Ofloxacin 200 mg tablet.

Question: Will I eat ofloxacin 200 mg before or after a meal?

Answer: By Pharmacist.
Ofloxacin can be administered without thinking about the effects of food because it can be eaten either before or after a meal. But for the convenience of the patient, it is generally recommended to be administered after a meal. And should avoid eating with antacids, iron (ferrous sulfate, ferrous fumarate, etc.), or zinc. Ofloxacin should be eaten separately from another drugs (antacids, iron, zinc) for 2 hours.

Proluton

Question: What is proluton?

Answer: Proluton is the trade name of hydroxyprogesterone caproate which is the progesterone hormone.

Indications are:

-  Prevent habitual and imminent abortion.

-  For case that can not be pregnant naturally. (Infertility due to the growth of the corpus luteum deficiency)

-  To treat primary and secondary amenorrhea.

References:

- Hydroxyprogesterone caproate. In: DRUGDEX System [database on the internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.

Emergency contraceptive

Question: If I ate emergency contraceptive, how do I know whether pregnant or not?

Answer: Emergency contraceptive pills are quite effective in preventing pregnancy, it produces endometrial changes unsuitable for implantation of fertilized egg. But it cannot prevent pregnancy 100%. So if menstruation errors more than predicted, may suspect pregnancy (however, the emergency contraceptive may cause menstruation period too late or maybe faster than expected about 1 week.

In addition, pregnant women may have early symptoms, these include fatigue, frequent urination. And at about 6 weeks of pregnancy may have nausea and vomiting.

So, it is recommended that you should be tested for pregnancy, if menstruation has error more than predicted.

References:

1. Armstrong C. ACOG recommendations on emergency contraception. Am Fam Physician 2010; 15: 1278.
2. Dipiro JT, Talbert RL, Yee GC, editors. Pharmacotherapy A pathophysiologic approach. 8ht ed. New York: McGraw-Hill; 2011.

Glucosamine and diabetes.

Question: Why Viaflex (glucosamine sulfate) should not be used in patients with diabetes, but Flexsa (glucosamine sulfate potassium chloride) can be used in patients with diabetes. What is the difference of these two salts that affect the secretion of insulin in people with diabetes.

Answer: Glucosamine is the component in the structure of cartilage. Glucosamine is used to build glycosaminoglycans and proteoglycans. Action of glucosamine is cartilage building and it is believed to reduce the symptoms of osteoarthritis.

It is reported that glucosamine may affect blood sugar levels. The mechanism does not involve the secretion of insulin, but glucosamine can interfere the functioning of the cells of the tissue which is the position of action of insulin. And cause insulin resistance and associated with the development of diabetes, or poorly controlled blood sugar level.

Clinical studies on the effect of glucosamine in patients with diabetes remain unclear and controversial. Thus, currently there are no definite conclusions about the effect of glucosamine on blood sugar level or insulin resistance. However, the current recommendation does not prohibit the use of glucosamine in patients with diabetes, it is recommended to monitor blood sugar level more often in patients received glucosamine. The different forms of salt of glucosamine do not affect blood sugar level.

The reason for both brands to warn aware or carefully use in patients with diabetes are not equal, perhaps because there is no clear conclusion of glucosamine for diabetes. So if patients received glucosamine whether of any brand, should continuous monitor blood sugar level.

References:

1. Simon RR, Marks V, Leeds AR, Anderson JW. A comprehensive review of oral glucosamine use and effects on glucose metabolism in normal and diabetic individuals. Diabetes Metab Res Rev 2011; 27: 14-27.

2. MICROMEDEX 2.0® [Database on the internet]: Truven health analytics; 2013. mobileMicromedex®, Glucosamine; Available from: http://www.micromedexsolutions.com

Pregnancy, oral contraceptives

Question: I do not know that I’m pregnant, while I have eaten contraceptive pills continuously for a while. Will it have an impact on the baby or not?

Answer: Studies on effects of oral contraceptives on the fetus when mothers received the drug during pregnancy have been different results.

The data obtained from studies in 1990, found that oral contraceptives do not increase the risk of abnormalities in the baby. However, in 2010 other studies have found that if the mother gets oral contraceptives during the first 3 months of pregnancy, this may be associated with an increased risk of occurrence of abdominal wall of infant that does not close completely (gastroschisis) and associated with the left ventricle of the infant’s heart that is severely underdeveloped (hypoplastic left heart syndrome).

So when you know that you are pregnant, you should immediately stop taking contraceptive.

References:

1. Bracken MB. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol 1990; 76: 552-7.

2. Waller DK, Gallaway MS, Taylor LG, Ramadhani TA, Canfield MA, Scheuerle A, et al. Use of oral contraceptives in pregnancy and major structural birth defects in offspring. Epidemiology 2010; 21: 232-9.

Ezitimibe, Atorvastain

Question: I have eaten Ezetrol 10 mg together with Xarator 20 mg. Using 2 drugs together cause side effects or not and what are they?

Answer: Ezetrol® 10 mg is the trade name of ezitimibe and Xarator® 20 mg is the trade name of atorvastatin. Both of drugs are used to treat high cholesterol. However, the mechanism of action and side effects are different.

-          Ezetimibe inhibits the absorption of cholesterol in the small intestine. Found that adverse events of drug have been a little report. Patients receiving drug, most are able to tolerate medication. Adverse effects that have been reported such as diarrhea (2.5-4%), joint pain (2.6-3%), muscle cramps (3.2%), infection of the respiratory tract (2.9 to 4%).

-          Atorvastatin inhibits the function of the enzyme which acts on the synthesis of cholesterol in the body. Atorvastatin is lipid-lowering drug which is effective in reducing blood cholesterol levels. Side effects of the drug are diarrhea (14.1%), joint pain (11.7%), muscle cramps (8.4%), infection of the respiratory tract (8.3%), pain in the arms and legs (9.3%), increase in liver enzymes (0.2% - 2.3%).

The indications suggest that ezetimibe can be used as monotherapy and has also been approved for use in combination with the statin group. (Atorvastatin is a drug in the statin group.) To control blood cholesterol levels, studies have found that when using two drugs together in reducing the fat will be effective more than increasing a double dose of statin in monotherapy.

Information on adverse effects when using atorvastatin together with ezetmibe did not differ when getting ezetimibe or atorvastatin alone.

Adverse effects on the muscle may increase. (Especially in patients receiving ezetimibe combined with atorvastatin about 8%. But in people who have atorvastatin 6% and ezitimibe 5%)

Adverse effects on liver enzyme (alanine aminotransferase) increase more than usual three times (especially in patients receiving ezetimibe combined with atorvastatin 2%, but in people who have atorvastatin <1% and ezitimibe 0%).

So side effects that may need to be careful when using combined drug, are muscle pain, muscle cramps and adverse effects on the liver (hepatitis or increased liver enzymes).

References:

1. Ballantyne CM, Houri J, Notarbartolo A, Melani L, Lipka LJ, Suresh R et al. Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia A prospective, randomized, double-blind trial. Circulation 2003; 107:2409-15.
2. Ezetimibe. In: DRUGDEX System [database on the Internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.
3. Atorvastatin. In: DRUGDEX System [database on the Internet]. Ann Arbor (MI): Truven Health Analytics; 2014. Available from: www.micromedexsolutions.com.
4. Mikhailidis DP. Comparative efficacy of the addition of ezetimibe to statinvsstatin titration in patients with hypercholesterolaemia: systematic review and meta-analysis. Current Medical Research & Opinion 2011; 27(6): 1191-210.

Vitamin B 3 (Niacin)

Question: After I ate vitamin B3, I have a fever, red face and red neck like urticaria, my ears were red and hot, and both hands and arms were itchy. After about 20 minutes the symptoms were gone. What caused it and when did these symptoms disappear?

Answer: Vitamin B3 or niacin has been reported to cause flushing about 88%. The symptoms mostly occur in the face or in the upper part of body. In some cases which have severe symptoms, can cause palpitations, hyperventilation, edema, burning sensation around the skin and fainting.

The mechanism is believed to be caused by niacin that can induce the body producing prostaglandin which causes vasodilation.

Such side effects are reduced:-

1. When administered in low dose, which gradually increase the dose of niacin later.

2. Avoid taking medicine on an empty stomach.

3. Taking aspirin before niacin can reduce side effect because aspirin can inhibit the formation of prostaglandin.

4. Avoid drinking alcohol because it may increase the severity of side effects.

It is reported that people those taking niacin can tolerate the side effect after 2-3 weeks of medication.

But niacin is not recommended in the case of the severe adverse reactions.

References:

1. Kamanna VS, Ganji SH, Kashyap ML. The mechanism and mitigation of niacin-induced flushing. Int J Clin Pract 2009; 63 (9). 1369-77.

2. MICROMEDEX 2.0® [Database on the internet]: Truven health analytics; 2014. mobileMicromedex®, Niacin; Available from: http://www.micromedexsolutions.com

Omega-3 and liver enzymes.

Question: I have eaten omega-3 for 2 weeks, then I went for blood examination, it appears that the decrease in liver enzymes. I suspected that the result associated with omega-3 or not?

Answer: Omega-3 means omega-3-polyunsaturated fatty acid (PUFA). Study on effects of omega-3 to the liver did not result in the same direction.

However, there are studies from systematic literature review and meta-analysis that collecting the result of studies about patients with non alcoholic fatty liver that often occurs in people with overweight and insulin resistance.

It found that PUFA can reduce the amount of liver fat and can reduce liver enzyme named AST (aspartate aminotransferase) significantly, and PUFA is likely to reduce the liver enzyme named ALT (alanine aminotransferase) but not clinically significant.

However we still do not know the accurate dose of PUFA for decreasing fat or reducing levels of liver enzymes.

The study did not gather information from randomized controlled trials. So the result of study is not enough reliability and may need more support, information, education in the future. Thus, from the results of the study now it may be possible that PUFA are useful in reducing fat in the liver and reducing liver enzymes (AST) in patients with non alcoholic fatty liver

References:

Parker HM, Johnson NA, Burdon CA, Cohn JS, O'Connor HT, GeorgeJ. Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol 2012; 56 (4): 944-51.

How fast can the narcotic be excreted from body?

Question: Do I want to know that there are any medications that make the narcotic be excreted from body within one day?

Answer: Each kind of narcotic was in body at different times. Generally, the body can excrete narcotic itself without the use of medicine to help excreted. How fast the narcotic is excreted and how much the remaining is in body, depending on the type of narcotic, the amount, frequency, duration, and physical state of drug users.

Most narcotics are excreted from the body through urine within 3-4 days. The diuretic stimulation or adjusting pH of the urine will drive narcotic out of the body faster. Also, drinking lots of water can make narcotics are excreted from the body faster too.

Therefore, drinking plenty of water is one way that can be done and no effect on the body due to no toxic side effects from medication use.

References:

Verstraete AG. Detection times of drugs of abuse in blood, urine, and oral fluid.Ther Drug Monit. 2004; 26: 200-5.

Nifedipine with side effect about sexual dysfunction

Question: Sexual dysfunction is side effect of Nifedipine, yes or not?

Answer: Nifedipine may cause erectile dysfunction, but no incident is reported absolutely.

The drug can affect the muscles around the tube for bringing sperm and affect the muscle around the gland that produce vitreous for sperm. So it may affect releasing of semen through the urethra and may make it more difficult to ejaculate.

However, the questioner should not be worry about it too much. Since Nifedipine is a drug that is useful and necessary for the treatment of hypertension or cardiovascular disease. And Nifedipine is classified as a drug which affect erectile dysfunction in moderate level compared with other antihypertensive drugs.

There are also reports of the incidence of erectile dysfunction in patients with high blood pressure (that is not treated), approximately 17.1%, which is higher than those who did not have high blood pressure approximately 6.9%. So the erectile dysfunction may be partly due to the illness as well.

References:

1. Arksdale JD, Gardner SF. The impact of first-line antihypertensive drugs on erectile dysfunction. Pharmacotherapy 1999; 19 (5): 573-81.

2. Nifedipine. In: DRUGDEX System [database on the internet]. Ann Arbor (MI): Truven Health Analytics; 2013. Available from: www.micromedexsolutions.com.

3. Doumas M, Douma S. The Effect of antihypertensive drugs on erectile function: A proposed management algorithm. J Clin Hypertens. 2006; 8 (5): 359-63.

PCEC Vaccination and Tetracycline

Question: The patient with allergic to tetracycline can receive pcec vaccination or not?

Answer: PCEC (purified chick embryo cell) vaccine is a vaccine against rabies, which derived from viral culturing in embryo cell of egg in chicken.

In the process of producing this vaccine, some antibiotic is used in the production process, and some companies may use chlortetracycline which has a structure similar to tetracycline.

So this vaccine is not recommended to be used to those people who have allergic to tetracycline because it can cause allergic reaction. For this reason, recommended to read the information that came with the product. Or to see details of label provided with the product.

References:

1. Mandell GL, Bennett JE, Dolin R. Principles and practice of infectious disease, 7th ed. Philadelphia: Churchill Livingstone Elsevier, 2010.

2. RABIPUR® [Consumer Medicine Information]. Thailand: Novartis, 2010.

3. Verorab® [Package insert]. Thailand: Sanofi Pasteur, 2010.

Urispas or Flavoxate 200 mg

Question: I was taking Urispas 200 mg during the first month of pregnancy

I do not know if there is a danger to pregnant or not.

Answer: Urispas is the trade name of flavoxate (chemical name) which is in the form of hydrochloride salt. Used for symptomatic relief of pain and urinary frequency due to smooth muscle spasm associated with inflammatory disorders of the urinary tract, dysuria and relief of vesico-urethral spasm.

Safety in the use of drugs during pregnancy, according to the US-FDA, flavoxate is provided in pregnancy category B.

Pregnancy category B means:

Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the first trimester (and there is no evidence of a risk in later trimesters).

Therefore, the use of urispas (flavoxate) during pregnancy is rather safety especially if it is used in the short time.

References:

1. MIMS Thailand. Bangkok: TIMs; 2014, issue 1, p.273.

2. Briggs GG, Freeman RK, Yaffe SJ. Drug in pregnancy and lactation, 8th ed. Philadelphia: Lippincott Williams and Willkins 2005, p.567-8.

3. Urispas (flavoxate hydrochloride). http://www.rxlist.com/urispas-drug/warnings-precautions.htm.