Saturday, December 22, 2007

Medical and Pharmacy Myth

According to British Medical Journal, below are the myths in medical field

1) People should drink at least eight glasses of water a day
2)We use only 10% of our brains
3)Hair and fingernails continue to grow after death
4)Shaving hair causes it to grow back faster, darker, or coarser
5)Reading in dim light ruins your eyesight
6)Eating turkey makes people especially drowsy
7)Mobile phones create considerable electromagnetic interference in hospitals.


According to pharmalogik, below are the myths in pharmacy field

1)Dr study more about drugs than pharmacist

2) Pharmacist in Malaysia dont need to serve the government for the total of 4 years before they can work elsewhere.

3) The working hours of a typical owner of community pharmacy is not 12 hours a day 6 days a week.

4) All doctors know how to perform complex calculation for therapeutic drug monitoring.

5) Pharmacist no need to go for Continue Medical Education every year

6) Pharmacist is richer than the Dr

7) Pharmacy profit margin > 25%

8) All medications are poison

9) Pharmacist not suppose to get their dispensing right

10) Pharmacist also can be called Farmist, Blood sucker, Vampire, Hantu, Mr. Discount, or Dr. They cannot be called pharmacist, Big Boss, Tau Keh, or Leng Cai. Ha haahaa......

Monday, December 17, 2007

Fake 50 cents coins appearing

2 different version of 50 cents, lima puluh sen, tipu, appearing in town.

Judge for yourselfCan you spot the different? Same year of manufacturing but diff design on both side?

The Wau design is clearly different in the middle.
Front design

One is real and one is fake.

Ask the pharmacist
1) Only ask health related questions. Do not ask the pharmacist what to do if u got this type of fake coin. Cause i also dont know wat to do.....Hahaha....

2)I dont know what gov will do about this. I also dont know the reason why the gov withdrawn RM 1.00 coin last time. Maybe due to this issue?

3) I believe the first one is fake and the second one is real. But does anybody care? Elderly people are the groups that can be duped easily since they can't see clearly and identify them.

4) Since the syndicate can make and copy this real 50 cents coin, why dont they do it exactly like the real? Mmmmm....

Thursday, December 13, 2007

Application of chemistry in supplements labelling

Zinc sulphate 66mg
Dose: take one tablet 3 times daily or as directed.

Customer: Can u explain what is written on the label? I read from somewhere we should take more than 50mg/day. Here is written 66mg. Three times a day somemore...wont it become toxic to our body?

66mg x3=198mg? toxic dose?

USRDA stand for United States Recommended Daily Allowances.
When used orally, zinc is safe in the amounts that do not exceed the tolerable upper intake level of 40-50mg/day. This is because higher dose might decrease copper absorption and result in anemia.

Ask the pharmacist!
This is how we pharmacist calculate

Zinc sulphate= ZnSO4. 7H20
Molecular weight=65+32+16*4+7(2+16)=287

Assume 287mg zinc sulphate contains 65mg of zinc, therefore 1 tablet 66mg of zinc sulphate contains how much zinc?
66*65/287= 14.9mg lor....

14.9mg* 3 is only 44.7mg = NON TOXIC DOSE

Another common misunderstanding is Calcium.
Is Calcium Lactate 300mg = Calcium Carbonate 300mg?

The calculations is more complicated than it is shown. Pls ask your pharmacist or me if u want to know more.

Calcium Molecular Weight=40
Calcium Carbonate= CaCO3 =100.1
Calcium Citrate= C12H10Ca3O14,4H2O =570.5
Calcium Lactate=C6H10CaO6,xH2O =218.2 (anhydrous); 308.3 (pentahydrate); 272.3(trihydrate)

Questions: (if u think u understand)
1)Are all calcium salts the same?
2)So do u know which calcium contain the most elemental calcium?
3)Is Calcium Lactate 300mg = Calcium Carbonate 300mg?
4) How many calcium carbonate 300mg u have to take/day if the recommended dose is 1200mg/day?
5) Which one is the best calcium?

Answer 1:
No. Usually government hospital supply calcium lactate, retail pharmacy sell more on calcium carbonate and calcium citrate.

Answer 2:
Calcium Carbonate 40/100=40%.
Calcium Citrate 40*3/570.5=21%
Calcium Lactate 40/308.3=13%

Answer 3:
Calcium Lactate 300mg= 13%*300mg = 39mg of elemental calcium
Calcium Carbonate 300mg= 40%*300mg = 120mg of elemental calcium

Answer 4: USRDA: 1000-1200mg/day
1200mg /39= 30 tablets. HAHAHA. Now u should know how many tablet of calcium u should eat if u r getting them from the hospital.

Answer 5: Here, we also need to apply the solubility of Calcium into calculations.

Simplified way:
Calcium carbonate is practically insoluble in water, but dissolve in hydrochloric acid. CaCo3+2HCL= Ca2+,2Cl-, H+, HCO3- (if i am not mistaken, my chemistry a bit karat liao)
This is also why we recommend to take calcium with food as food stimulate acid secretion in the stomach. And do not take antacid or your gastric medicine with your calcium supplements.

Calcium lactate= soluble in water (can take with food or without)
Calcium citrate= slightly soluble in water but freely soluble in diluted hydrochloric acid (can take with food or without)

BEST CALCIUM? I think it would be Calcium Lactate, provided u dont mind swallowing 30 tablets/day. Or else just stick with the 2 tablets of Calcium Carbonate 600mg with food.

For further informations, feel free to ask me. Absorption is a very complicated process.

Tuesday, December 11, 2007

Comparing Vitamins in Pregnancy

Best vitamins to take pre and post pregnancy

Iberet Folic Obimin Pramilet
Elemental Iron 105mg 30mg 5mg
Vitamin C 500mg 100mg 60mg
Niacinamide 30mg 20mg 10mg
Calcium Pantothenate 10mg 7.5mg 1mg
Vitamin B1 6mg 10mg 3mg
Vitamin B2 6mg 2.5mg 2mg
Vitamin B6 5mg 15mg 3mg
Vitamin B12 25mcg 4mg 3mg
Folic Acid 800mcg 250mcg 500mcg
Vitamin A
6000USP 4000IU
Vitamin D
400USP 400IU
Calcium Lactate
0.1mg 0.15mg
0.1mg 0.1mg




Ask the pharmacist

1)Vitamins to be taken during pregnancy are:
a)B12 >5mcg
Especially for vegetarian women, because they may give birth to infants who suffer early and serious signs of megaloblastic anemia and failure to thrive due to low B12.
b)Folic acid > 400mcg will reduce the incidence of neural tube defects by 50%
c) Elemental iron 30-65mg/day
d) Calcium: Milk, cheese and yogurt should be taken.
2)Energy requirement: 300 more kcal/day (less in first trimester, more during 3rd trimester)
Protein: 10g/day increase to support fetal and placental growth.
Weight: Average women gain 25-30pounds during pregnancy.

4)Which vitamin better to take?
After comparing these 3, Obimin seems the winner for normal pregnancy without complications. I like the high doses of B6 in Obimin, which can reduce complications of nausea and vomiting happens during the first 4-8 weeks. Furthermore it is the cheapest vitamin in the market. Due to lower folic acid, we would usually recommend Obimin+folic acid supplementation from milk.

Iberet Folic seems to be the taikor as it has high doses of iron, folic acid and B12, vitamin C (to enhance absorption of iron). So it is the most useful in anemic pregnant lady.

Just remember do not take several prenatal vitamins as it may expose mother and baby to the toxicity and teratogenic dose of vitamin A.

5)Remember, each individual is different. Always ask your Dr or pharmacist if u r not clear.

6) Want to know expected date of confinement?
Rough calculation:
Last menstrual period+ 7days -3months+ 1 year.
(assumes ovulation on day 14 of 28 day cycle)

Hope u will get a healthy baby!

Saturday, December 01, 2007

Is pharmacy retail profession really good?

How much margin do u think pharmacy is making for each sale transaction?

Ask the pharmacist

1) <2% Is it possible? Yes, we offer blood pressure and referral letter to hospital free of charge. For blood glucose test and cholesterol test, we only charge for the strips and lancets. We consider this as our profession service.

2) 2-10% Most of our medicine margin in this group especially for common medicine.

3)10-30% Enough to cover. We do have products at this range. Or else, we wouldn't have survive until now.

4) 30-50% Living comfortably. Hard to achieve, i would said. That is why i am still using the hard backside car.

5) >100% Blood sucking? I don't know who are the people who vote for this...and i really hope that this perfect situation will come true somehow. Right now i dont even dare to dream to Maybe by selling Nospan, codeine cough syrup, sleeping pills, Cofdex etc to drug abuser? But as the name implies, pharmaLOGIK do not deal with drug abuser.
Don't believe me? Send your son/daughter to study pharmacy after Form 6, then work as houseman in hospital for 1 year, then serve the government 3 years, and open his own pharmacy, then u will know the truth.

Come back to my question: Is pharmacy retail profession really good? Ask your neighborhood retail pharmacist.

Tuesday, November 27, 2007

Johor pharmacies flouting laws..

ohor pharmacies flouting laws

JOHOR BARU: Nearly a quarter of pharmacies in Johor were found to have violated pharmaceutical regulations.

The offences include selling of controlled drugs without doctor’s prescriptions, operating illegally and having unlicensed pharmacists.

Johor Local Government and Health Committee chairman Datuk Halimah Sadique (BN-Pasir Raja) said written warnings had been issued to the respective outlets.

“Action will be taken if they continue to violate the regulations,” she said in reply to a question posed by Dr Abdul Rashid Abd Mokti (BN-Sedili) at the Johor State Assembly here Monday.

In the operations conducted, Halimah said 32 out of the 150 pharmacies checked were found to have violated pharmaceutical regulations.

Dr Abdul Rashid also proposed for the installation of CCTVs at these outlets but Halimah rejected it as it would be difficult to tell the drugs sold.

Ask the pharmacist!

1)Selling of controlled drugs without doctor’s prescriptions

This is definitely wrong to sell certain controlled drugs under Group B (hypertension, cholesterol, etc) without Dr's prescription.

Am i hearing that Dr will write out prescription for the patient to buy it from a pharmacy instead of them dispensing it in their clinic? Pls take note that a pharmacist can sell Group C without prescription (cough, cold, flu, creams, eye drops, over the counter medicine, allergy, pain medicine, etc)

2)Operating illegally and having unlicensed pharmacist

What does that means? The laws already specify that Only a pharmacist can open a pharmacy and how does the pharmacy open and continue operation if they don't have a licensed pharmacist at the first place?

Do u think a written warning is enough? Don't u think that having an unlicensed pharmacist to operate that outlet is serious enough to close down the pharmacy? It just like a clinic operated by a bogus Dr.

What do they do? Issue a letter of warning? Want to wait for bad things before taking action?

Maybe they should publish the pharmacies name to the public so that the public can identify them. Lets see.

3) Dont worry as 25% is not majority (according to our minister). Majority of us are still good. Most of my friends work up to 12 hours a day 7 days a week to serve the people. I work 12 hours 6 days a week but closed for rest on Sunday. I am no robot lar.... and with this kind of working hours i can only drive proton iswara with a hard backside. Haha..

Thursday, November 15, 2007

How can a tissue improve?

I attended one of my friend's wedding in ipoh last month, Sitting: Poh Kheng, my wife, me, Seok Liang, Kok Onn, Alister, Doris
Standing: The bride and the Groom lor

and the things which attracted me the most is this.
Ya, a WET TISSUE! Remember how we usually get a packet of wet tissue after the dinner in restaurant? The one which produce a POP sound when we open it by force? Haha....
Look at the contents!!
By looking at the wet tissue contents which is very impressive. I WOW for 5 times.

Can it be improve somemore?
1)Reverse Osmosis Water: Sterile 100% RO distilled water?
2)Vitamin C----> Vitamin A-Z?
3)Fragrance---> Fragrance suitable for sensitive skin
4)Lotion---> Er....whitening lotion?
5)Preservative---> Preservative free?
6)Spunlace Nonwoven---> I no tissue design expert
7)Infused with natural botanical extracts: Next improvement is 100% natural?

I wonder how much does it cost to make this tissue? Tissue also got class now.
First Class: Used by the richest of the richest (mentioned above)

Second Class - Used by professionals/ Rich people

Third Class: Used by studentsForth class: Used by "kiam siap" people like me...haha

Monday, November 12, 2007

Public Question: Glucosamine

By SL,
1) I have doubt abt the efficacy of them and also, isn't glucosamine will be better if it is combined with chondriotin? what is the main difference of taking powder over capsule aside more convenient?
2) You mentioned that glucosamine is not working well in topical form, but some studies actually showed that topical form works better as it is avoided from first pass metabolism, so more will be deposited into the join.
hope that you can help me to clear my doubts out of my mind!
good day!

Ask the pharmacist
1) U may try adding on chondroitin sulphate if glucosamine alone is not effective at full dose. No research shows chondroitin combination will have more benefits compare with glucosamine alone.
2) I never come across topical glucosamine before.
There is also no research showing that glucosamine can be absorbed topically. If u have topical glucosamine cream, mind to share with me the ingredients? Those cream may have menthol, methysalicylate, or camphor which can give symptomatic relief becoz of its counterirritant effect.

SL, u r correct in saying studies actually showed that topical form works better as it is avoided from first pass metabolism, just that it does not apply to glucosamine.

Saturday, November 10, 2007

Tuesday, October 30, 2007

Blogs are rubbish! Majority will always wins!

Do u read the NST interview recently? These were some interesting comments. Download the full article.

Q: Some 1,000-2,000 lawyers were involved in the Bar Council walk. Are you saying that that many lawyers have been misled?
A: Only 1,000 went to the ground. There are 13,000 registered members of the Bar.

Q: You don’t think 1,000 is enough?

1,000 of 13,000 — is that a majority? What’s the big deal? In a democracy, the minority cannot control the majority. The minority does not speak for the majority.
Q: Do you read blogs?
I don’t. I don’t waste my time. The few pieces that people print for me are just rubbish.
I’d rather spend my time to do things that are constructive; that go down directly to the people who are really in need of the help of the government.

Our bloggers are really not up to standard. When they put up something, it’s not something that they want to discuss in a very intellectual way. It’s more because of their anger - the language they use. Why should I read all this rubbish? When the standard of our bloggers is upgraded, then probably I will look at what is written. But anyway, they are a minority. My concern is for the majority.

Ask the pharmacist!
1) What the puck... 1,000 out of 13,000 is not majority (1/13)? Can we ignore 2 million out of 26 million (1/13) people if they protesting on the street?
2) Do not read u know u r spending your time reading all these rubbish...Why am i updating rubbish anyway? Hahaha..
3) Maybe he should show us what is the standard, so we can follow.

4) Now i knew why we pharmacist will never going to get dispensing right. Who cares about minority? Even we were to protest, it will fall into deaf ear.
5) Do not become a pharmacist as they r minority, choose a profession to become the majority. Don't say i didn't warn u.....

Thursday, October 18, 2007

Secret code revealed! MAL registration numbers

Every wonder what does MAL which is stated in every box of medicine and supplements we buy means? It is a code which is only known by the insiders? Does it make any sense that by looking at the code we can know and consume only the best supplements and medicine? Answer lies below...

Another typical situation in my pharmacy:
Customer: My friend doing direct selling tells me the vitamin E i bought from u previously is no good. It is not natural and contains harmful chemical.
Pharmacist: ? Which brand?
Customer: This..
Pharmacist: Let me check it for u....natural vegetable oil....mmm.... How do u know it contain chemicals?Customer: It is stated in the box lar....
Pharmacist: Is it? Where? Customer: U see the MAL?
Pharmacist: Ya. It stand for registration numbers.
Customer: U see the C behind the MAL? That one stand for chemical. My friend told me only certain people know about this secret code. Now i know which brand to buy.. Direct selling products good because they dont have the "C"
Pharmacist: ....mmmmm.....( in cartoon or movie, the pharmacist would have collapsed)

Ask the pharmacist:

1) Here i will reveal the so called secret code: (Pls note that the code is only known by few people including pharmalogik readers, pls keep it as secret)

A: Scheduled Poisons (only can get from pharmacy)
X: Non-scheduled Poisons (over the counter products)
T: Traditional Medicines
K: Cosmetics
C: Contract Manufactured (made in malaysia under contract)
E: Export Only
R: Repacked (products available in foreign countries with different labelling and package)
S: Second source (also available in other places)

2) Do you know that our ministry also change the label of medicine box from POISON into CONTROLLED MEDICINE?

into this
Same situation or misunderstanding happens, because when we take western medicine, people said it is no good as we are consuming POISON... Do u dare to take your medicine as the box labelled outside POISON?

Public Question: If i am wearing contact lens, can i use an eye drop with benzalkonium chloride? like tears naturale !?

Artificial tears use cellulose ethers (hydroxypropyl methylcellulose) to stabilize the tear film, which retards tear evaporation, which relieves eyes symptoms like dry eyes.

Usually preservatives are added into the eye drop solution to destroy the microorganisms which may be introduced during manufacture or use. There a many types like benzalkonium, chlorhexidine, thimerosal, chlorbutanol, polyquad.

Benzalkonium chloride (BAK) is often used because of its stability, excellent antimicrobial activity and long shelf life. But Benzalkonium chloride actually have toxic effects on both the tear film and corneal epithelium. A single drop of 0.01% BAK can break the superficial lipid layer of the tear film into numorous oil droplets. This preservative can reduce the tear film breakup time and thus may represent a poor choice for an antimicrobial preservative in artificial tear products.BAK can be retained in ocular tissues for up to 7 days and thus repetitive use may lead to cumulative effect. Long term use can damage conjunctival and corneal epithelial cells.

It makes the matter worse if the person is wearing a contact lens as the contact lens can act as a reservoir for BAK.

So what is the conclusion?
If it is really harmful, i think the health ministry must have taken action long time ago. There are so many considering factors involved, especially the cost.
Almost all bottled eye drops use BAK as its preservative. Even the antimicrobial eye drop itself like Chloramphenicol and Ciprofloxacin eye drop also contains BAK. Do we really have a choice here?

Ask the pharmacist!
1)Ask yourself whether u are going to use the artificial tears long term? If price is not a problem, always choose the best option available, which is preservative free artificial tears vial.

Some of the preservative free artificial tears
2) Contact lens user, maybe it is better to use spectacles? i have been using specs for the past 16 years++.
3) As usual, consult your ophthalmologist or doctor or pharmacist for advise.
4) For further reading, pls visit here.

Tuesday, October 09, 2007

I am a millionaire now....

Dear Lucky Winner,

We are pleased to inform you of the result of the just concluded annual final
draws of UNITED KINGDOM NATIONAL PROGRAM. After this automated
computer ballot,
your e-mail address emerged as one of two winners in the category "A" You are
therefore been approve to claim the sum of 1,000,000 (One Million Pounds
Sterling) with the information below:

REF No: UK/9420X2/68/BRT
BATCH No: 074/05/ZY369/BRT

To file for your claim, Contact the processing Consultant:

Contact Person: John Campbell
Tell: +447045721627

Do fill out the claims form to Mr.John Campbell,in other to process the
claims of your prize without delay.


1.Name in full
7.Present Country

Comments: Fuyoh......Money money money....MONEY!!

But wait......I think it is one of the fake scam again....

Why do i think it is fake?

1) They dont have my real name
2) I never enter any online lottery before
3) They r using yahoo email account. Anyone can open an account like,,, etc
4) Google for UNITED KINGDOM NATIONAL PROGRAM does not show anything relevant
5) Mrs Cindy Howard for UK National Lottery? Who?
6) I dont think i am so lucky...
7) Do u think it is real? Use my reference number to claim my 1 million, then if u r kind, i would glad if u can give me back 10,000.

Monday, October 08, 2007

Roof collapsed!

(pictures by Andrew Ronaldo)

Extracted from the Star:

Joy turns into mourning for wireman’s family

TELUK INTAN: It was a happy occasion for wireman J. Nadarajan when he was given the task of fixing the electrical wiring at the Teluk Intan Municipal Council arena square.

But barely two days into the job, the joyous moment became a day of mourning for the family when the 34-year-old Nadarajan was killed after the roof of the RM1.5mil arena square collapsed on Friday.

Another wireman S. Sunder, 30, and Indonesian construction workers Mohamad, 33, and Khalid Abdullah, 28, were injured.

“This is most shocking for us. Who would expect that a government project could collapse just like that?” Nadarajan’s brother Balaguru said when met at his house in Jalan Kampung Banjar here yesterday.

Balaguru said Nadarajan had been a wireman for the past 10 years and had also been involved in some sub-contracting work.

He was now concerned about having to take care of Nadarajan’s four children, aged two to seven.

“My brother was the sole breadwinner of his family while his spouse is a housewife,” added Balaguru.

Nadarajan’s wife Uvaneshwary, 32, and mother P. Muniamah, 68, were too distraught to speak to the press.

Hilir Perak Municipal Council president Ibrahim Ahmad said work on the arena square had been temporarily suspended.

“We are waiting for a report from the contractor’s architect on why the roof gave way,” he said, adding that the contractor was based in Teluk Intan.

District police chief Asst Comm Goh Kok Liang said three reports had been lodged regarding the incident.

Action would be taken against the contractor only if investigations revealed there was criminal element in the incident, he added.


My comment: My condolence to the victims family... :(

Last time, roof leakage, now roof collapsed!! U know why it collapse? Your guess should be same as mine..Comments here... Now i believe Malaysia truly Boleh!

Friday, September 28, 2007

Glucosamine dilema: Which brand to choose?Hydrochloride or Sulphate?

You know you have osteoarthritis, then u must have taken glucosamine before...
Almost all known pharmaceutical company in Malaysia come out with their own glucosamine and claim theirs to be the best. So how do we choose which brand to buy?

Here is a list of glucosamine brands in Malaysia.

Different brands 1 tab
1 Apex Atronil 500mg
2 Artril 250 250mg
3 Artril Forte 500mg
4 Bio Life 500mg
5 Blackmores 500mg
6 CCM Catril-S 250mg
7 Donna Capsule 250mg
8 Glucosamine YSP 250mg
9 Gold Life 250mg
10 Hovid Cosamine 250mg
11 Move Free Advance (US only) 750mg
12 Quest Glucosamine 500mg
13 Rematril 250mg
14 Thomson Osteopro 250mg
15 Viartril-S capsule (brand) 250mg
16 Viartril-S powder (brand) 1500mg
17 Consulf Sulphate (taken together) 400mg
(not including Direct Selling products)
Total of 16 products in to choose?

Lets looks at the Evidence based support:
Based on the clinical studies done by Rottapharm Viartril-S (glucosamine sulphate) have proven to show not only an improvement in symptoms but also an improvement in joint space narrowing on radiograph.
But National Institute of Health study (not using glucosamine sulphate) concluded that there is no statistically significant improvements comparing to placebo.

This lead to the argument below, becoz glucosamine exist in the market in 2 forms, so
Sulfate vs hydrochloride: Which one better?

Group 1(support sulphate): Sulfate moiety in glucosamine sulphate might be responsible for the effect. Sulphate is required for articular cartilage glycosaminoglycan synthesis. That is why Viartril-S (sulphate) is proven to be effective.

Group2(support HCL): Glucosamine hydrochloride contains more glucosamine. A dose of 1500mg of glucosamine hydrochloride is equivalent to 1985mg of glucosamine sulphate. This is because HCL form carries 83.1% of glucosamine, where the sulphate form carries only 62.8%. Therefore glucosamine HCL is better and cheaper as well. Claim that Rotta use sulphate to protect their patent on the manufacture of Viartril-S.

Group3(support non): The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine.

**Panadol metabolism requires sulfur so if glucosamine sulphate is taken together with panadol, by right the patients will feel less effectiveness of the glucosamine sulphate. But the pain maybe relieved by panadol and not glucosamine.

Ask the pharmacist!
1) Glucosamine sulfate might not be effective for more severe, long standing, older, and heavier patients. So for heavy people having pain at the knee, loose weight should be the first option.

2) There is no research showing glucosamine is absorbed topically. Do not apply on the knee.

3) You are free to experience any brand you like. If u want the best, buy the one with proven clinical studies or buy the one with promotion/offer.

4)So far there is no head to head studies comparing glucosamine hydrochloride and glucosamine sulphate with placebo as it is still a question which one is actually better?Of all the products registered in Malaysia, all are using sulphate. How do we compare? Even the famous Move Free Glucosamine HCL Combinations (only available in US) also contains sulphate in the form of Chondroitin sulphate.

5)From what i heard from my good friend, Glucosamine HCL will be classed under Controlled Medicine if it is available. Reason? I also dont know.

6) Leave a comment here if u support HCL or sulphate. Correct me if i am wrong or u disagree. Pls share your experience here.

Public Question: Can Dexcophan be taken if there is a pregnancy plan?

"Dexchophan" is a brand name for Dextromethorphan HBr 15mg/tab manufactured by company Hovid. Chemical name is 3-methoxy-17-methyl-9(alpha), 13(alpha), 14(alpha)-morphinan hydrobromide monohydrate. It is a derivative of narcotic analgesic and can be used as a cough suppressant.
After the drug is consumed by the mother, it will undergo metabolism through o-demethylation to dextrophan. Ability and the rate of metabolism is determined genetically. If the individuals is a slow metabolizer, then the drug may stay much longer in the blood.

This may pose some risk as
the molecular weight of dextromethorphan is about 271 and this makes it small enough to transfer across to the fetus. The slower the mother's liver metabolize the drug, the longer the drug will stay in the mother's blood and it can cross over to the fetus more.

Studies that lead to the conclusion of dextromethorphan safety in pregnancy
1)The Collaborative Perinatal Project do not support a relationship between the drug and congenital malformations.

2)Case report in 1981: A women taking cough syrup with potential daily doses of 1.68g of dextromethorphan, 16.8g of guafenesin, 5.0g of pseudoephedrin, and 79.8ml of ethanol throughout pregnancy. The newborn infant had facial features of fetal alcohol syndrome.
Fetal alcohol syndromeOther defects were umbilical hernia and labia that appeared hypoplastic. No conclusion on whether is it dextromethorphan or the other causes like alcohol?

3)Surveillance study in 1985. In 59 mothers who used dextromethorphan, only 1 give birth to an infant with major anomaly. Conclusion no strong association.

4)Spanish Collaborative Study of Congenital Malformations concluded that the use of the drug in first trimester is not associated with an increase in congenital defects.

5)Rodent (using rats and rabbits) studies: No evidence of teratogenicity despite the use of doses higher than that used clinically.

6)Chick Embryo study: Teratogenic but the study model is poor.

Ask the pharmacist!
1)Based on the available human data, dextromethorphan do not demonstrate a major teratogenic risk if used at the usual dose 15-30mg three times a day.
Pregnancy Category: C= Should only be used if the benefit justifies the potential risk.

2)We can assume it is safe for consumption in pregnancy. But if the use of liquid preparations of dextromethorphan contain ethanol, should be avoided becoz ethanol is known teratogen. If you love your baby, dont drink!

3)For more information, pls refer back to my previous post : Medication in pregnancy

4)This conclusion is only justified for the moment this post was made, pls refer to your doctor or pharmacist for latest informations.

5)Can Dexcophan be taken if there is a pregnancy plan?
Answer: Why do u want to take at the first place? Does the benefit of taking it justify the potential risk? You can determine for yourself.

Tuesday, September 18, 2007

My prewedding photos

Here r some of my favorites prewedding pictures... i must said Teluk Intan have so many nice places to take pictures...beside the famous leaning clock tower...

Old temple (if not mistaken it was built in 1880) --------------------------------------------
Paddy field

Old house
Sungai Perak Riverside

Come to Teluk Intan to take your wedding pictures....