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....

Thursday, September 13, 2007

Skin whitening for Melasma

Many of us may suffer from a skin condition called melasma due to the overexposure of sun. Here we will discuss how does it looks like and the usual pharmaceutical treatment for it. Below is the pictures of my customer having this problem of hyperpigmentation (melasma) due to sun exposure.
She allowed me to take her picture .Rx treatment (pls note that all these creams are only available in the pharmacy):
Hydroquinone 2%-4%
Action: Inhibit tyrosinase(enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylamine , decreased production of melanin. Lighten both healthy and hyperpigmented skin.
Usage: Apply 2 times a day. Discontinue use if no effect after 2 months.

Tretenoin 0.1% cream
Action: Works by increasing keratinocyte turnover and limiting the transfer if melanosomes to keratinocytes.
Usage: Apply in the evening. Response to treatment can be slow, improvement may take 6 months or longer.
Adverse Reaction: Skin irritation, temporary photosensitivity and paradoxial hyperpigmentation can occur.

Azelaic acid 20%
Action: Reduce DNA synthesis, target only hyperactive melanocytes, No phototoxic or photoallergic.
Usage: 2 times daily
Soap containing salicylic acid 3% (keratolytic) may help to exfoliate the hyperpigmented skin.

Ask the pharmacist!
1)Regardless of the treatments used, all will fail if sunlight is not strictly avoided.
2)Avoid sunlight, use hats, use sunscreen at least with SPF 15 eg. titanium dioxide, zinc oxide.
3)Always check with your dermatologist.
4)Do not buy those products sold in pasar malam. Buy from your reputable pharmacy.
5) Test your skin sensitivity before using any product by applying to small area of unbroken skin- (minor redness is ok, but if itching, vesicle formation or excessive inflammatory response, not it is not ok).
6)Email me for more info.

7)Lastly do not simply use unknown and unregistered products.

Saturday, September 08, 2007

Benglish version of Pharmalogik

What if PharmaLogik blog is written by Ah Beng, and not me? This is how they will looks like....

This link may contain content that is inappropriate for some users, as flagged by Pharmalogik's user community.

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(ATTENTION: It contains foul language, pls use your own discretion before clicking and you should be more than 18 years old, pls exit if u find the language used is offensive)

Copied from
p/s it is funny though, hope it can cheer your day....(laughter is the best medicine) even it may tarnish my brog! Hahaha