Drugs In Malaysia Research Articles

A comparative drug utilisation study of the treatment of diabetes in Malaysia and Australia.

Once a disease of developed countries, type 2 diabetes mellitus (T2DM) has become widespread worldwide. For people with T2DM, achievement of therapeutic outcomes demands the rational and quality use of medicine. The primary aim of this study was to examine the prevalence of diabetes and prescribing patterns of anti-diabetic medications in Australia and Malaysia. The most recent, publicly available, statistical reports (2004-2008) on the use of medicines published in Australia and in Malaysia were evaluated. Defined daily doses (DDDs/1,000 population/day) were derived from the reports and used to rank and compare individual drug use. There was an increasing trend in the prevalence of diabetes in Australia, although there is a greater predicted increase in prevalence for Malaysia. While drugs used for the treatment of diabetes were not the most highly used drugs in Australia, their use increased during the study period, from 42.64 to 48.61 DDD/1,000/day. Anti-diabetic drugs were the most frequently dispensed class of drugs in Malaysia. Although the total consumption of anti-diabetic drugs in Malaysia decreased between 2006 and 2007 (from 40.30 to 39.72), this was followed by a marked increase to 46.69 in 2008. There was a marked reduction in the dispensing of insulin in Malaysia from 2004 to 2007 (7.77 to 3.23). The use of drugs to treat diabetes does not reflect the usage patterns found in Australia. Effective drug use reviews are required to ensure impartial access in middle- and low-income countries.

Common adverse cutaneous drug reaction patterns and the causative drugs in Malaysia

Background: Patients with adverse cutaneous drug reactions (ACDRs) are frequently referred from primary care to tertiary centres for further management. This causes a loss of information regarding ACDRs as these patients discontinue primary care follow-up upon referral to tertiary care. The aim of this study is to determine the prevalence and characteristics of ACDR, and to use this valuable information to enhance awareness of primary care physicians regarding this condition.Method: A retrospective cross-sectional study on ACDR was done at the Dermatology Clinic, Kuala Lumpur General Hospital from January 2009 to December 2010.Results: The prevalence of ACDR was 0.2%. The majority of patients (71.6%) were below 59 years of age. ACDR commonly (55.2%) occurs within hours to days of drug ingestion and is of mild to moderate severity (74.6%). About 27.6% of affected patients took 1 to 5 drugs concurrently. Common cutaneous manifestation of ACDR includes maculopapular rash (22.4%) and Stevens–Johnson syndrome ...

Treatment Readiness, Attitudes Toward, and Experiences with Methadone and Buprenorphine Maintenance Therapy Among People Who Inject Drugs in Malaysia

BackgroundLittle is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. MethodsIn 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experiences with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). ResultsAll 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), higher stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. ConclusionThere are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.

High prevalence of non-fatal overdose among people who inject drugs in Malaysia: Correlates of overdose and implications for overdose prevention from a cross-sectional study

BackgroundOverdose is the leading cause of death among opioid users, but no data are available on overdose among people who inject drugs in Malaysia. We present the first estimates of the prevalence and correlates of recent non-fatal overdose among people who inject drugs in Malaysia. MethodsIn 2010, 460 people who inject drugs were recruited using respondent-driven sampling (RDS) in Klang Valley to assess health outcomes associated with injection drug use. Self-reported history of non-fatal overdose in the previous 6 months was the primary outcome. Sociodemographic, behavioral and structural correlates of non-fatal overdose were assessed using multivariable logistic regression. ResultsAll 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Most injected daily (91.3%) and were male (96.3%) and ethnically Malay (90.4%). Overall, 20% of participants had overdosed in the prior 6 months, and 43.3% had ever overdosed. The RDS-adjusted estimate of the 6-month period prevalence of overdose was 12.3% (95% confidence interval [CI] 7.9–16.6%). Having injected for more years was associated with lower odds of overdose (adjusted odds ratio [AOR] 0.6 per 5 years of injection, CI: 0.5–0.7). Rushing an injection from fear of the police nearly doubled the odds of overdose (AOR 1.9, CI: 1.9–3.6). Alcohol use was associated with recent non-fatal overdose (AOR 2.1, CI: 1.1–4.2), as was methamphetamine use (AOR 2.3, CI: 1.3–4.6). When adjusting for past-month drug use, intermittent but not daily methadone use was associated with overdose (AOR 2.8, CI: 1.5–5.9). ConclusionThis study reveals a large, previously undocumented burden of non-fatal overdose among people who inject drugs in Malaysia and highlights the need for interventions that might reduce the risk of overdose, such as continuous opioid substitution therapy, provision of naloxone to prevent fatal overdose, treatment of polysubstance use, and working with police to improve the risk environment.

A newly emerging HIV-1 recombinant lineage (CRF58_01B) disseminating among people who inject drugs in Malaysia.

The HIV epidemic is primarily characterised by the circulation of HIV-1 group M (main) comprising of 11 subtypes and sub-subtypes (A1, A2, B–D, F1, F2, G, H, J, and K) and to date 55 circulating recombinant forms (CRFs). In Southeast Asia, active inter-subtype recombination involving three main circulating genotypes—subtype B (including subtype B′, the Thai variant of subtype B), CRF01_AE, and CRF33_01B—have contributed to the emergence of novel unique recombinant forms. In the present study, we conducted the molecular epidemiological surveillance of HIV-1 gag-RT genes among 258 people who inject drugs (PWIDs) in Kuala Lumpur, Malaysia, between 2009 and 2011 whereby a novel CRF candidate was recently identified. The near full-length genome sequences obtained from six epidemiologically unlinked individuals showed identical mosaic structures consisting of subtype B′ and CRF01_AE, with six unique recombination breakpoints in the gag-RT, pol, and env regions. Among the high-risk population of PWIDs in Malaysia, which was predominantly infected by CRF33_01B (>70%), CRF58_01B circulated at a low but significant prevalence (2.3%, 6/258). Interestingly, the CRF58_01B shared two unique recombination breakpoints with other established CRFs in the region: CRF33_01B, CRF48_01B, and CRF53_01B in the gag gene, and CRF15_01B (from Thailand) in the env gene. Extended Bayesian Markov chain Monte Carlo sampling analysis showed that CRF58_01B and other recently discovered CRFs were most likely to have originated in Malaysia, and that the recent spread of recombinant lineages in the country had little influence from neighbouring countries. The isolation, genetic characterization, and evolutionary features of CRF58_01B among PWIDs in Malaysia signify the increasingly complex HIV-1 diversity in Southeast Asia that may hold an implication on disease treatment, control, and prevention.

Adeeba Kamarulzaman: fighting HIV/AIDS in Malaysia

Adeeba Kamarulzaman: fighting HIV/AIDS in Malaysia

Letters to the Editor

Journal of Pharmacy Practice and ResearchVolume 40, Issue 2 p. 164-166 Other SectionFree Access Letters to the Editor Alamin HMA Alabid MSc, Alamin HMA Alabid MSc PhD candidate, Senior Lecturer [email protected] Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MalaysiaSearch for more papers by this authorMohamed Izham M Ibrahim, Mohamed Izham M Ibrahim PhD Professor Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MalaysiaSearch for more papers by this authorMohamed Azmi A Hassali PhD, Mohamed Azmi A Hassali PhD Senior Lecturer, Director of Pharmacy Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville) Faculty of Medicine, Nursing and Health Sciences, Monash University (Traralgon)Search for more papers by this authorAnne Leversha BPharm, MRuralHlth, FSHP, Anne Leversha BPharm, MRuralHlth, FSHP Clinical Senior Lecturer [email protected] Latrobe Regional Hospital, Traralgon, Vic., 3844Search for more papers by this authorTasma J Wagner BPharm, Tasma J Wagner BPharm Chief Pharmacist [email protected] Specialist Clinical Pharmacist Port Augusta Hospital and Regional Health Service, Port Augusta, SA, 5700Search for more papers by this author Alamin HMA Alabid MSc, Alamin HMA Alabid MSc PhD candidate, Senior Lecturer [email protected] Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MalaysiaSearch for more papers by this authorMohamed Izham M Ibrahim, Mohamed Izham M Ibrahim PhD Professor Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MalaysiaSearch for more papers by this authorMohamed Azmi A Hassali PhD, Mohamed Azmi A Hassali PhD Senior Lecturer, Director of Pharmacy Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville) Faculty of Medicine, Nursing and Health Sciences, Monash University (Traralgon)Search for more papers by this authorAnne Leversha BPharm, MRuralHlth, FSHP, Anne Leversha BPharm, MRuralHlth, FSHP Clinical Senior Lecturer [email protected] Latrobe Regional Hospital, Traralgon, Vic., 3844Search for more papers by this authorTasma J Wagner BPharm, Tasma J Wagner BPharm Chief Pharmacist [email protected] Specialist Clinical Pharmacist Port Augusta Hospital and Regional Health Service, Port Augusta, SA, 5700Search for more papers by this author First published: 13 April 2015 https://doi.org/10.1002/j.2055-2335.2010.tb00525.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Wong SS. Pharmacy practice in Malaysia. Malaysian J Pharm 2001; 1: 3– 9. 2Hassali MA, Shafie AA, Jayabalan T, Subish P. Medicine dispensing in Malaysia: a case for separation of roles. Ind J Pharm Pract 2009; 2: 84– 5. 3Babar ZU, Ibrahim MI, Singh H, Bukahri NI, Creese A. Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia. PLoS Med 2007; 4: e82. 4Cruez AF. Doctors to be disallowed from dispensing medicines. Kuala Lumpur: The New Straits Times Press (M) Berhad; 2008. Available from <www.mma.org.my/Portals/0/Doctors%20to%20be%20disallowed%20from%20dispensing%20medicine.290308.pdf>. 5Rutter P. Community pharmacy: symptoms, diagnosis and treatment. 2 ed. Edinburgh: Churchill Livingston; 2009. 6 Malaysian laws on poisons and sales. 3rd ed. Selangor Darul Eshan: International Law Book Services; 2007. Volume40, Issue2June 2010Pages 164-166 ReferencesRelatedInformation

Antiretroviral Therapy in Malaysia: Identifying Barriers to Universal Access

Despite a good public healthcare infrastructure and greater availability of antiretroviral drugs in Malaysia since 2005, the number of HIV-infected patients receiving treatment remains disproportionately small. Barriers to greater access include a lack of trained human resources to deliver antiretroviral therapy (ART) in a highly individualized and specialized model and, until recently, a lack of treatment for substance abuse in a predominantly injecting drug-use epidemic. However, one of the biggest barriers, and perhaps the most challenging to overcome, is the stigma and discrimination towards HIV-infected people, especially injecting drug users, which prevented many from accessing treatment and care. Increasing and improved access to ART for HIV-infected patients will entail a multipronged strategy that includes the decentralization of clinical care, increased and ongoing training of healthcare workers and support staff, and a comprehensive and intensive effort to reduce stigma and discrimination. Creation of an enabling environment through public education and a well-trained and nonprejudicial healthcare work force, coupled with policy and legal reforms, are essential in ensuring a greater and sustainable access to ART for all.

Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia

BackgroundMalaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components.Methods and FindingsThe methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%–76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high—25%–38% and 100%–140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector.ConclusionsThe free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required.

Risk of hospitalization for upper gastrointestinal tract complications associated with non-selective non-steroidal anti-inflammatory drugs in Malaysia: a retrospective case control study

Aims: To assess the association between non-steroidal anti-inflammatory drug (NSAID) use and upper gastrointestinal (GI) tract-related hospitalizations and to evaluate inpatient healthcare resource utilization associated with these complications in Malaysia. Methods: A retrospective case control study was performed using medical records of patients admitted to two Malaysian hospitals during 1999 and 2000. Cases were identified based on mode of presentation at hospital admission. One control was identified for each case, matched by age, sex and admission date. NSAID exposure was determined by drug use during one year prior to admission. Conditional logistic regression analysis was used to determine the association between NSAID use and upper GI complications, adjusting for predictors. Results: The 273 cases were significantly more likely to have used NSAIDs in the year prior to hospitalization than controls (27.8%vs. 6.2% of patients; P < 0.0001). Conditional logistic regression analysis adjusting for other predictors showed that the odds of being hospitalized for upper GI tract complications were 4.1 times higher among NSAID users than non-users (95% CI = 1.88–9.12). Other risk factors for GI-related hospitalizations were a history of upper GI tract complications (OR = 5.8, 95% CI = 1.28–26.53), use of gastroprotective agents (OR = 5.3, 95% CI = 1.67–16.79), and use of antacids (OR = 5.0, 95% CI = 2.10–11.91) in the previous year. Conclusion: This study demonstrated that NSAID exposure was significantly higher among patients hospitalized for GI-related complications than for other reasons, indicating that NSAID use is an independent risk factor for upper GI tract complications in this Malaysian sample.

Guidelines planned for online sale of drugs in Malaysia

Guidelines planned for online sale of drugs in Malaysia

The Drug Information Service at a University Hospital in Malaysia: Characteristics of Drug Inquiries

A retrospective review of the records of drug inquiries received by the Hospital Universiti Sains Malaysia Drug Information Unit (DIU) was undertaken to provide baseline data for future development...

A Follow-up Study: Assessing the Effectiveness of Malaysia's Drug Rehabilitation System

In order to assess the effectiveness of Malaysia's massive anti-drug campaign, a follow-up study was conducted in 1987-88. In this study, the incidence of newly identified drug abusers, demographic variables and drug usage trends are examined as one method of assessing the effectiveness of the Malaysian effort. In addition, those components of the Malaysian rehabilitation system that would be most applicable to the American effort were discussed.

Assessing the effectiveness of Malaysia's drug prevention education and rehabilitation programs

The multifaceted drug prevention education and rehabilitation system of Malaysia appears to have contributed to the steady decrease of the number of identified drug abusers in the country. In this article, those components of the Malaysian system that would be most applicable to the American effort were examined. In the same manner, because the fastest growing minority group in the United States are Asian Americans, in which a significant proportion involve persons from Southeast Asia, those components in the Malaysian system that are applicable to Southeast Asian Americans were examined.

Malaysia' Rehabilitation System: A Challenge to the Drug Problem

Because of the seriousness of the drug problem in Malaysia, the country declared a national emergency on February 19, 1983, and launched a massive effort in law enforcement, preventive education and rehabilitation. In this article, the magnitude of Malaysia's drug problem and their highly developed rehabilitation system will be discussed.