDDIs and pDFIs of 627 PwMS aged
⩾18 years. Data collection was performed through patient record reviews,
clinical examinations and structured patient interviews. pDDIs and pDFIs
were identified using two DDI databases: Drugs.com Interactions Checker and
Stockley’s Interactions Checker. Results: We identified 2587 pDDIs (counted with repetitions). Of 627 PwMS, 408 (65.1%)
had ⩾ 1 pDDI. Polypharmacy (concomitant use of ⩾ 5 drugs) was found for 334
patients (53.3%). Patients with polypharmacy (Pw/P) were found to have a
15-fold higher likelihood of having ⩾ 1 severe pDDI compared with patients
without polypharmacy (Pw/oP) (OR: 14.920, p < 0.001).
The most frequently recorded severe pDDI was between citalopram and
fingolimod. Regarding pDFIs, ibuprofen and alcohol was the most frequent
severe pDFI. Conclusion: Pw/P were particularly at risk of severe pDDIs. Age and educational level
were found to be factors associated with the occurrence of pDDIs,
independent of the number of medications taken. Screening for pDDIs/pDFIs
should be routinely done by the clinical physician to increase drug safety
and reduce side effects.
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Affiliation(s)
- Jane Louisa Debus
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Paula Bachmann
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Niklas Frahm
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Pegah Mashhadiakbar
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Silvan Elias Langhorst
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Barbara Streckenbach
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany; Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Julia Baldt
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany; Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Felicita Heidler
- Department for Neurology, Ecumenic Hainich Hospital gGmbH, Mühlhausen, Germany
| | - Michael Hecker
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Uwe Klaus Zettl
- Neuroimmunology Section, Department of Neurology, Rostock University Medical Centre, Rostock, Germany
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Wakamiya S, Morimoto O, Omichi K, Hara H, Kawase I, Koshiba R, Aramaki E. Exploring Relationships Between Tweet Numbers and Over-the-counter Drug Sales for Allergic Rhinitis: Retrospective Analysis. JMIR Form Res 2022; 6:e33941. [PMID: 35107434 PMCID: PMC8851323 DOI: 10.2196/33941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health-related social media data are increasingly being used in disease surveillance studies. In particular, surveillance of infectious diseases such as influenza has demonstrated high correlations between the number of social media posts mentioning the disease and the number of patients who went to the hospital and were diagnosed with the disease. However, the prevalence of some diseases, such as allergic rhinitis, cannot be estimated based on the number of patients alone. Specifically, individuals with allergic rhinitis typically self-medicate by taking over-the-counter (OTC) medications without going to the hospital. Although allergic rhinitis is not a life-threatening disease, it represents a major social problem because it reduces people's quality of life, making it essential to understand its prevalence and people's motives for self-medication behavior. OBJECTIVE This study aims to explore the relationship between the number of social media posts mentioning the main symptoms of allergic rhinitis and the sales volume of OTC rhinitis medications in Japan. METHODS We collected tweets over 4 years (from 2017 to 2020) that included keywords corresponding to the main nasal symptoms of allergic rhinitis: "sneezing," "runny nose," and "stuffy nose." We also obtained the sales volume of OTC drugs, including oral medications and nasal sprays, for the same period. We then calculated the Pearson correlation coefficient between time series data on the number of tweets per week and time series data on the sales volume of OTC drugs per week. RESULTS The results showed a much higher correlation (r=0.8432) between the time series data on the number of tweets mentioning "stuffy nose" and the time series data on the sales volume of nasal sprays than for the other two symptoms. There was also a high correlation (r=0.9317) between the seasonal components of these time series data. CONCLUSIONS We investigated the relationships between social media data and behavioral patterns, such as OTC drug sales volume. Exploring these relationships can help us understand the prevalence of allergic rhinitis and the motives for self-care treatment using social media data, which would be useful as a marketing indicator to reduce the number of out-of-stocks in stores, provide (sell) rhinitis medicines to consumers in a stable manner, and reduce the loss of sales opportunities. In the future, in-depth investigations are required to estimate sales volume using social media data, and future research could investigate other diseases and countries.
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Affiliation(s)
- Shoko Wakamiya
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara, Japan
| | | | | | | | | | | | - Eiji Aramaki
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara, Japan
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10
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Moura ML, Boszczowski I, Blaque M, Mussarelli RM, Fossaluza V, Pierrotti LC, Campana G, Brandileone MC, Zanella R, Almeida SCG, Levin AS. Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil. Emerg Infect Dis 2022; 28:180-187. [PMID: 34932455 PMCID: PMC8714220 DOI: 10.3201/eid2801.201928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although restricting over-the-counter (OTC) antimicrobial drug sales is recommended globally, no data track its effect on antimicrobial resistance (AMR) in bacteria. We evaluated the effect of a national policy restricting OTC antimicrobial sales, put in place in November 2010, on AMR in a metropolitan region of São Paulo, Brazil. We reviewed associations between antimicrobial sales from private pharmacies and AMR in 404,558 Escherichia coli and 5,797 Streptococcus pneumoniae isolates using a dynamic regression model based on a Bayesian approach. After policy implementation, a substantial drop in AMR in both bacterial species followed decreased amoxicillin and trimethoprim/sulfamethoxazole sales. Conversely, increased ciprofloxacin sales were associated with increased ciprofloxacin resistance, and extended spectrum β-lactamases-positive E. coli isolates and azithromycin sales increases after 2013 were associated with increased erythromycin resistance in S. pneumoniae isolates. These findings suggest that restricting OTC antimicrobial sales may influence patterns of AMR, but multifaceted approaches are needed to avoid unintended consequences.
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11
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Elrggal ME, Alamer SI, Alkahtani SA, Alshrahili MA, Alharbi A, Alghamdi BA, Zaitoun MF. Dispensing Practices for Weight Management Products in Eastern Saudi Arabia: A Survey of Community Pharmacists. Int J Environ Res Public Health 2021; 18:ijerph182413146. [PMID: 34948755 PMCID: PMC8700952 DOI: 10.3390/ijerph182413146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/03/2022]
Abstract
Due to changing lifestyles and socioeconomic status, obesity prevalence has been rising in Saudi Arabia, and community pharmacists often counsel patients about its management. The study aimed to evaluate practices of community pharmacists involved in dispensing products for weight control in four cities located in the eastern province of Saudi Arabia. A cross-sectional study was conducted involving community pharmacists in Dammam, Dhahran, Khobar, and Al-Ahsa, using a Likert format questionnaire. Only those who consented to participate were handed the questionnaire. A total of 100 complete responses were analyzed. The median value for packs sold per month for tea containing products Al-Diafa Slimming Tea, Jamue Tea, and Green Tea was ≥6 while the same for orlistat and apple cider vinegar were ≤4. Moreover, >50% of pharmacists mentioned that orlistat and apple cider vinegar were effective while ≥35% mentioned that metformin and Jamue tea were effective. Furthermore, ≥25% mentioned that green tea and Al-Diafa slimming tea were effective. Excluding orlistat, >50% of pharmacists did not know about adverse effects for other products. The rate of dispensing of several weight loss products was significant for participants’ background characteristics, such as time duration of consultation, gender, and age of patients, and pharmacist work experience (p < 0.05). The tea products and orlistat were the most frequently sold products, and community pharmacists appeared most knowledgeable about the effectiveness and adverse effect of orlistat. The pharmacists seemed to be aware about the effectiveness of other weight loss products; however, their knowledge about their potential adverse effects was unsatisfactory.
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Affiliation(s)
- Mahmoud E. Elrggal
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.A.)
| | - Sarah Ibrahim Alamer
- Pharmacy Practice Department, College of Clinical Pharmacy, King Faisal University, Al Hofuf 31982, Saudi Arabia;
| | - Saad A. Alkahtani
- Clinical Pharmacy Department, College of Pharmacy, Najran University, Najran 55461, Saudi Arabia;
| | | | - Adnan Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.A.)
| | - Bayan Ali Alghamdi
- Pharmaceutical Care Administration, Armed Forces Hospitals Southern Region, Khamis Mushait 61961, Saudi Arabia;
| | - Mohammad Fathullah Zaitoun
- Pharmaceutical Care Administration, Armed Forces Hospitals Southern Region, Khamis Mushait 61961, Saudi Arabia;
- Correspondence:
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12
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Lee M, Kim K, Rhew K, Choi KH. A Knowledge, Attitude, and Practice Survey on Medication Safety in Korean Older Adults: An Analysis of an Ageing Society. Healthcare (Basel) 2021; 9:1365. [PMID: 34683048 DOI: 10.3390/healthcare9101365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/01/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Older adults have certain limitations in acquiring and understanding information regarding medication safety. This study surveyed their medication habits and analysed the importance of relevant education to improve knowledge, attitudes, and practice (KAP). Methods: Our survey included adults aged 65 years or older. We developed a questionnaire on medication safety based on the KAP model. To identify the interrelationships among KAP, we calculated the correlation coefficients using Pearson’s correlation analysis. A t-test was performed to verify the differences in KAP associated with the respondents’ medication safety education experience. Results: We found that 79.4% of respondents self-administered their medications. Of the respondents, 28.2% had received medication safety education. Overall, the respondents had typical levels of knowledge, attitude responses, and behavioural practices associated with medication safety. The results showed significant differences between knowledge and practice; those who were educated on medication safety performed higher levels of safe practice than those who were not (p < 0.05). Conclusion: The KAP survey confirmed that knowledge about the safe use of medication positively affected older adults’ attitudes and practices. To improve their medication usage habits, older adults should receive well-organised medication safety education.
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Mannasaheb BA, Al-Yamani MJ, Alajlan SA, Alqahtani LM, Alsuhimi SE, Almuzaini RI, Albaqawi AF, Alshareef ZM. Knowledge, Attitude, Practices and Viewpoints of Undergraduate University Students towards Self-Medication: An Institution-Based Study in Riyadh. Int J Environ Res Public Health 2021; 18:8545. [PMID: 34444294 PMCID: PMC8394125 DOI: 10.3390/ijerph18168545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
Rational and responsible self-medication (SM) is not only the key to better health outcomes, but also key to limiting adverse drug events. This institution-based cross-sectional study utilized seven- and four-item scales to assess the knowledge and attitude towards SM. Similarly, SM practices were measured using eight scale questions consisting of SM practice during the last six months, type of drug consumed, reason and frequency of SM, and so on. Statistical analyses were performed using SPSS. Overall, 371 students completed the questionnaire. The students with a good level of knowledge and positive attitude towards SM were 60.64% and 66.8%, respectively. About 55.5% of students practiced SM during the last six months using antipyretics (37.7%), multivitamins (36.4%), sleeping aids (20.2%), and anti-histamines (18.6%). Headache (79.2%), fever (37.7%), pain (25.9%), and colds and coughs (25.3%) were the illnesses for which they sought SM. The students admitted that drug side effects (75%), drug resistance (33.7%), drug interaction (41.5%), and poor treatment outcome (28.3%) were the consequences of irrational SM practice. Students (87.6%) propose that extending SM awareness through the Ministry of Health (83%) and pharmaceutical companies (48%) as major platforms would improvise the rational practice. Since AlMaarefa University students will be future healthcare professionals, their perception must be considered and accordingly educated to practice rational SM.
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Affiliation(s)
| | - Mohammed Jaber Al-Yamani
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia;
| | - Sarah Abdulrahman Alajlan
- College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia; (S.A.A.); (L.M.A.); (S.E.A.); (R.I.A.); (A.F.A.); (Z.M.A.)
| | - Lamyaa Munahi Alqahtani
- College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia; (S.A.A.); (L.M.A.); (S.E.A.); (R.I.A.); (A.F.A.); (Z.M.A.)
| | - Shrouq Eid Alsuhimi
- College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia; (S.A.A.); (L.M.A.); (S.E.A.); (R.I.A.); (A.F.A.); (Z.M.A.)
| | - Razan Ibrahim Almuzaini
- College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia; (S.A.A.); (L.M.A.); (S.E.A.); (R.I.A.); (A.F.A.); (Z.M.A.)
| | - Abeer Fahad Albaqawi
- College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia; (S.A.A.); (L.M.A.); (S.E.A.); (R.I.A.); (A.F.A.); (Z.M.A.)
| | - Zahaa Majed Alshareef
- College of Pharmacy, AlMaarefa University, Riyadh 13713, Saudi Arabia; (S.A.A.); (L.M.A.); (S.E.A.); (R.I.A.); (A.F.A.); (Z.M.A.)
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Cravo AS, Shephard A, Shea T. Efficacy of Triprolidine in the Treatment of Temporary Sleep Disturbance. J Clin Pharmacol 2021; 61:1156-1164. [PMID: 33768603 DOI: 10.1002/jcph.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/19/2021] [Indexed: 11/06/2022]
Abstract
Triprolidine, a first-generation antihistamine for allergic rhinitis, has a shorter half-life and fewer persistent effects relative to other antihistamines and may be useful in the treatment of temporary sleep disturbance. Patients aged ≥18 years old were randomized 1:1:1 to receive either triprolidine 2.5 mg (n = 65), triprolidine 5 mg (n = 66), or placebo (n = 67) on 3 consecutive nights. Sleep disturbance index was monitored via wrist actimeter. Subjective measures were assessed via diary card. Triprolidine 2.5 mg had a significantly lower sleep disturbance index versus placebo on night 1 (P = .02); however, when adjusted for outliers, sleep disturbance index did not significantly differ between either dose of triprolidine versus placebo on night 1. Adjusted sleep disturbance index was significantly lower with triprolidine 2.5 and 5 mg versus placebo on night 3 (P = .0017 and P = .011, respectively) and for the mean of all 3 nights (P = .01 and P = .015, respectively). Sleep latency was significantly improved for triprolidine 2.5 mg versus placebo on nights 2 and 3 and for the mean of all 3 nights and for triprolidine 5 mg versus placebo for the mean of all 3 nights. Subjective measures showed those on both doses of triprolidine felt more refreshed on awakening versus placebo for the mean of all 3 nights, with no increase in daytime sleepiness. The frequency of adverse events was similar across groups. The optimum dose of triprolidine for treatment of temporary sleep disturbance was 2.5 mg. There were improvements in both objective and subjective measures of sleep quality versus placebo, with no safety concerns raised.
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Affiliation(s)
- Ana Santos Cravo
- Global Medical Affairs Senior Advisor (Respiratory), Reckitt Benckiser Healthcare Ltd, Slough, UK
| | - Adrian Shephard
- Global Marketing Director, Reckitt Benckiser Healthcare Ltd, Slough, UK
| | - Tim Shea
- Senior Medical Scientist (Respiratory), Reckitt Benckiser Inc., Parsippany, New Jersey, USA
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Branco SEMT, Mattoso CRS, Botelho AFM, Soto-Blanco B, Melo MM. Intravenous lipid emulsion treatment in rabbits with ivermectin toxicosis. J Vet Emerg Crit Care (San Antonio) 2021; 31:340-350. [PMID: 33709617 DOI: 10.1111/vec.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/17/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect and safety of IV lipid emulsion in rabbits with acute ivermectin toxicosis. DESIGN Randomized controlled trial. SETTING University research facility. ANIMALS Twenty-four healthy male adult New Zealand rabbits. INTERVENTIONS Three groups of rabbits (IV, IV_RL, and IV_LE) received 80 mg/kg of ivermectin (8 mL/kg) through a nasogastric tube, and 1 group (LE) received an equivalent volume (8 mL/kg) of 0.9% sodium chloride. Group IV_RL was treated with Ringer's lactate (2 mL/kg bolus, followed by 0.25 mL/kg/min for 60 minutes), whereas groups IV_LE and LE received 20% lipid emulsion. The rabbits were submitted to clinical and neurological evaluation, and blood samples were collected for biochemical analysis. All animals were euthanized, and tissue samples were collected and processed for histopathological evaluation and ivermectin quantification. MEASUREMENTS AND MAIN RESULTS All animals exposed to ivermectin manifested clinical changes consistent with toxicosis, but the ones that received IV lipid emulsion infusion showed no significant clinical improvement. Intense increase in serum glucose and triglyceride concentrations was seen after ivermectin exposure, along with increased urea and creatinine concentrations, but the last 2 remained within the reference range. Lipid emulsion caused an intense increase in triglycerides and cholesterol concentrations. No pathological abnormalities were seen in the organs sampled. Toxicological analysis showed greater ivermectin concentration in adipose tissue and liver, followed by kidney and, finally, brain. The treatments did not change ivermectin tissue concentration. CONCLUSIONS When given to rabbits intoxicated with ivermectin, IV lipid emulsion was biochemically and histologically safe but was not effective in treating, delaying, or reversing clinical signs and progression, nor did it alter ivermectin tissue concentration.
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Affiliation(s)
| | | | | | - Benito Soto-Blanco
- Toxicology Laboratory, Veterinary School of the Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marília Martins Melo
- Toxicology Laboratory, Veterinary School of the Federal University of Minas Gerais, Belo Horizonte, Brazil
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Al-Ghamdi S, Alfauri TM, Alharbi MA, Alsaihati MM, Alshaykh MM, Alharbi AA, Aljaizani NS, Allehiby IA, Alzahrani MA, Alharbi AS. Current self-medication practices in the Kingdom of Saudi Arabia: an observational study. Pan Afr Med J 2020; 37:51. [PMID: 33209178 PMCID: PMC7648480 DOI: 10.11604/pamj.2020.37.51.24098] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/23/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction medication without prescription is a growing public health concern or phenomenon worldwide. This cross-sectional study was designed to study the trends of self-medication among Saudi population. Methods a prospective, cross-sectional study including 2004 participants was carried out from different family clinics across the Kingdom of Saudi Arabia (KSA). The clinicians used a self-designed questionnaire to collect the data, using stringent inclusion criteria and exclusion criteria. The questionnaire recorded participants' demographics and included several closed-ended and open-ended questions with options to choose from. The results were gathered, inserted into an excel spreadsheet and analyzed using SPSS version 23. The analyzed information was presented as frequencies and percentages. Results our research showed that 924 respondents (46.1%) found it difficult to reach a hospital. Another 45.2% considered the inefficiency of health centers in providing necessary care as the main reason for self-medication. Other causes of self-medication included a lack of medical insurance, insurance not covering the costs for the drugs, and symptoms of the disease being mild enough for not going to the hospital. Analgesics were the most commonly self-administered drugs (84.58%), followed by antipyretics (71.26%), cough syrups (46.86%), eye drops (35.98%), antibiotics (35.28%), flu medication (32.83%), heartburn medication (23.15%), medicines for joint pain (15.02%), and so on. Conclusion the majority of Saudi Arabians engage in self-medication and rely on advice from friends and family most of the time, instead of consulting a health professional.
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Affiliation(s)
- Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj11942,Al-Kharj, Saudi Arabia
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Sobczak Ł, Goryński K. Pharmacological Aspects of Over-the-Counter Opioid Drugs Misuse. Molecules 2020; 25:E3905. [PMID: 32867117 DOI: 10.3390/molecules25173905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Several over-the-counter (OTC) drugs are known to be misused. Among them are opioids such as codeine, dihydrocodeine, and loperamide. This work elucidates their pharmacology, interactions, safety profiles, and how pharmacology is being manipulated to misuse these common medications, with the aim to expand on the subject outlined by the authors focusing on abuse prevention and prevalence rates. The reviewed literature was identified in several online databases through searches conducted with phrases created by combining the international non-proprietary names of the drugs with terms related to drug misuse. The results show that OTC opioids are misused as an alternative for illicit narcotics, or prescription-only opioids. The potency of codeine and loperamide is strongly dependent on the individual enzymatic activity of CYP2D6 and CYP3A4, as well as P-glycoprotein function. Codeine can also be utilized as a substrate for clandestine syntheses of more potent drugs of abuse, namely desomorphine (“Krokodil”), and morphine. The dangerous methods used to prepare these substances can result in poisoning from toxic chemicals and impurities originating from the synthesis procedure. OTC opioids are generally safe when consumed in accordance with medical guidelines. However, the intake of supratherapeutic amounts of these substances may reveal surprising traits of common medications.
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18
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Moura A, Barros PP. Entry and price competition in the over-the-counter drug market after deregulation: Evidence from Portugal. Health Econ 2020; 29:865-877. [PMID: 32515019 PMCID: PMC7384133 DOI: 10.1002/hec.4109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/04/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
In the last two decades, many European countries allowed the sale of over-the-counter (OTC) drugs outside pharmacies. This was expected to lower retail prices through increased competition. Evidence of such price reductions is scarce. We assess the impact of supermarket and outlet entry in the OTC drug market on OTC prices charged by incumbent pharmacies using a difference-in-differences strategy. We use price data on five popular OTC drugs for all retailers located in Lisbon for three distinct points in time (2006, 2010, and 2015). Our results suggest that competitive pressure in the market is mainly exerted by supermarkets, which charge, on average, 20% lower prices than pharmacies. The entry of a supermarket among the main competitors of an incumbent pharmacy is associated with an average 4% to 6% decrease in prices relative to the control group. These price reductions are long-lasting but fairly localized. We find no evidence of price reductions following OTC outlet entry. Additional results from a reduced-form entry model and a propensity score matching difference-in-differences approach support the view that these effects are causal.
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Affiliation(s)
- Ana Moura
- Department of Econometrics and Operations ResearchTilburg UniversityTilburgNetherlands
| | - Pedro Pita Barros
- Nova School of Business and EconomicsUniversidade Nova de LisboaLisbonPortugal
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Volqvartz T, Vestergaard AL, Aagaard SK, Andreasen MF, Lesnikova I, Uldbjerg N, Larsen A, Bor P. Use of stimulants, over-the-counter and prescription drugs among Danish pregnant women. Basic Clin Pharmacol Toxicol 2020; 127:205-210. [PMID: 32058678 DOI: 10.1111/bcpt.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/29/2022]
Abstract
Using self-reports and blood samples from 225 unselected Danish first trimester pregnant women, the purpose of this study was to assess their use of stimulants, for example caffeine and nicotine as well as over-the-counter (OTC) and prescription drugs. According to self-reported information, 24% had used prescription drugs and 48% had used OTC drugs mainly acetaminophen (42%), 9.3% were habitual smokers, 44% stated a daily use of caffeinated beverages, and 1.3% used illegal drugs. Ultra-performance liquid chromatography with high-resolution time-of-flight mass spectrometry (UPLC-HR-TOFMS) analysis was performed on corresponding blood samples applying golden standards for use of UPLC-HR-TOFMS in forensic medicine. Traces of prescription drugs were detected in 5.3% of the samples and 8.9% contained OTC drugs (acetaminophen 7.1%). Traces of smoking were identified in 8.0%, caffeine in 83% and illegal drugs in 0.9%. These results indicate a substantial use of OTC drugs and caffeine among Danish pregnant women. Blood analysis indicated that many women could be unaware of their caffeine intake. As common substances may be associated with adverse pregnancy outcomes, healthcare professionals should inquire about such habits during pregnancy. The results also underline the need for more research into the molecular effects of such drugs on placental function and foetal development.
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Affiliation(s)
- Tabia Volqvartz
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.,Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
| | - Anna Louise Vestergaard
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.,Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
| | - Sissel K Aagaard
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.,Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
| | - Mette F Andreasen
- Section for Forensic Chemistry, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - Iana Lesnikova
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Niels Uldbjerg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnete Larsen
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark
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Niwandinda F, Lukyamuzi EJ, Ainebyona C, Ssebunya VN, Murungi G, Atukunda EC. Patterns and Practices of Self-Medication Among Students Enrolled at Mbarara University of Science and Technology in Uganda. Integr Pharm Res Pract 2020; 9:41-48. [PMID: 32104665 PMCID: PMC7025657 DOI: 10.2147/iprp.s237940] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/31/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Self-medication is drug use without advice from a medical professional. Proper self-medication can reduce health expenses and physician waiting time. However, prescription or over-the-counter drugs are considered unsafe when used irrationally. Presumably, university students can make informed decisions regarding their lives. However, there are limited studies documenting self-medication in Ugandan universities. This study sought to document the prevalence, patterns and factors associated with self-medication among students enrolled at Mbarara University of Science and Technology (MUST). Patients and Methods A descriptive cross-sectional study was done on 385 medical and non-medical students. Data were collected by interviewer-led semi-structured questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS) version 20. The statistical significance was considered as p < 0.05 for both univariate and multivariate analyses. Results This study showed a 63.5% prevalence of self-medication. Self-medication reasons were classifying illnesses as minor (33%), time-saving (15%), having old prescriptions (11%) and high consultation fees (9%). Not self-medicating reasons included risk of using wrong drugs (19%), insufficient knowledge (17%), fear of side effects (15%), wrong drug use (15%) and misdiagnosis (14%). Respondents accessed drugs from pharmacies (56%), friends/family (17%) or private clinics (15%). Headache relievers, pain relievers and antibiotics were most commonly self-medicated. In adjusted analysis, being female, existing allergies, and being in advanced years of study were associated with increased odds of self-medication. No statistically significant difference existed between medical and non-medical students regarding self-medication. Self-medication likelihood increased with a lack of access to medical services. Conclusion There is a high rate of self-medication amongst female students, those in advanced years of study and those with existing allergies. Medical services access significantly reduced the chances of self-medication. Vital medical services need to be extended to the university students to receive information on medicines, diagnosis, prescription and treatment. More studies should evaluate the impact of a high rate of self-medication among these students.
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Affiliation(s)
- Faith Niwandinda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edward John Lukyamuzi
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Calvin Ainebyona
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Godwin Murungi
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Esther C Atukunda
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
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Kantar A, Klimek L, Cazan D, Sperl A, Sent U, Mesquita M. An overview of efficacy and safety of ambroxol for the treatment of acute and chronic respiratory diseases with a special regard to children. Multidiscip Respir Med 2020; 15:511. [PMID: 32269775 PMCID: PMC7137760 DOI: 10.4081/mrm.2020.511] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/14/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Ambroxol (2-amino-3,5-dibromo-N-[trans-4-hydroxycyclohexyl]benzylamine), an over-the-counter product, is a mucoactive agent and has been used widely to treat both acute and chronic respiratory diseases since 1978. This review aims to provide an overview of the clinical evidence available on the use of ambroxol in children with acute and chronic respiratory diseases. Data for this review were obtained from both published and unpublished clinical studies, and real-world evidence studies. Although conducted prior to the introduction of Good Clinical Practice (GCP), these studies, representing almost 1,300 pediatric patients, report strong clinical outcomes following the use of ambroxol in pediatric patients. Furthermore, efficacy findings were consistent irrespective of age, including for patients as young as 1 month old. Additionally, the majority of studies found ambroxol to be well tolerated in children. Taken together, the clinical evidence for ambroxol shows treatment effects that offer significant benefits to pediatric patients for its licensed use as a secretolytic therapy in acute and chronic bronchopulmonary disorders associated with abnormal mucus secretion and impaired mucus transport. The findings from this review indicate that ambroxol, for its intended over-the-counter indications, is both efficacious and well tolerated in children and that the favorable benefit/risk profile of ambroxol reported in adults extends to the pediatric population, starting from early infancy, with acute and chronic respiratory diseases.
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Affiliation(s)
- Ahmad Kantar
- Pediatric Cough and Asthma Center, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy
| | - Ludger Klimek
- Wiesbaden Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Dorotheea Cazan
- Maria Hilf Kliniken, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Aachen, Mönchengladbach, Germany
| | - Annette Sperl
- Wiesbaden Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Ulrike Sent
- Medical Advisor CHC GSA, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Margarida Mesquita
- Global Medical Lead CHC, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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22
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Simundic AM, Filipi P, Vrtaric A, Miler M, Nikolac Gabaj N, Kocsis A, Avram S, Gligorovic Barhanovic N, Bulo A, Cadamuro J, van Dongen-Lases E, Eker P, Vital-E-Silva A, Homsak E, Ibarz M, Labudovic D, Nybo M, Pivovarníková H, Shmidt I, Siodmiak J, Sumarac Z, Vitkus D. Patient's knowledge and awareness about the effect of the over-the-counter (OTC) drugs and dietary supplements on laboratory test results: a survey in 18 European countries. Clin Chem Lab Med 2019; 57:183-194. [PMID: 30055099 DOI: 10.1515/cclm-2018-0579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 12/19/2022]
Abstract
Background Nowadays over-the-counter (OTC) drugs and dietary supplements are widely used. Their use can have a significant impact on the validity of laboratory results. The aim of this multicenter European study was to determine the frequency of consumption of various dietary products and OTC drugs among patients and explore their level of knowledge and awareness about the potential impact of various products on laboratory test results. Methods Eighteen European countries participated in this study. The survey was carried out anonymously on a subsequent series of outpatients (n=200) in each participating country. Included were patients who were referred to the laboratory for blood sampling and who voluntarily agreed to participate in the study. The survey included questions about the frequency of consumption of various products, awareness of the importance of informing physicians and laboratory staff about it and information about influence of preanalytical factors in general on laboratory test results. Results In total, 68% of patients were regularly taking at least one OTC drug or dietary supplement. The frequency of patients consuming at least one OTC drug or dietary supplement differed between countries (p=0.001). Vitamins (38%), minerals (34%), cranberry juice (20%), acetylsalicylic acid (ASA) (17%) and omega fatty acids (17%) were the most commonly used in our study. Conclusions The use of various OTC drugs and dietary supplements is highly prevalent in Europe and patients are often not willing to disclose this information to the laboratory staff and ordering physician. The education of both patients and healthcare staff is needed.
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Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital Sveti Duh, Zagreb, Croatia, E-mail:
| | - Petra Filipi
- Department of Medical Laboratory Diagnostics, University Hospital Centre Split, Split, Croatia
| | - Alen Vrtaric
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Marijana Miler
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Andrea Kocsis
- Department of Laboratory Diagnostics, Jósa University Hospital, Mátészalka, Fehérgyarmat, Nyírbátor, Hungary
| | - Sanja Avram
- Department for Laboratory Diagnostics, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | | | - Anyla Bulo
- Laboratory Department, Clinical Biochemistry Laboratory, University Hospital Center "Mother Teresa", University of Medicine, Tirana, Albania
| | - Janne Cadamuro
- Department of Laboratory Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | | | - Pinar Eker
- Umraniye Research and Training Hospital, Istanbul, Turkey
| | | | - Evgenija Homsak
- Department for Laboratory Diagnostics, University Clinical Centre Maribor, Maribor, Slovenia
| | - Mercedes Ibarz
- Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Danica Labudovic
- Department of ME Biochemistry, School of Medicine, SsCyril and Methodius University in Skopje, Skopje, Macedonia
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Hedviga Pivovarníková
- synlab slovakia s.r.o. Prešov, Private Diagnostic Laboratory, Hospital Jan Adam Reiman, Prešov, Slovakia
| | - Inna Shmidt
- Clinical Diagnostic Laboratory, Clinical Hospital Saint Luke, Saint Petersburg, Russia
| | - Joanna Siodmiak
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Zorica Sumarac
- Policlinic Laboratory Diagnostics Department, Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Dalius Vitkus
- Institute of Biomedical Sciences, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Demir K, Döneray H, Kara C, Atay Z, Çetinkaya S, Çayır A, Anık A, Eren E, Uçaktürk A, Can Yılmaz G, Törel Ergür A, Kendirci M, Aycan Z, Bereket A, Aydın M, Orbak Z, Özkan B. Comparison of Treatment Regimens in Management of Severe Hypercalcemia Due to Vitamin D Intoxication in Children. J Clin Res Pediatr Endocrinol 2019; 11:140-148. [PMID: 30396880 PMCID: PMC6571531 DOI: 10.4274/jcrpe.galenos.2018.2018.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE No large study has been conducted to date to compare the effectiveness of prednisolone, alendronate and pamidronate as first-line treatment in children with hypercalcemia due to vitamin D intoxication. The aim was to perform a multicenter, retrospective study assessing clinical characteristics and treatment results. METHODS A standard questionnaire was uploaded to an online national database system to collect data on children with hypercalcemia (serum calcium level >10.5 mg/dL) due to vitamin D intoxication [serum 25-hydroxyvitamin D (25(OH)D) level >150 ng/mL] who were treated in pediatric endocrinology clinics. RESULTS Seventy-four children [median (range) age 1.06 (0.65-1.60) years, 45 males (61%) from 11 centers] were included. High-dose vitamin D intake was evident in 77% of the cases. At diagnosis, serum calcium, phosphorus, alkaline phosphatase, 25(OH)D and parathyroid hormone concentrations were 15±3.2 mg/dL, 5.2±1.2 mg/dL, 268±132 IU/L, 322 (236-454) ng/mL, and 5.5 (3-10.5) pg/mL, respectively. Calcium levels showed moderate correlation with 25(OH)D levels (rs=0.402, p<0.001). Patients were designated into five groups according to the initial specific treatment regimens (hydration-only, prednisolone, alendronate, pamidronate, and combination). Need for another type of specific drug treatment was higher in children who initially received prednisolone (p<0.001). Recurrence rate of hypercalcemia was significantly lower in children who were treated with pamidronate (p=0.02). CONCLUSION Prednisolone is less effective in the treatment of children with severe hypercalcaemia secondary to vitamin D intoxication and timely implementation of other treatment regimens should be considered.
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Affiliation(s)
- Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Hakan Döneray
- Atatürk University Faculty of Medicine, Department of Children’s Health and Disease, Erzurum, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Children’s Health and Disease, Samsun, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Semra Çetinkaya
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease, Health Implementation and Research Center, Ankara, Turkey
| | - Atilla Çayır
- Erzurum State Training and Research Hospital, Clinic of Pediatric Endocrinology, Erzurum, Turkey
| | - Ahmet Anık
- Adnan Menderes University Faculty of Medicine, Department of Children’s Health and Disease, Aydın, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Ahmet Uçaktürk
- Ankara Children’s Hematology and Oncology Training Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Gülay Can Yılmaz
- Ondokuz Mayıs University Faculty of Medicine, Department of Children’s Health and Disease, Samsun, Turkey
| | - Ayça Törel Ergür
- Kırıkkale University Faculty of Medicine, Department of Children’s Health and Disease, Kırıkkale, Turkey
| | - Mustafa Kendirci
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Zehra Aycan
- University of Health Sciences, Dr. Sami Ulus Obstetrics and Gynecology, Children’s Health and Disease, Health Implementation and Research Center, Ankara, Turkey,Yıldırım Beyazıt University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University Faculty of Medicine, Department of Children’s Health and Disease, Samsun, Turkey
| | - Zerrin Orbak
- Atatürk University Faculty of Medicine, Department of Children’s Health and Disease, Erzurum, Turkey
| | - Behzat Özkan
- University of Health Sciences Dr. Behçet Uz Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: University of Health Sciences Dr. Behçet Uz Children’s Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 411 60 00 E-mail:
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Fingleton N, Duncan E, Watson M, Matheson C. Specialist Clinicians' Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory. Pharmacy (Basel) 2019; 7:E25. [PMID: 30841493 PMCID: PMC6473901 DOI: 10.3390/pharmacy7010025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/28/2019] [Indexed: 12/01/2022] Open
Abstract
The aim of the study was to establish how non-prescription medicine (NPM) dependence is treated by doctors in specialist substance misuse treatment services and to identify perceived barriers to providing treatment. An online survey was conducted to establish current practice and whether changes to service provision are needed to facilitate treatment (n = 83). Semi-structured interviews, based on the Theoretical Domains Framework, were conducted to derive a detailed exploration of suggested changes (n = 11). Most survey respondents had encountered cases of NPM dependence. Analgesics containing codeine were the most frequently NPMs of dependence mentioned by respondents. Most respondents were unaware of specific guidelines for the treatment of NPM dependence. The most frequently identified barriers to providing treatment identified by interviewees were limited resources or capacity and the challenges presented by this client group. There was a perception that this client group could be difficult to treat due to comorbidities, and these this client group perceived themselves to be different from people dependent on alcohol or illicit drugs. This study identified a clear need for specific clinical guidelines for the treatment of NPM dependence. Such guidance should be appropriate for specialist and generalist clinicians as the current pressure on resources may force more treatment into general practice. Appropriate care pathways need to be established and defined, and sufficient resources allocated to accommodate this client group.
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Affiliation(s)
- Niamh Fingleton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Margaret Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK.
| | - Catriona Matheson
- Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK.
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Popiołek I, Piotrowicz-Wójcik K, Porebski G. Hypersensitivity Reactions in Serious Adverse Events Reported for Paracetamol in the EudraVigilance Database, 2007⁻2018. Pharmacy (Basel) 2019; 7:E12. [PMID: 30658389 DOI: 10.3390/pharmacy7010012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 01/12/2019] [Indexed: 01/18/2023] Open
Abstract
Paracetamol is a popular and easily available drug which is used world-wide as analgesic, antipyretic agent. Hypersensitivity reactions to this drug involve a wide range of symptoms of various importance for patient management. The EudraVigilance (EV) database serves as a system for monitoring adverse events (AE) due to drug intake. We retrospectively recorded AE reports for "paracetamol" reported from 1 January 2007 to 1 October 2018 which fulfilled the category of "serious" in EV. For further analysis the retrieved AE reports were selected according to the keywords corresponding to hypersensitivity symptoms. We included in the study 4589 AE reports with 9489 particular AEs. 24.2% of all the AE reports concerned children. The most often reported symptoms were "angioedema," "rash" and "urticaria" (each of them with a frequency of >10% in the AE reports). An important group of AEs were oedema reported as being located in the head, neck or respiratory tract. We recorded 58 AE reports with fatal outcomes, including 9 Stevens-Johnson syndrome/toxic epidermal necrolysis cases (SJS/TEN), 10 anaphylactic reactions, 21 cases of hepatic failure and a further 18 cases which occurred for other reasons. SJS/TEN, acute generalized exanthematous pustulosis and drug reaction with eosinophilia and systemic symptoms were reported 129, 42 and 25 times, respectively. Prodromes and symptoms of potentially life-threating SJS/TEN appeared in 286 of the AE reports. 380 AE reports pointed to a diagnosis of anaphylaxis. To improve patient safety, healthcare professionals, including pharmacists, can identify warning signs of severe hypersensitivity reactions to paracetamol.
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Catlin JR, Brass EP. The Effectiveness of Nonprescription Drug Labels in the United States: Insights from Recent Research and Opportunities for the Future. Pharmacy (Basel) 2018; 6:E119. [PMID: 30373134 PMCID: PMC6306891 DOI: 10.3390/pharmacy6040119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/18/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022] Open
Abstract
Despite providing a consistent and comprehensible format for over-the-counter (OTC) drug communication, research suggests important limitations in the communication effectiveness of the Drug Facts Label required on OTC drugs in the United States. This literature is reviewed and some of these critical limitations of the Drug Facts Label (DFL) highlighted. These include difficulty communicating complex information that requires integration of multiple pieces of label information and limited adaptability to serve the unique needs of individual populations (e.g., low literacy or older consumers). Potential ways to improve the DFL's communication effectiveness are identified along with complementary opportunities to improve OTC drug communication by leveraging the role of pharmacists and use of adjunctive technologies.
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Affiliation(s)
- Jesse R Catlin
- College of Business Administration, California State University, Sacramento, CA 95819, USA.
| | - Eric P Brass
- Department of Medicine, University of California, Los Angeles, CA 90095, USA.
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Mikhail A, Tanoli O, Légaré G, Dubé PA, Habel Y, Lesage A, Low NCP, Lamarre S, Singh S, Rahme E. Over-the-Counter Drugs and Other Substances Used in Attempted Suicide Presented to Emergency Departments in Montreal, Canada. Crisis 2018; 40:166-175. [PMID: 30215303 DOI: 10.1027/0227-5910/a000545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Over-the-counter (OTC) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: To identify patient characteristics associated with OTC drug use as a suicide attempt method among adults. Method: A cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ED) of two adult general hospitals following a suicide attempt during 2009-2010 in Montreal, Canada. Results: Among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used OTC drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use OTC drugs, while those who were Caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the Fall were less likely to do so. Substances most frequently used were: acetaminophen among OTC drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: Reasons for the suicide method choice were not available. Conclusion: OTC drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.
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Affiliation(s)
| | - Omaid Tanoli
- 1 Department of Medicine, McGill University, Montreal, QC, Canada
| | - Gilles Légaré
- 2 Bureau d'information et d'analyse en santé des populations, Institut National de Santé Publique du Québec, QC, Canada
| | - Pierre-André Dubé
- 3 Direction de la santé environnementale et de la toxicologie, Institut National de Santé Publique du Québec, QC, Canada
| | - Youssef Habel
- 4 Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Alain Lesage
- 5 Départment de Psychiatrie, Université de Montréal, QC, Canada
| | - Nancy C P Low
- 4 Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,6 Department of Psychiatry, McGill University Health Centre, Montreal, QC, Canada.,7 Mental Health Service, Services for Students, McGill University, Montreal, QC, Canada
| | - Suzanne Lamarre
- 8 Department of Psychiatry, St-Mary's Hospital, Montreal, QC, Canada
| | - Santokh Singh
- 8 Department of Psychiatry, St-Mary's Hospital, Montreal, QC, Canada
| | - Elham Rahme
- 1 Department of Medicine, McGill University, Montreal, QC, Canada.,4 Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Hedenrud T, Andersson Sundell K, Martinsson J, Håkonsen H. Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study. Int J Pharm Pract 2018; 27:17-24. [PMID: 29687513 DOI: 10.1111/ijpp.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 03/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population. METHODS Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression. KEY FINDINGS Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs. CONCLUSIONS Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.
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Affiliation(s)
- Tove Hedenrud
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Martinsson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Helle Håkonsen
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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29
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Kim HJ, Yang YM, Choi EJ. Use patterns of over-the-counter (OTC) medications and perspectives on OTC medications among Korean adult patients with chronic diseases: gender and age differences. Patient Prefer Adherence 2018; 12:1597-1606. [PMID: 30214162 PMCID: PMC6118289 DOI: 10.2147/ppa.s173873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A number of symptomatic patients tend to use over-the-counter (OTC) medications and prescription medications. OTC medications can be easily obtained in pharmacies for self-treatment, but using OTC medications is not always safe and beneficial for patients. The aims of this study were to examine the use patterns of OTC medications and assess patients' perspectives regarding the use of OTC medications in Korean patients with chronic diseases. PATIENTS AND METHODS A descriptive, cross-sectional survey was carried out with Korean patients who visited the community pharmacy, located at the southern region of South Korea, during September 2015. RESULTS A total of 345 patients participated in this survey. Approximately 64% of Korean survey respondents reported that they had used OTC drugs. The most commonly used OTC medications were antipyretics, analgesics and anti-inflammatory drugs. The perception level of Korean consumers on adverse drug reactions and drug-drug interactions from OTC medications was relatively low. Although OTC package leaflets are a main source of information about OTC medications, Korean consumers' level of reading OTC package leaflets was relatively low. CONCLUSION Based on these results, this study can serve as a meaningful starting point for interventions of health care professionals regarding OTC medications in South Korea. In particular, pharmacists should inform their consumers of drug-related problems from OTC drugs during consultation with the consumers; however, information about OTC drugs should be tailored to consumer information needs with the consideration of his or her circumstance. It is somewhat difficult to generalize the results from this study to other regions of South Korea since most of the respondents were probably residents of a small rural city located in the southern region of South Korea.
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Affiliation(s)
- Hyun Jeong Kim
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea,
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea,
| | - Eun Joo Choi
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea,
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Mahrous MS. Frequency of use of non-prescribed medication among population sample from Al Madina City and its impact on quality of care in Saudi Arabia. Int J Health Sci (Qassim) 2018; 12:3-9. [PMID: 30202401 PMCID: PMC6124833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Self-medication can be defined as the practice of using drugs that have not been prescribed, recommended, or controlled by a certified health-care professional. This term can be used when discussing patients who use non-prescription medications to treat self-diagnosed disorders or symptoms, without consulting a medical practitioner and without any medical supervision. The objectives of this study are to identify patterns of self-medication in Saudi Arabia, to measure the association between gender and the use of non-prescribed medication, and to identify the type of medications involved, the dosages used, and patient's sources of knowledge regarding the types, and doses of medications. METHOD Cross-section analytical observational study, conducted in Al Medina city, Saudi Arabia, over 6 months using a pretested self-administered questionnaire using a convenience sampling technique. RESULTS With a response rate of 68.8%, it was found that 72.5% reported the use of non-prescribed medication and 24.3% reported a history of experiencing side effects from using non-prescribed medication with no significant difference between male and female. 81% were keen to read the medication instruction with higher response among females.Analgesics were the most common type of medication used with an 86.5% agreement with no statistical significant differences between male and females. CONCLUSION The study found heavy use of non-prescribed medication among the Al Medina residents sampled. This suggests a need for specialist training programs that could be directed at pharmacists, to help them disseminate information on the safe use of OTC or non-prescribed medications.
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Affiliation(s)
- Mohamed Saad Mahrous
- Department of Medical Education, College of Dentistry, Taibah University, Madinah, Saudi Arabia,Address for correspondence: Mohamed Mahrous, Department of Medical Education, College of Dentistry, Taibah University, Madinah, Saudi Arabia, P.O. Box: 1263. Phone: +966555309009. E-mail:
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Seubert LJ, Whitelaw K, Boeni F, Hattingh L, Watson MC, Clifford RM. Barriers and Facilitators for Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Focus Group Study. Pharmacy (Basel) 2017; 5:E65. [PMID: 29211054 PMCID: PMC5748546 DOI: 10.3390/pharmacy5040065] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022] Open
Abstract
Consumers are confident managing minor ailments through self-care, often self-medicating from a range of over-the-counter (OTC) medicines available from community pharmacies. To minimise risks, pharmacy personnel endeavour to engage in a consultation when consumers present with OTC enquiries however they find consumers resistant. The aim was to determine stakeholder perspectives regarding barriers and facilitators for information exchange during OTC consultations in community pharmacies and to understand the elicited themes in behavioural terms. Focus groups were undertaken with community pharmacist, pharmacy assistant and consumer participants. Independent duplicate analysis of transcription data was conducted using inductive and framework methods. Eight focus groups involving 60 participants were conducted. Themes that emerged indicated consumers did not understand pharmacists' professional role, they were less likely to exchange information if asking for a specific product than if asking about symptom treatment, and they wanted privacy. Consumers were confident to self-diagnose and did not understand OTC medicine risks. Pharmacy personnel felt a duty of care to ensure consumer safety, and that with experience communication skills developed to better engage consumers in consultations. They also identified the need for privacy. Consumers need education about community pharmacists' role and responsibilities to motivate them to engage in OTC consultations. They also require privacy when doing so.
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Affiliation(s)
- Liza J Seubert
- Division of Pharmacy, The University of Western Australia, M315, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Kerry Whitelaw
- Division of Pharmacy, The University of Western Australia, M315, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Fabienne Boeni
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Klingelbergstrasse 50, CH-4056 Basel, Switzerland.
| | - Laetitia Hattingh
- School of Pharmacy and Pharmacology, Griffith University, Gold Coast Campus, Queensland 4222, Australia.
| | - Margaret C Watson
- Department of Pharmacy and Pharmacology, University of Bath, 5W 3.33, Claverton Down, Bath BA2 7AY, UK.
| | - Rhonda M Clifford
- Division of Pharmacy, The University of Western Australia, M315, 35 Stirling Hwy, Crawley, WA 6009, Australia.
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Badzi CD, Ackumey MM. Factors influencing use of analgesics among construction workers in the Ga-Eastmunicipality of the Greater Accra region, Ghana. Ghana Med J 2017; 51:156-163. [PMID: 29622829 PMCID: PMC5870788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Analgesics also known as painkillers are widely used for pain relief. There are severe health implications associated with excessive use of analgesics. This paper examines factors influencing the use of analgesics among construction workers in the Ga-East Municipality (GEM) of the Greater Accra region of Ghana. METHODS This is a cross-sectional study involving 206 construction workers randomly sampled from 7 construction sites in the GEM. A structured questionnaire was used to elicit responses on knowledge of analgesics, types of analgesics used and factors influencing the use of analgesics. Chi-square test analysis was used to examine factors influencing analgesic use. RESULTS The majority of workers were aged between 15 to 44 years (89.8%) and 51.9 percent of respondents had completed Junior high school. Many respondents (68.0%) used Brand 1 a locally manufactured analgesic with paracetamol, aspirin and caffeine as the active ingredients and 31.6 percent of respondents had no knowledge of possible side effects of continuous use of analgesics. Chi square analysis showed that age was significantly associated with use of analgesics (p<0.01). Knowledge of the types of analgesics, dosage and side effects did not influence use (p>0.05). Television and radio advertisements influenced use of analgesics (p<0.01). CONCLUSION Knowledge on analgesic use and knowledge of probable serious side effects was inadequate. Pharmacists and chemists involvement in education of clients of the side effects of analgesics is highly recommended to minimise misuse. The Food and Drugs Authority should regulate the proliferation of advertisements for analgesics in the media. FUNDING None declared.
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Affiliation(s)
- Caroline D Badzi
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon
| | - Mercy M Ackumey
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Legon
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Foroughinia F, Zarei P. Evaluation of knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter drugs for the treatment of diarrhea in children: A pretest-posttest survey. J Res Pharm Pract 2016; 5:200-4. [PMID: 27512712 PMCID: PMC4966240 DOI: 10.4103/2279-042x.185735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: In this study, we aimed to assess knowledge, attitude, and practice of community pharmacists toward administration of over-the-counter (OTC) antidiarrheal drugs in our city pharmacies, Shiraz, Iran. Methods: In this descriptive cross-sectional study, 90 pharmacies among 128 pharmacies in our city were randomly chosen. The study was designed into two phases: A standard questionnaire to determine the level of knowledge and attitude of pharmacists and a simulated client method to evaluate practice among them. An educational pamphlet was then given to the pharmacists. One month later, knowledge, attitude, and performance of studied pharmacists were evaluated again using the same method. Findings: Our results showed that an average consultation time by female pharmacists was considerably more than male pharmacists (P < 0.001). Before intervention, only 37.8% of pharmacists performed appropriately by prescribing the proper medicine while this increased to 58.44% after intervention. The average score of pharmacists’ knowledge was statistically increased (P < 0.001) and the pharmacists’ performance was significantly improved (P < 0.001) after the educational intervention. In related to the attitude, pharmacists’ tendency toward prescribing oral rehydration salt solutions (ORS) (P < 0.001) and their belief about the great effect of ORS on the treatment of diarrhea increased significantly after the intervention. Conclusion: It is concluded that training programs such as educational pamphlets and continuing educational seminars may play important roles in increasing pharmacists’ knowledge and therefore improving their performance in prescribing OTC medicines.
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Affiliation(s)
- Farzaneh Foroughinia
- Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Zarei
- Student Research Committee, International Branch, Shiraz University of Medical Sciences, Shiraz, Iran
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Cea Soriano L, Soriano-Gabarró M, García Rodríguez LA. Validation of low-dose aspirin prescription data in The Health Improvement Network: how much misclassification due to over-the-counter use? Pharmacoepidemiol Drug Saf 2015; 25:392-8. [PMID: 26660710 PMCID: PMC5064646 DOI: 10.1002/pds.3926] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/16/2022]
Abstract
Purpose We aimed to quantify the extent of over‐the‐counter (OTC) low‐dose aspirin use among patients in The Health Improvement Network (THIN) in the UK. Methods In September 2013, a random sample of low‐dose aspirin users (75 past users and 75 never users) was identified based on prescriptions recorded in THIN. Primary care practitioners (PCPs) were sent questionnaires to provide information on patients' use of OTC low‐dose aspirin. Results One hundred and forty valid questionnaires were received (93.30% [95%CI: 88.16–96.34] response rate). Current use of low‐dose aspirin was reported by PCPs in 4.23% (95%CI: 1.45–11.70) (n = 3) of past users (OTC use in one patient) and in 2.9% (95%CI: 0.78–9.70) (n = 2) of never users (OTC use in one patient). In addition, PCPs reported past use of low‐dose aspirin in 88.70% (95%CI: 79.31–94.18) (n = 63) of past users (all prescribed; none as OTC) and in 2.82% (95%CI: 0.78–9.70) (n = 2) of never users (as OTC). Among past users, PCPs reported the indication for low‐dose aspirin as primary cardiovascular disease (CVD) prevention in 63.16% (95%CI: 50.18–74.48) of patients and secondary CVD prevention in 31.58% (95%CI: 21.00–44.48) of patients. Corresponding percentages based on THIN were 78.95% (95%CI: 66.71–87.53) and 21.1% (95%CI: 12.47–33.29), respectively. Conclusion Our findings show the small impact of potential misclassification of low‐dose aspirin use in THIN due to unrecorded OTC use. The small proportion of false negatives confirms the utility of THIN for utilization and outcome studies of low‐dose aspirin. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Affiliation(s)
- Lucía Cea Soriano
- Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain
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Matyas RA, Mumford SL, Schliep KC, Ahrens KA, Sjaarda LA, Perkins NJ, Filiberto AC, Mattison D, Zarek SM, Wactawski-Wende J, Schisterman EF. Effects of over-the-counter analgesic use on reproductive hormones and ovulation in healthy, premenopausal women. Hum Reprod 2015; 30:1714-23. [PMID: 25954035 DOI: 10.1093/humrep/dev099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/25/2015] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Does use of commonly used over-the-counter (OTC) pain medication affect reproductive hormones and ovulatory function in premenopausal women? SUMMARY ANSWER Few associations were found between analgesic medication use and reproductive hormones, but use during the follicular phase was associated with decreased odds of sporadic anovulation after adjusting for potential confounders. WHAT IS KNOWN ALREADY Analgesic medications are the most commonly used OTC drugs among women, but their potential effects on reproductive function are unclear. STUDY DESIGN, SIZE, DURATION The BioCycle Study was a prospective, observational cohort study (2005-2007) which followed 259 women for one (n = 9) or two (n = 250) menstrual cycles. PARTICIPANTS, SETTING, METHODS Two hundred and fifty-nine healthy, premenopausal women not using hormonal contraception and living in western New York state. Study visits took place at the University at Buffalo. MAIN RESULTS AND THE ROLE OF CHANCE During study participation, 68% (n = 175) of women indicated OTC analgesic use. Among users, 45% used ibuprofen, 33% acetaminophen, 10% aspirin and 10% naproxen. Analgesic use during the follicular phase was associated with decreased odds of sporadic anovulation after adjusting for age, race, body mass index, perceived stress level and alcohol consumption (OR 0.36 [0.17, 0.75]). Results remained unchanged after controlling for potential confounding by indication by adjusting for 'healthy' cycle indicators such as amount of blood loss and menstrual pain during the preceding menstruation. Moreover, luteal progesterone was higher (% difference = 14.0, -1.6-32.1, P = 0.08 adjusted) in cycles with follicular phase analgesic use, but no associations were observed with estradiol, LH or FSH. LIMITATIONS, REASONS FOR CAUTION Self-report daily diaries are not validated measures of medication usage, which could lead to some classification error of medication use. We were also limited in our evaluation of aspirin and naproxen which were used by few women. WIDER IMPLICATIONS OF THE FINDINGS The observed associations between follicular phase analgesic use and higher progesterone and a lower probability of sporadic anovulation indicate that OTC pain medication use is likely not harmful to reproduction function, and certain medications possibly improve ovulatory function. STUDY FUNDING/COMPETING INTERESTS This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract # HHSN275200403394C). The authors have no conflicts of interest to disclose.
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Affiliation(s)
- R A Matyas
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - S L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - K C Schliep
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - K A Ahrens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - L A Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - N J Perkins
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - A C Filiberto
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
| | - D Mattison
- Risk Sciences International and University of Ottawa, Ottawa, ON, Canada
| | - S M Zarek
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD, USA
| | - J Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - E F Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD, USA
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Mhatre SK, Sansgiry SS. Assessing a conceptual model of over-the-counter medication misuse, adverse drug events and health-related quality of life in an elderly population. Geriatr Gerontol Int 2015; 16:103-10. [PMID: 25613189 DOI: 10.1111/ggi.12443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 01/31/2023]
Abstract
AIM The objectives of the present study were to test Spilker's quality of life model in the elderly population consuming over-the-counter (OTC) medications. It was hypothesized that OTC medication misuse increases adverse drug events (ADEs), ADEs as a result of OTC medication misuse decrease health-related quality of life (HRQoL) and the impact of OTC medication misuse on patients' HRQoL is fully medicated by ADEs associated with OTC medications. METHODS Data were used from a previously carried out cross-sectional study using survey instruments with elderly patients consuming OTC medications in Houston, Texas, USA. The presence/absence of OTC misuse was assessed by an expert panel based on patient reported information on drug use characteristics; ADE was self-reported and HRQoL was measured using the Short Form-12v2, which contains a physical component summary score (PCS) and a mental component summary score (MCS). RESULTS Of the 154 respondents, 18.2% misused OTC medications and 22.1% reported ADE as a result of OTC medications. The mean ± SD score of PCS and MCS was 40.6 ± 6.8 and 46.4 ± 7, respectively. The hypothesized framework provided a well-fitted solution to the data (χ(2) = 1.387, d.f. = 2, P = 0.49; weighted root mean square residual = 0.317). Misuse of OTC medications significantly increased ADEs associated with OTC medications (β = 0.298) and increased ADEs significantly decreased patient reported PCS (β = -0.312), but not MCS (β = -0.213). OTC medication misuse indirectly decreased PCS and MCS by mediating the effect of an increase in ADE; however, the association was not statistically significant. CONCLUSIONS Misuse of OTC medications is highly associated with ADEs. ADEs are capable of decreasing the physical health of elderly patients.
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Koffeman AR, Valkhoff VE, Celik S, W't Jong G, Sturkenboom MCJM, Bindels PJE, van der Lei J, Luijsterburg PAJ, Bierma-Zeinstra SMA. High-risk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study. Br J Gen Pract 2014; 64:e191-8. [PMID: 24686883 PMCID: PMC3964463 DOI: 10.3399/bjgp14x677815] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/11/2013] [Accepted: 01/14/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with serious adverse drug events (ADEs). AIM To determine the prevalence of over-the-counter (OTC) NSAID use in the general population and in patients with a high risk of developing a serious NSAID-related ADE. DESIGN AND SETTING Cross-sectional study in four general practices in the Netherlands. METHOD Two patient samples were selected: a random sample of adults (general population sample); and adult patients with a high risk of developing a serious ADE in case of NSAID use (high-risk sample). All included patients were sent a questionnaire regarding their use of OTC NSAIDs in the 4 weeks prior to participation. RESULTS In the general population sample, 118 of 456 (26%) invited patients completed the questionnaire. Of these, 35 (30%) had used an OTC NSAID. In the high-risk sample, 264 of 713 (37%) invited patients completed the questionnaire, and of these high-risk patients 33 (13%) had used an OTC NSAID. Over 20% of OTC NSAID users in the general population sample and over 30% in the high-risk sample had used the OTC NSAID for >7 days. OTC NSAIDs were used in a dosage exceeding the recommended daily maximum by 9% and 3% of OTC NSAID users in the general population and the high-risk sample respectively. CONCLUSION OTC NSAIDs are used by almost one-third of the general population. In the high-risk patients selected, one in eight patients used an OTC NSAID. Continued efforts by health authorities and healthcare professionals to inform patients of the risks of these drugs are warranted.
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Abstract
Pediatric cases of vitamin D intoxication (VDI) with dietary supplements have not been previously reported. We report on 7 children with VDI caused by consumption of a fish oil supplement containing an excessively high dose of vitamin D due to a manufacturing error. Seven children aged between 0.7 and 4.2 years were admitted with symptoms of hypercalcemia. Initial median (range) serum concentrations of calcium and 25-hydroxyvitamin D were 16.5 (13.4-18.8) mg/dL and 620 (340-962) ng/mL, respectively. Repeated questioning of the parents revealed use of a fish oil that was produced recently by a local manufacturer. Analysis of the fish oil by gas chromatography/mass spectrometry revealed that the vitamin D3 content was ~4000 times the labeled concentration. Estimated daily amounts of vitamin D3 intake varied between 266,000 and 800,000 IU. Patients were successfully treated with intravenous hydration, furosemide, and pamidronate infusions. With treatment, serum calcium returned to the normal range within 3 days (range: 2-7 days). Serum 25-hydroxyvitamin D levels normalized within 2 to 3 months. Complications, including nephrocalcinosis, were not observed throughout the 1-year follow-up. In conclusion, errors in manufacturing of dietary supplements may be a cause of VDI in children. Physicians should be aware of this possibility in unexplained VDI cases and repeatedly question the families about dietary supplement use. To prevent the occurrence of such unintentional incidents, manufacturers must always monitor the levels of ingredients of their products and should be rigorously overseen by governmental regulatory agencies, as is done in the pharmaceutical industry.
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Affiliation(s)
- Cengiz Kara
- Division of Pediatric Endocrinology, Department of Pediatrics, Ondokuz Mayıs University, 55139, Kurupelit, Samsun, Turkey.
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Abstract
Acute generalized exanthematous pustulosis is an uncommon cutaneous reaction characterized by sudden onset of generalized non-follicular aseptic pustules. It is most often secondary to drugs but causes as varied from viral infection to insect bites are reported. A case report of a 48-year-old male who developed pustular eruptions after taking acetylsalicylic acid is reported here. Clinicians need to be aware of this entity when dealing with pustular rash as this rare side effect of a very common drug is both, easy to miss and easy to manage.
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Affiliation(s)
- Amit Bahuguna
- MD, Graded specialist, Skin Department, 92 Base Hospital, India
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Votova K, Blais R, Penning MJ, Maclure MK. Polypharmacy meets polyherbacy: pharmaceutical, over-the-counter, and natural health product use among Canadian adults. Can J Public Health 2013; 104:e222-8. [PMID: 23823886 DOI: 10.17269/cjph.104.3695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 05/03/2013] [Accepted: 03/22/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Natural health products (NHP) are increasingly being used to supplement prescription medications (PM) and over-the-counter (OTC) products. The objective of this study was to examine patterns of overall health product use and how these patterns are associated with social and health factors. METHODS We used direct health measures data from the Canada Health Measures Survey (CHMS) Cycle 1.0 (2007/2009) to examine recent product use among adults aged 18-79 years (n=3,721). Latent class analyses were used to detect use (propensity) and intensity of use among users of all three product types. Associations between social and health covariates and product patterns were examined using linear and multinomial logit regression procedures. RESULTS Three latent classes of health product use were identified. The largest (43%) was characterized by a high probability of PM and NHP but not OTC use. Class two (37%), in contrast, had a low probability of using any of the three health products. Class three (20%) had a high probability of PM and OTC but not NHP use. Age, gender, immigrant status, household size, co-morbidity, perceived health status, and having a regular doctor were associated with these patterns of use. Analyses of intensity of product use among users revealed seven distinct classes; these were differentiated by age, household size, co-morbidity and weight (BMI status). CONCLUSION If defining polypharmacy or polyherbacy is based simply on number of health products used, then for Canadians under age 80 neither practice appeared to be widespread. More work needs to be done to define the "poly" in polypharmacy and polyherbacy. This will inform the conversation on appropriate product use, particularly given that about one half of Canadians used medications and NHPs concurrently.
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Affiliation(s)
- Kristine Votova
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Wolf MS, King J, Jacobson K, Di Francesco L, Bailey SC, Mullen R, McCarthy D, Serper M, Davis TC, Parker RM. Risk of unintentional overdose with non-prescription acetaminophen products. J Gen Intern Med 2012; 27:1587-93. [PMID: 22638604 PMCID: PMC3509295 DOI: 10.1007/s11606-012-2096-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 02/07/2012] [Accepted: 03/14/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is increasing concern over the risk of consumer unintentional misuse of non-prescription (a.k.a. 'over-the-counter') medications containing acetaminophen, which could lead to acute liver failure. OBJECTIVE To determine the prevalence of potential misuse and overdose of over-the-counter medications containing acetaminophen, either alone or in combination. DESIGN Cross-sectional, structured interviews with literacy assessment. SETTING One academic and one community-based general internal medicine practice in Chicago, IL, and one academic general internal medicine practice and a public hospital clinic in Atlanta, GA. PATIENTS Five hundred adults seeking primary care, ages 18-80. MEASUREMENT Demonstration of how and when patients would take over-the-counter medications containing acetaminophen, alone or in combination with one another, over a 24-hour period. RESULTS Overall, 23.8 % of participants demonstrated they would overdose on a single over-the-counter acetaminophen product by exceeding a dose of four grams in a 24-hour period; 5.2 % made serious errors by dosing out more than six grams. In addition, 45.6 % of adults demonstrated they would overdose by 'double-dipping' with two acetaminophen-containing products. In multivariable analyses, limited literacy (Relative Risk Ratio (RR) 1.65, 95 % Confidence Interval (CI) 1.03-2.66) and heavy acetaminophen use in the past six months (RR 1.70, 95 % CI 1.10-2.64) were independently associated with overdosing over-the-counter products. CONCLUSION Misunderstanding of the active ingredient and proper instructions for over-the-counter medications containing acetaminophen is common. The potential for errors and adverse events associated with unintentional misuse of these products is substantial, particularly among heavy users of acetaminophen and those with limited literacy.
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Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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Plantinga L, Grubbs V, Sarkar U, Hsu CY, Hedgeman E, Robinson B, Saran R, Geiss L, Burrows NR, Eberhardt M, Powe N. Nonsteroidal anti-inflammatory drug use among persons with chronic kidney disease in the United States. Ann Fam Med 2011; 9:423-30. [PMID: 21911761 PMCID: PMC3185478 DOI: 10.1370/afm.1302] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Because avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States. METHODS A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999-2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defined by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥ 30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular filtration rate of 15-59 mL/min/1.73 m(2)). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting. RESULTS Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P=.979). CONCLUSIONS Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.
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Affiliation(s)
- Laura Plantinga
- Department of Medicine, University of California, San Francisco, California, USA.
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Merante A, Gareri P, Marigliano NM, De Fazio S, Bonacci E, Torchia C, Russo G, Lacroce P, Lacava R, Castagna A, De Sarro G, Ruotolo G. Laxative-induced rhabdomyolysis. Clin Interv Aging 2010; 5:71-3. [PMID: 20396636 PMCID: PMC2854053 DOI: 10.2147/cia.s8832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Indexed: 11/23/2022] Open
Abstract
The present study describes a case of laxative-induced rhabdomyolysis in an elderly patient. An 87-year-old woman was hospitalized for the onset of confusion, tremors, an inability to walk, and a fever that she had been experiencing for 36 hours. She often took high dosages of lactulose and sorbitol syrup as a laxative (about 70 g/day). During her physical examination, the patient was confused, drowsy, and she presented hyposthenia in her upper and lower limbs, symmetric and diffuse moderate hyporeflexia, and her temperature was 37.8°C. Laboratory tests revealed severe hyponatremia with hypokalemia, hypocalcemia, hypochloremia, and metabolic alkalosis. Moreover, rhabdomyolysis markers were found. The correction of hydroelectrolytic imbalances with saline, potassium and sodium chlorure, calcium gluconate was the first treatment. During her hospitalization the patient presented acute delirium, treated with haloperidol and prometazine chloridrate intramuscularly. She was discharged 12 days later, after resolution of symptoms, and normalized laboratory tests. Over-the-counter drugs such as laxatives are usually not considered dangerous; on the other hand, they may cause serum electrolytic imbalance and rhabdomyolysis. A careful monitoring of all the drugs taken by the elderly is one of the most important duties of a physician since drug interactions and their secondary effects may be fatal.
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Affiliation(s)
- Alfonso Merante
- Geriatrist, Geriatric Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
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Jenkins AJ, Stillwell ME. The Use of Over-The-Counter Medications to Facilitate Sexual Assault. Forensic Sci Rev 2010; 22:75-82. [PMID: 26242457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over-the-counter drugs are medications that are available without the requirement of a prescription. They are considered relatively safe and well-tolerated when taken in accordance with the dosing instructions on the package label. However, when taken alone or in combination with other drugs, they possess pharmacological properties that have the potential to facilitate sexual assault. This chapter reviews the chemistry and pharmacology of these drugs. Additionally, a brief overview of analytical methodology is presented.
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Affiliation(s)
- A J Jenkins
- Department of Hospital Laboratories, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - M E Stillwell
- Oklahoma State Bureau of Investigation, Forensic Science Center, Edmond, OK, USA
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Abstract
BACKGROUND Effective use of over-the-counter (OTC) medications depends on purchasers' knowledge of their indications. This study examines consumer knowledge regarding the urinary tract analgesic phenazopyridine, which recently became available without prescription. METHOD We conducted a cross-sectional survey of a stratified cluster random sample of purchasers of OTC phenazopyridine (N = 434) in 31 Los Angeles retail pharmacies. RESULTS The response rate was 58%. Only 42% correctly characterized the likely cause of their symptoms, and only 57% correctly characterized the action of the drug. Worse consumer knowledge was associated with nonwhite race, first-time use, and less contact with health providers. CONCLUSION Many consumers possess poor knowledge about phenazopyridine, potentially leading to undertreatment, especially in groups with worse access to care.
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Affiliation(s)
- Chih-Wen Shi
- Department of Family & Preventive Medicine, University of California, San Diego, 9500 Gilman Dr, Mailcode-0807, La Jolla, CA 92093, USA.
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