Pharmacy Outlets Research Articles

Perceptions of Pharmacy Owners and Drug Inspectors about the Storage of Medicines on Required Temperature Inside the Pharmacy Outlets in Rural Areas of Sindh, Pakistan

Perceptions of Pharmacy Owners and Drug Inspectors about the Storage of Medicines on Required Temperature Inside the Pharmacy Outlets in Rural Areas of Sindh, Pakistan

Identifying high risk medications causing potential drug-drug interactions in outpatients: A prescription database study based on an online surveillance system.

Drug-drug interactions (DDIs) are a significant cause for adverse drug events (ADEs). DDIs are often predictable and preventable, but their prevention and management require systematic service development. Most DDI studies focus on interaction rates in hospitalized patients. Less is known of DDIs in outpatients, particularly how community pharmacists could contribute to DDI management by applying their surveillance systems for identifying high-risk medications. The study was related to the implementation of the first online DDI surveillance system in Finnish community pharmacies. The goal was to demonstrate how community pharmacies can utilize their prospective surveillance system 1) for identifying high risk medications causing potential DDIs in outpatients, 2) for collaborative service development with local physicians, and 3) for academic risk management research purposes. All DDI alerts given by the online surveillance system were collected during a one-month period in 16 out of 17 University Pharmacy outlets in Finland, covering approximately 10% of the national outpatient prescription volume. The surveillance system was based on the FASS database, which categorizes DDIs into four classes (A-D) according to their clinical significance. Potential drug-drug DDIs were analyzed for 276,891 dispensed community pharmacy prescriptions. Potential DDIs were associated with 10.8%, or 31,110 of these prescriptions. Clinically significant interaction alerts categorized as FASS classes D (most severe, should be avoided) and C (clinically significant but controllable) were associated with 0.5% and 7.0% of the prescriptions, respectively. Methotrexate and warfarin had the highest risk of causing potentially serious (class D) interactions. These interaction alerts were most frequently between methotrexate and NSAIDs and warfarin and NSAIDs. In general, NSAIDs were the most commonly interacting drugs in this study. This study demonstrates that community pharmacies can actively contribute to DDI risk management and systematically use their surveillance systems for identifying patients having clinically significant DDIs. The findings also indicate that the majority of potentially serious interactions in outpatients involve a limited number of drugs, particularly NSAIDs, warfarin and methotrexate. Further research should focus on community pharmacists' involvement in DDI risk management in collaboration with local health care providers.

DETERMINATION OF ELEMENTAL IMPURITIES IN SOME COMMERCIAL PAEDIATRIC AND ADULT FORMULATIONS OF ARTEMETHER – LUMEFANTRINE IN THE NIGERIAN MARKET BY ATOMIC ABSORPTION SPECTROSCOPY

The composition of elemental impurities in paediatric powder for suspension (PPS) and double strength tablet (DST) commercial anti-malarial formulations of artemether-lumefantrine (AL) were determined. Six randomly selected PPS and DST products from a list of marketed products were purchased from a registered Pharmacy outlet and analyzed using flame atomic absorption spectrophotometer. The heavy metal levels were compared with the official limits for permitted daily exposure. The paediatric and adult products of AL presented the same types and number of elements with a total of 10 metals and levels ranging from 0.001-0.016 and 0.001-0.017ppm for the PPS and DST formulation, respectively. One of the DST and PPS products had significantly higher levels of cadmium, copper, chromium, nickel and cobalt compared with their respective formulation types (p<0.05). There was significant difference in the levels of chromium, nickel and cobalt but no difference in the levels of cadmium, lead, zinc and arsenic when DST and PPS products were compared (p<0.05). The drug products presented elemental oral exposure significantly lower than the permitted daily exposure. The levels of elemental impurities are satisfactory with respect to safety requirements. These impurities may adversely affect drug stability, shelf-life and bioequivalence of the products. Key words : Elemental impurities, Permitted Daily Exposure, Artemether-lumefantrine, Paediatric Powder for Suspension, Double Strength Tablets

PTU-159 Comparison of three commercially available point of care tests for coeliac disease: Abstract PTU-159 Table 1

<h3>Introduction</h3> Coeliac disease (CD) remains underdiagnosed. A rapid point of care test (POCT) may increase uptake of serological testing in appropriate patient groups. 3 POCTs are commercially available in the UK and in continental European pharmacy outlets: Biocard an IgA tissue tranglutaminase (tTG) test (BHR pharmaceuticals); Celiac Quick Test (Biohit Healthcare) detecting IgA, IgG and IgM tTG and Simtomax (Tillotts Pharma) which detects IgA and IgG antibodies against deamidated gliadin peptides (DGP). A fourth POCT has also been developed but not marketed (Xeliac Test Pro, Personal Diagnostics), with availability being solely from the manufacturer and no published data existing supporting its validity. Of the 3 commercially available POCTs, there is a limited evidence base with significant ascertainment bias. For this reason we decided to compare 3 commercially available tests in an endoscopic setting. <h3>Method</h3> Patients referred with a positive endomysial antibody (EMA) for duodenal biopsy to confirm CD were recruited. All patients had repeat serum EMA, tTG and immunoglobulins and were tested simultaneously with the 3 POCTs as per the manufacturers’ instructions. All patients had quadrantic duodenal biopsies from the second part of the duodenum as well as a duodenal bulb biopsy. Demonstration of villous atrophy (VA) was required to diagnose CD. <h3>Results</h3> 82 patients (51.2% female, mean age 41.0) have been recruited. In 10 patients the EMA had normalised on repeat testing. None of these patients had VA on duodenal biopsy. 9 of these patients were referred with a weak EMA and had a negative tTG. One patient had a tTG of 10 times the upper limit of normal, and subsequent gluten challenge revealed a positive EMA and VA. Of the remaining 72 patients 59 new cases of CD were confirmed with the presence of villous atrophy, of the 13 EMA positive patients without VA 8 had Marsh 1 or 2 changes present with the remaining 5 patients having normal histology. Full sensitivity, specificity PPV and NPV for all of the tests compared to VA on duodenal biopsy are shown in Table 1. <h3>Conclusion</h3> In this pilot data set Simtomax appears to be the most sensitive of the POCTs when compared to histology with similar results to serum tTG as screening test. Further work is required in larger cohorts and lower prevalence populations to confirm the utility of these tests in adult CD. <h3>Disclosure of interest</h3> P. Mooney: None Declared, S. Wong: None Declared, M. Burden: None Declared, M. Kurien: None Declared, M. Hadjivassiliou: None Declared, D. Sanders Grant/ Research Support from: BHR pharmaceuticals; Tillotts Pharma for investigator led studies.

Sa1307 Comparison of Three Commercially Available Point of Care Tests for Celiac Disease

Introduction Coeliac disease (CD) remains underdiagnosed. A rapid point of care test (POCT) may increase uptake of serological testing in appropriate patient groups. 3 POCTs are commercially available in the UK and in continental European pharmacy outlets: Biocard an IgA tissue tranglutaminase (tTG) test (BHR pharmaceuticals); Celiac Quick Test (Biohit Healthcare) detecting IgA, IgG and IgM tTG and Simtomax (Tillotts Pharma) which detects IgA and IgG antibodies against deamidated gliadin peptides (DGP). A fourth POCT has also been developed but not marketed (Xeliac Test Pro, Personal Diagnostics), with availability being solely from the manufacturer and no published data existing supporting its validity. Of the 3 commercially available POCTs, there is a limited evidence base with significant ascertainment bias. For this reason we decided to compare 3 commercially available tests in an endoscopic setting. Method Patients referred with a positive endomysial antibody (EMA) for duodenal biopsy to confirm CD were recruited. All patients had repeat serum EMA, tTG and immunoglobulins and were tested simultaneously with the 3 POCTs as per the manufacturers’ instructions. All patients had quadrantic duodenal biopsies from the second part of the duodenum as well as a duodenal bulb biopsy. Demonstration of villous atrophy (VA) was required to diagnose CD. Results 82 patients (51.2% female, mean age 41.0) have been recruited. In 10 patients the EMA had normalised on repeat testing. None of these patients had VA on duodenal biopsy. 9 of these patients were referred with a weak EMA and had a negative tTG. One patient had a tTG of 10 times the upper limit of normal, and subsequent gluten challenge revealed a positive EMA and VA. Of the remaining 72 patients 59 new cases of CD were confirmed with the presence of villous atrophy, of the 13 EMA positive patients without VA 8 had Marsh 1 or 2 changes present with the remaining 5 patients having normal histology. Full sensitivity, specificity PPV and NPV for all of the tests compared to VA on duodenal biopsy are shown in Table 1. Conclusion In this pilot data set Simtomax appears to be the most sensitive of the POCTs when compared to histology with similar results to serum tTG as screening test. Further work is required in larger cohorts and lower prevalence populations to confirm the utility of these tests in adult CD. Disclosure of interest P. Mooney: None Declared, S. Wong: None Declared, M. Burden: None Declared, M. Kurien: None Declared, M. Hadjivassiliou: None Declared, D. Sanders Grant/ Research Support from: BHR pharmaceuticals; Tillotts Pharma for investigator led studies.

Pharmacoeconomics of Selected Essential Medicines for Chronic Diseases in Bhiwani District, Haryana, India

Introduction: Medicines represent a substantial proportion of the economic costs for treating chronic diseases. In low and middle income countries (LMIC) 50–90% of the population have to pay for medicines themselves. Inappropriate access and availability of essential medicines contribute substantially to out-of-budget expense. A significant population of developing countries (up to 90%) purchase medicines through out-of-pocket payments. This research study was conducted to investigate the comparative availability and relative price to patient for selected essential medicines used in the treatment of chronic diseases in Bhiwani district. Material and methods: A research study on availability and price to patient for selected essential medicines used in the treatment of chronic diseases was conducted. Standardized methodology of World Health Organization and Health Action International was employed. The research study was conducted on retail pharmacy outlets of Bhiwani District, i.e., residential areas of Bhiwani city and five administrative areas of Bhiwani district. Results:Overall percent availability of the most of the surveyed medicines used in the treatment of chronic diseases was found to be less than 50%. Huge difference in price of brands/generics was found in different administrative areas for a single brand/generic of each surveyed medicine. Conclusions: Dissemination of well documented information on availability and relative price to medicine consumers in all residential areas may enhance consumer demand for lower price medicine and thus may serve to enhance the availability of demanded medicine (lowest priced) in all the areas of Bhiwani district.

Comparative Analysis of Five Brands of Lisinopril Tablets in Yemeni Market

Background: In poor countries such as Yemen, the cost of drugs is a factor affecting the patient’s decision to buy it and generic medicines are introduced as cheaper alternatives to the high cost brands. However, it has been believed that generic medicines are inferior in quality compared to the branded medicines. Thus, the aim of the present study is to investigate the physicochemical equivalence of five brands of tablets containing Lisinopril (antihypertensive) sourced from different retail pharmacy outlets in the Yemeni market. Methods: The quality and physicochemical equivalence of five different brands of Lisinopril tablets were assessed. The assessment included the evaluation of uniformity of weight, friability, crushing strength, disintegration and dissolution tests as well as chemical assay of the tablets. Results: Results obtained showed that all five brands of the Lisinopril 5 mg tablets passed the British Pharmacopoeia (BP) standards for uniformity of weight, the crushing strength/hardness test and the friability test. All the brands passed the disintegration test and standard assay of content of active ingredients Conclusion: The five brands of Lisinopril 5mg tablets that were analysed passed all the BP quality specifications and were physically and chemically equivalent. All tested formulations were found to be equivalent.

Antibiotic Use in Some Nigerian Communities: Knowledge and Attitudes of Consumers

Purpose: To assess the knowledge and attitude of consumers in Jos, Nigeria towards the use of antibiotics. Methods: A cross-sectional questionnaire survey involving 430 clients of registered community pharmacy outlets located in some communities in Jos, Nigeria was conducted in November, 2011. Data collected were analysed using SPSS version 16 and logistic regression was used to determine independent predictors of low antibiotic knowledge. Results: About 56.5 % of respondents reported using an antibiotic within a month preceding the survey, with a prevalence of 22.3 % of self-medication use of antibiotics among respondents. The antibiotic knowledge assessment test revealed that 30.5% of respondents had low knowledge; while 40.9% and 28.6 % of respondents had intermediate and high knowledge levels respectively. Respondents’ educational level was the only demographic predictor (p < 0.01) of low antibiotic knowledge found, as those with primary level of education were more likely (OR = 13.224; CI = 3.296-53.052) to have low antibiotic knowledge than those with tertiary education. Respondents showed negative attitude (< 50 % positive response rate) in about 60 % of the attitude statements they responded to. The most common negative attitudes demonstrated by respondents were their expectation to be prescribed an antibiotic for cold (66.3 %) and taking an antibiotic when they have cold to get better quickly (60.9 %). However, respondents demonstrated positive attitudes in looking at the expiry dates of antibiotics before using them (93.3 %), and taking antibiotics according to the instructions on the label (84.2 %). Conclusion: The study showed that inadequate antibiotic knowledge and negative attitudes towards antibiotics use exists among consumers.

Comparative in - Vitro Pharmaceutical Evaluation of Four Brands of Metronidazole Tablets Marketed in Gulf Region = مقارنة التقييم الدوائي المختبري لأربع علامات تجارية من حبوب الميترونيدازول المتداولة في منطقة الخليج الشرق الأوسط

Metronidazole is an antiprotozoal drug which is also effective against anaerobic bacteria. It exhibits pronounced in-vitro and in-vivo activity against Trichomonas vaginalis and E. histolytica. Many different brands and dosage forms of Metronidazole are available in the gulf countries that place physicians and pharmacists in a dilemma of drug substitution in case of non availability of a particular brand. The present study was aimed to evaluate the pharmaceutical equivalence of four brands of 250 mg Metronidazole tablets marketed in Middle East countries. Four brands of Metronidazole tablets were purchased locally from the retail pharmacy outlets in Muscat, Oman and their solubility, partition coefficient (log P) and pharmaceutical quality were assessed by using in-vitro tests as per the United States Pharmacopoeia (USP) and unofficial standards as recommended by the manufacturers. Selected brands of Metronidazole were found to be highly soluble, highly permeable and also passed all the official and unofficial in- vitro quality control tests prescribed for the tablets except hardness test. All brands of Metronidazole tablets released more than 70% of their drug content within 45 minutes. Thus, based on the above results, it can be concluded that tested brands of Metronidazole tablets being eligible for biowaiver, are pharmaceutically equivalent and therefore can be considered for drug substitution for each other.

Cambodian Ministry of Health Takes Decisive Actions in the Fight against Substandard and Counterfeit Medicines

Cambodia's Ministry of Health and the Department of Drugs and Food have been actively working to reduce the amount of poor quality medicines circulating in the pharmaceutical sector since fake mefloquine and artesunate were first found in 1998. From 2005-2012, legal private sector facilities and illegal outlets in twelve Cambodian provinces were targeted for routine surveillance of medicine quality through sample collection and testing of various anti-infective medicines, the majority of which were anti-malarials and anti-biotics. The Medicine Quality Monitoring program samples from the field were analyzed through a three level approach including field and advanced laboratory testing. 4,381 medicines were collected and tested from 2005-2012; 106 have failed quality testing resulting in an overall failure rate of 2.4%. 28 of the failed samples (26.4%) were counterfeit. The most commonly found counterfeit medicines were chloroquine, artesunate, mefloquine, ampicillin and penicillin. Cambodia has closed over 99% of illegal pharmacy outlets through the Inter-Ministerial Committee to Fight against Counterfeit & Substandard Medicines (IMC) by the end of November 2011. In the past, a lack of resources as well as coordination among the various ministries was identified as a major barrier in combating the presence of poor quality medicines. With financial support from USAID, PMI, and other donors, paired with the technical support from the U.S. Pharmacopeial Convention Promoting the Quality of Medicines program, the IMC developed an action plan to significantly reduce the number of substandard and counterfeit medicines. Based on the data shown, the plan has been successful in reducing the failure rates of samples collected in Cambodia from a high of 7.4% in 2006 to a low of 0.7% in 2011. Continued efforts to monitor and actively ensure the quality of medicines in Cambodia will be required to maintain these low rates; sustainability of these efforts is critical.

Microbial Quality of some Herbal Products in Benue State

The study was conducted to investigate the microbial qualities of some herbal products in Benue State, Nigeria. A total of twenty-one samples were randomly collected from herbal medicine sales outlets and retail pharmacy outlets and subjected to bacteriological examination using pour plate and modified pour plate method for isolation of bacteria and fungi colonies respectively. Gram reaction, Potassium Hydroxide string techniques and Biochemical analysis were used for identification of bacterial isolates. While fungi colonies were identified using simplified key to classes of fungi. Four microorganisms namely Escherichia coii, Salmonella typhi, Staphylococcus aureus and Fungi namely Aspergillus sp., Mucorsp., Fusarium sp. , and Rhizopus sp . were also found to be implicated in some of the samples examined. The total bacterial counts for Escherichia coii, Staphylococcus aureus, Salmonella typhi and Fungi ranged from 1.50 × 10 3 -13.0×10 3 , 1.0×10 3 -4.0×10 3 , 1.0×10 2 -1.5×10 2 and 1.2×10 4 -6.0×10 3 cuf/ml respectively. The microbial load of the products varied considerably. Six (28.6%) of the samples were without microbial contamination while fifteen (71.4%) were contaminated by one or more of the microorganisms isolated. 7(33.3 %) of the samples were contaminated by E. coli, 1 (4.8 %), 5(23.8%) Staphylococcus aureus , 3(27.3%) Aspergillus sp. , 4(36.4%) Mucorsp ., 2(18.2%) Fusarium sp . and 2(18.2%) Rhizopus sp. respectively. This research indicated that herbal medicinal products in Benue region of Nigeria required an urgent attention in process improvement to provide better quality products for consumers.

Impact of educational intervention on knowledge of dispensers working at community pharmacies in Pakistan

To evaluate the impact of training of dispensers on knowledge of dispensers working at community pharmacies in context to storage temperature, prescription terminologies and status of medicines in Islamabad, Pakistan. A randomized, controlled, blinded intervention study was designed and implemented. Before the implementation of intervention, a baseline study was performed to assess the knowledge of dispensers working at community pharmacies. The study population included all community pharmacy outlets in Islamabad. Pharmacies of Islamabad which were visited in pre intervention phase (n=118) were divided into two geographical regions: A (intervention) and B (control). Thirty pharmacies were randomly selected from each region. Keeping in view the results of the baseline study an educational intervention was designed to improve the knowledge of dispensers working at community pharmacies in Pakistan. A significant difference in the overall knowledge of dispensers was observed between the pre-post intervention groups. Knowledge of dispensers regarding storage of drugs, prescription terminologies and status of drugs was improved after the training. On the other hand no significant difference was observed between the pre-post control groups. The study has highlighted that improvements in knowledge of dispensers working at community pharmacies are possible through suitable interventions. But, results of interventions can only be sustainable through continuous monitoring and reinforcement of the training.

Patterns and Predictors of Non-Prescription Medicine Use among Malaysian Pharmacy Patrons: A National Cross Sectional Study

ObjectiveThe study aims to evaluate the predictors of non-prescription medicine purchasing patterns among pharmacy patrons in Malaysia.MethodsA cross-sectional nationwide study was undertaken in 2011 in sixty randomly selected community pharmacies across 14 Malaysian states. A pharmacy exit survey was conducted over a 6-month period across Malaysia. A one-stage random cluster sampling technique was employed as there was no national sampling framework available for conducting this survey. Face-to-face interviews using a validated and pre-tested questionnaire were conducted by trained data collectors. The non-prescription medicine purchasing pattern was explored and analysed descriptively. Chi-square/Fisher exact test was used to determine the association between study variables. Multinomial logistic regression analysis was used to determine the predictors of type of non-prescription medicine purchased.ResultsA total of 2729 pharmacy patrons agreed to participate in 60 selected pharmacy outlets. A total of 3462 non-prescription medicine were purchased during the study period with an average of 1.3 medicines per participant. Most of the non-prescription medicine purchased was meant for alimentary tract and metabolism (31.8%), followed by respiratory system (19.4%) and musculoskeletal system (15.8%) usage. Factors found to be associated with the choice of non-prescription medicine purchased were age group [χ2 = 170.75, (df = 57), p<0.01], locality [χ2 = 48.16, (df = 19), p<0.01], gender [χ2 = 32.93, (df = 13), p = 0.002], ethnic group [χ2 = 118.89, (df = 39), p<0.01] and type of occupation [χ2 = 222.434, (df = 117), p<0.01]. Non-prescription medicine purchased defined about 20% of the variance in the combination of predictors such as locality, gender, age, ethnicity, type of occupation and household income.ConclusionThe predictors for selection of non-prescription medicine were locality (urban or rural), gender, age, ethnicity, type of occupation and household income per month. Future studies need to explore the safety and effectiveness of using these non-prescription medicines.

Community Pharmacy/Hospital Based Assessment of Clinical Pharmacist Intervention for Safe and Effective Drug Use

The purpose of the work was to evaluate the extent of interception of prescriptions requiring review for drug order that could have led to adverse drug events or irrational drug use in the community and public hospital pharmacy unit. Three government hospitals and community pharmacy outlets in Ikot Ekpene senatorial district in Akwa Ibom state, Nigeria were selected for the study which lasted 4 months. The pharmacists in the various units were inducted into the purpose of the work and the associated documentation processes. The data collected were patient’s details, reasons for the intervention, doctor’s contact details. The years of experience of the pharmacists in the community was significantly higher than those in the hospital setting in the study (P<0.05). Within the study period, 698 and 1280 interventions were noted in the community and hospital units respectively. The prevalence of pharmacists intervention in terms of ratio of prescriptions generated and interventions made in the hospital was not significantly higher than in the community setting (P<0.05). There was no significant difference in the ratio of therapy/information to safety intervention for the two units of practice but there was significant difference in the frequency of safety to therapy/information intervention within the individual units (P<0.05).The percentage frequency of the safety interventions recorded in the hospital and community pharmacy units were thirty two percent (32) and thirty eight percent (38%) respectively. Active screening of prescriptions that leads to effective pharmaceutical interventions during dispensing process can provide useful contribution to healthcare delivery.

Impact of Training of Dispensers on Case Management of Acute Respiratory Tract Infections at Community Pharmacies in Pakistan

Purpose: To evaluate the impact of training of dispensers on the process of case management of ARI at community pharmacies in context to history taking and provision of advice working at community pharmacies in Islamabad, Pakistan. Method: A randomized, controlled, blinded intervention study was designed and implemented. Before the implementation of intervention, a baseline study was performed to assess the process of case management for ARI at community pharmacies. The study population included all community pharmacy outlets in Islamabad. After data collection, data was analyzed. The result of the study revealed that the overall process of disease management of ARI at community pharmacies in Pakistan is not satisfactory. Pharmacies of Islamabad which were visited in pre intervention phase (118) were divided into two geographical regions A (intervention) and B (control). From which thirty pharmacies were selected randomly from each region. The targeted group of the interventions was drug sellers. Keeping in view the results of the base line study an educational intervention was designed to improve the case management of ARI at community pharmacies in Pakistan. Results: No significant difference (p ≤ 0.05) was seen in the process of history taking and advice provision in case of ARI management at community pharmacies between pre and post control groups. On the other hand significant difference in the process of history taking and provision of advice for ARI was observed in the intervention group before and after training. Conclusion: The study has highlighted that improvements in the current dispensing practices at community pharmacies are possible through appropriate educational interventions. The dispensers have the potential to provide fast and low cost healthcare to the masses in the country where the presence of doctors and qualified pharmacist is low; to date they are an untapped and underutilized source in the country.

Knowledge, treatment seeking and preventive practices in respect of malaria among patients with HIV attending Lagos University Teaching Hospital, Nigeria.

The synergistic interaction between Human Immunodeficiency virus (HIV) disease and malaria makes it mandatory for patients with HIV to respond appropriately in preventing and treating malaria. Such response will help to control the two diseases. This study assessed the knowledge of 495 patients attending the HIV clinic, in Lagos University Teaching Hospital, Nigeria. Their treatment seeking, preventive practices with regards to malaria, as well as the impact of socio-demographic / socioeconomic status were assessed. Out of these patients, 245 (49.5%) used insecticide treated bed nets; this practice was not influenced by sociodemographic or socioeconomic factors. However, knowledge of the cause, knowledge of prevention of malaria, appropriate use of antimalarial drugs and seeking treatment from the right source increased with increasing level of education (P < 0.05). A greater proportion of the patients, 321 (64.9%) utilized hospitals, pharmacy outlets or health centres when they perceived an attack of malaria. Educational intervention may result in these patients seeking treatment from the right place when an attack of malaria fever is perceived.

Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study

BackgroundIn order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK.MethodsWe used data on general hospital presentations for non-fatal self-harm for 2002 - 2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings.ResultsThere were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36).ConclusionsThe difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant.

Quality and influence of tropical storage conditions on amoxicillin formulations marketed in ethiopia

The quality of drugs in some less developed countries is inadequate. The quality of drugs in countries having a tropical climate may be adversely affected if their formulations have not been optimized forstability under these conditions. Amoxicillin is a broad-spectrum penicillin, active against certain Gram negative and Gram-positive organisms, and is a widely used. There are currently severalformulations of it in Ethiopia. The aim of the present study was to investigate the physicochemical equivalence of eight brands of amoxicillin capsules and five brands of amoxicillin for oralsuspensions sourced from different retail Pharmacy outlets in Addis Ababa, Ethiopia market and to study the effect of tropical storage conditions on the their quality with respect to the USP and BPrequirements using the WHO guidelines. The assessment included the evaluation of uniformity of weight, identification, moisture content, dissolution profiles and the pH values of the reconstitutedoral suspensions in addition to the quantitative determination of the amoxicillin content for the studied formulations. Almost all of the amoxicillin formulations examined met Pharmacopoeial requirements at zero time, three-months and six months after storage under tropical condition.

Paracetamol availability in pharmacy and non-pharmacy outlets in Dublin, Ireland

In 2004, there were 11,092 presentations to Irish hospitals with deliberate self-harm, including 7,933 cases of drug overdose, of which 31% involved paracetamol. Limiting the availability of paracetamol reduces morbidity and mortality associated with paracetamol overdose. The present study aimed to determine the level of compliance with statutory regulations governing the sale of paracetamol in Ireland. Researchers visited pharmacy (n = 20) and non-pharmacy outlets (newsagents, mini-markets and supermarkets) (n = 50) in Dublin city and attempted to purchase amounts of paracetamol that exceeded the statutory limits for a single transaction. Amounts of paracetamol in excess of statutory limits for a single transaction were purchased in 50.0% of pharmacies, 81.8% of newsagents/mini-markets and 20.0% of supermarkets. One year later, we again visited pharmacy (n = 20) and non-pharmacy outlets (n = 50) in Dublin city and purchased amounts of paracetamol in excess of statutory limits in 50.0% of pharmacies, 52.3% of newsagents/mini-markets and 10.0% of supermarkets. We recommend that (a) notwithstanding the improvement in compliance rates in newsagents/mini-markets, the sale of paracetamol in these outlets should be discontinued; (b) the sale of paracetamol in supermarkets should continue, although automated checkout tills should be appropriately re-programmed; and (c) there should be greater efforts to ensure compliance with statutory regulations in pharmacies.

IN–VITRO PHARMACEUTICAL EVALUATION OF TWO BRANDS OF DISPERSIBLE ACETYL SALICYLIC ACID TABLETS AVAILABLE IN OMAN

Acetyl salicylic acid (ASA), a non-steroidal anti-inflammatory drug (NSAID) is widely used for its analgesic, antipyretic, antiinflammatory and anti-thrombotic action. The aim of the present study was to investigate the pharmaceutical equivalence of two brands of dispersible ASA tablets marketed in Oman. Two different brands of dispersible ASA tablets (300mg) were purchased from the retail pharmacy outlets and their pharmaceutical quality were assessed by using in-vitro tests as per the British Pharmacopoeia (BP) and unofficial standards as recommended by the manufacturers. The assessment of tablets included the evaluation of uniformity of weight and diameter, friability, crushing strength, disintegration and chemical assay by volumetric titration and colorimetric methods to determine the content of active pharmaceutical ingredient (API). Both brands of the ASA tablets passed the BP standards for uniformity of weight and diameter, disintegration, friability and crushing strength. However one of the two brands did not comply with the standard assay of content of active ingredient. Thus based on these results it can be concluded that these two brands of ASA are not pharmaceutically equivalent. Key words: ASA tablets, pharmaceutical equivalence, disintegration, volumetric method.