Drug safety

PINOY KASI


Drug safety
By Michael Tan
Inquirer

Last updated 01:33am (Mla time) 03/16/2007

MANILA, Philippines -- A man wakes up in the middle of the night with diarrhea, gropes around and takes what he thinks are anti-diarrheal tablets. Next thing you know, he’s trying to kill his wife.

Over in Cavite province, men have started making decoctions out of a popular ornamental called coral plant, supposedly to enhance their virility. Yet, as early as 1921, Leon Maria Guerrero, an authority on Philippine medicinal plants, already wrote about the plant being a dangerous cathartic, meaning it causes severe diarrhea. In another botany book, “Burkill’s Dictionary of Economic Products of the Malay Peninsula,” I found out that the plant was used for “criminal poisoning” in Latin America.

The US Food and Drug Administration (FDA) estimates that there are some 2 million serious adverse drug reactions (ADRs) each year in the United States, leading to about 100,000 fatalities and making ADRs the fourth leading cause of death in the country.

We don’t have estimates on such cases and fatalities in the Philippines, but I am certain they are quite high. There are probably cases where people die of the medicines they were taking, without the family ever realizing it. Many medicinal plants, for example, have low levels of the dangerous substances, but these can accumulate; so even the persons taking the decoctions may not know they are being slowly poisoned.

The causes of ADRs in the country include carelessness among health professionals, a lack of health literacy among Filipinos, inadequate instructions on drug products, and unclear advice from health providers. I’d say, even the barrage of drug advertising, by proclaiming particular medicines as safe—when in fact, no drug, not even your “ordinary” pain-killers, not even your medicinal plants, is truly safe—contributes to ADRs.

The two cases I cited at the beginning of this article were brought up by speakers at the recent convention of the Society of Hospital Pharmacists. Dr. Kenneth Hartigan-Go, who is a physician specializing in pharmacology, gave the story about the anti-diarrheals, which I’ll explain in greater detail in a while. Another speaker, Dr. Annabelle Reyes Borromeo, is a nurse and management expert who shared experiences from her work in American hospitals, including how Filipina nurses get into serious trouble because of a lack of consciousness about drug safety. I was the third speaker and I concentrated on cultural aspects that affect drug safety, including a discussion on some of the problems that come with traditional medicines.

The hospital pharmacists are your unsung heroines (and a few heroes . . . it’s a very female profession). You rarely see them but they work quietly in the hospital pharmacies, checking and double-checking medicines that have been prescribed and preparing them in the right doses so they can be dispensed safely.

Outside the hospital though, we don’t have these pharmacists checking on what we take, so I thought I’d take off from the horror stories shared at the convention and go straight to a very basic drug safety measure: Know what your medicine is.

Names, names

How do you get to know about the medicines you’re taking? The key is the generic name, which in the Philippines is printed in a box above the brand name. Unfortunately, medicines in other countries often have the generic names in very small print. Sometimes, the generic names aren’t just printed.

The case Dr. Hartigan-Go gave as an example involved a man who had worked overseas and had brought home one of the medicines he had been prescribed while abroad. The name was Dia-tabs, which, as we know is an anti-diarrheal in the Philippines. But in the country the man was working, it was the brand name for a diabetes drug.

When diarrhea struck this overseas worker in the middle of the night, he forgot that his Dia-tabs was an anti-diabetic, not an anti-diarrheal. He took several tablets, basically overdosing himself with an anti-diabetic, and this caused chaos in his blood sugar, which then drove him into the psychosis that made him want to kill his wife. When you think more about it, those few tablets could have caused two deaths.

So, learn to recognize your medicines by their generic names, and what they do. This is especially important in our age of the Filipino diaspora. So many Filipinos come home from overseas, bringing with them medicines with missing labels, or with brand names that can be confusing.

But the brand name problem applies even to local drugs. Medicol, a common drug, used to be paracetamol. And then the manufacturers decided to change it to ibuprofen, which is also a pain killer but which requires different precautions. Paracetamol’s side effects, caused by high and frequent doses, are mainly on the liver. Ibuprofen, on the other hand, even with the right dose, can cause severe allergy reactions, because people are sensitive to that drug and its relatives like aspirin.

Another reason why you need to know your medicine’s generic name is to be sure that you don’t “duplicate” it. If you consult two different doctors, as many Filipinos do, they may prescribe the same drug but with a different brand name. That could cause an overdose.

“Generic literacy” applies even to traditional medicine. The coral plant’s scientific name is Jatropha multifida. One look at the plant and I could tell it was a relative of Jatropha curcas, or "tubang-bakod," which also has cathartic effects and which is being studied as a source of biofuels.

Remember, too, that drugs can interact with each other, so you have to be prepared by knowing what drugs you’re taking.

For example, if your dentist wants to inject the local anesthetic lidocaine, you should inform her about the drugs that you’re currently taking. Lidocaine can amplify the effects of such medicines as hypotensives (lowering blood pressure) and tranquillizers.

There is no such thing as a totally safe drug. Antihistamines or anti-allergy drugs, for example, often cause drowsiness. So if you need to drive, or handle machinery that requires alertness, you have to be extra careful about those medicines. Be aware, too, that these anti-allergy medicines are also often found in cold remedies.

How can you keep track of the generic names? For now, you might want to buy a copy of MIMS, available in most bookstores, but be aware that this is produced by the drug industry and contain very minimal information. It’s very weak on safety issues, and does not include products that use medicinal plants. (This is understandable since such products are approved as food supplements rather than as drugs.)

I use MIMS mainly to double-check on the generic names of drugs, and then use that generic name to get more reliable information from medical textbooks and from the Internet. But be careful too when using the Internet. Not all the information there is reliable.