Case reports in western populations reported that fenofibrate enhances the anticoagulatory effect of warfarin. We are reporting ten cases of warfarin-fenofibrate interaction among Malaysian patients’ cases that were managed at the anticoagulation clinic of Hospital Kuala Lumpur. Patients taking warfarin and micronized fenofibrate 145mg daily concurrently between the year 2014 to 2018 were identified in May 2018. Ten active patients were included, and the relevant data were retrieved retrospectively. All patients received warfarin for stroke prevention in atrial fibrillation (AF), with a target international normalised ratio (INR) of 2 to 3. No dose adjustment was done upon initiation of fenofibrate. Warfarin doses were adjusted to achieve the targeted range but fenofibrate was not discontinued. Eight patients had INR levels above the target range when INR being reassessed between 20 to 62 days after initiation of fenofibrate. Their weekly warfarin doses were between 17.5mg-46.5mg. Baseline INR ranged between 1.6 -3.1. Percentage of dose reduction ranged between 5%-60%. Four of the patients were on other concurrent interacting medications such as statin and levothyroxine. Only one patient, whose case was with an INR 3.1 before initiation of fenofibrate, required admission for hematoma (INR 12). Two patients had INR within the target range, and INR were assessed at 14 and 21 days after fenofibrate initiation. Their weekly warfarin doses were between 24.5mg and 26.5mg while baseline INR was 2.8 and 1.9 respectively. Interaction between fenofibrate and warfarin may increase INR among Malaysian patients, thus close monitoring of INR is warranted. Empirical warfarin dose reduction may be considered upon initiation of this drug combination for patients with AF. The next INR reassessment date should be arranged not later than three weeks after initiation of fenofibrate.
Anti-peptic ulcer drugs (APUDs) such as proton pump inhibitors (PPI), H2 receptor antagonists (H2A), antacids are widely prescribed. This study is aimed to describe the utilisation pattern of APUDs based on WHO Defined Daily Dose (DDD) and identify most commonly used APUD in the selected hospital. A retrospective study was carried out in outpatient of the selected hospital for year 2017. Sample size was calculated using Raosoft. DDD of APUDs and direct drug cost were calculated. Data were collected through electronic medical record by retrieving patients’ registration number. Inclusion criteria were patients above 18 years old and APUDs prescribed for gastrointestinal related indications. A total of 160 prescriptions were randomly selected for data analysis. Based on the DDD calculated, Rabeprazole 20mg was most prescribed drug among PPI (n=33), while Maalox is most prescribed drug among the antacids (n=23). Based on the DDD calculated, Pantoprazole 20mg recorded highest rates per user per day about 1.26 DDD / user / day while antacids, Actal reported highest usage rate with 7.11 DDD / user / day. Besides, there are 5.4 days supplied per user for this drug. Dexlansoprazole 60mg is the most expensive drug among all the PPI listed in hospital formulary. It has 18.5 days supplied/user, which is the second shortest duration of treatment among all the other PPIs. In contrast, omeprazole 20mg is the lowest cost PPI but the duration supplied per user is longer resulting in higher total cost of therapy. In conclusion, PPIs were the most commonly prescribed.
Introduction: Lipid-modifying drugs have been used to treat dyslipidemia as well as for the primary
and secondary prevention of CVDs and stroke. Objectives: This study aims to describe the drug
utilization pattern of lipid-modifying drugs in a private hospital. Method: A retrospective study was
carried out in outpatient of the selected hospital. Patients were selected based on inclusion and
exclusion criteria by using convenience sampling. Data were collected through KCIS by retrieving
patients’ registration number. Defined daily dose (DDD) was calculated and compared to World
Health Organization DDD. Medicine prices were also analysed. Results: A total of 180 patients’
record were analysed, 70% of them were male; 40.6% of the patients were from the age range of 50
to 59 years old; ethnicity breakdown was Malay (69.4%), Indian (18.3%) and Chinese (12.2%).
Among all lipid-modifying drugs, utilization of statins was the highest as statins are the preferred
line in the treatment of dyslipidemia. Innovator brands were more preferred where most of the lipidmodifying
drugs used in the selected hospital are innovator brand drugs. In terms of cost, lipidmodifying
drugs contributes to about 27% of the total cost of prescription in average. Conclusion:
The utilization of all lipid-modifying drugs in the selected hospital was lower as compared to WHO
DDD. As compared to combination therapy, monotherapy with atorvastatin was generally preferred
in the selected hospital. The utilization of atorvastatin was found to be the highest in the OPD of the
selected hospital.
Objective: The main objective of this study is to compare patients’ outcome in anticoagulation treatment before and after Warfarin Medication Therapy Adherence Clinic (WMTAC). The study compares the cost of INR test between usual care (UC) and WMTAC. The study also determines factors affecting International Normalized Ratio (INR) level among WMTAC patients.
Methods: A retrospective study involving WMTAC patients was conducted by trained pharmacists at Dungun Hospital. Patients were reviewed by UC for 4 months and continuously followed up by WMTAC for another 4 months were included in this study. Patients who passed away, transferred out and defaulted were excluded from the study. The data were derived from Patient Medical Record and recorded in Warfarin Data Collection Form for analyze.
Results: The time in therapeutic range (TTR) was 73.46% for WMTAC and 45.58% for UC (p
Essential medicines have become indispensable to maintain and to improve our lives and health. Latest literature again reiterated that inappropriate use of medicine is a global phenomenon in both developed and developing countries still prevail. Poor adherence is associated with negative clinical outcome of the disease. It is important to note that about 50% of treatment failures are due to poor medication adherence and this results in substantial morbidity and mortality. Patient’s belief and perception have been reported to influence medication adherence. Low rate of adherence was found strongly associated with patient’s belief across the studies with chronic diseases with hypertension, coronary heart disease, diabetes, asthma and renal disease. Exploring the health beliefs of patients is vital to improve adherence and thereby blood pressure among the patients with hypertension. Lack of knowledge about usage of medication and various misleading perceptions of hypertension management have resulted inappropriate use of medication especially medication adherence among community-dwelling patients with hypertension. Literatures classified non-adherence into primary and secondary. Primary non-adherence refers to medication is purposefully never filled or taken; Secondary non-adherence is defined as medication is not taken properly or continued as prescribed and further classified into intentionally and unintentionally. Patient education aims to train patient in the skill and self-management of their chronic disease by adapting to the treatment or lifestyle changes. Despite improving in patients’ skill and self-care by providing information about the treatment, patient education could enhance their empowerment and medication adherence. Patient education is a basic right of the patients and healthcare members have responsible to provide such information. However, the authenticity of the available information is yet to be verified. Therefore, healthcare professional could play a vital role here to educate their patients about the appropriate information.
Pharmacist’s interventions in anaemia management have been shown to improve clinical and economic outcomes. To determine the outcome of hemoglobin (Hb) level after the implementation of ESA monitoring card and counselling, a prospective, single-blinded randomised controlled study involved patients attending the CAPD clinic in Terengganu tertiary hospital, Malaysia was carried out. Intervention group received ESA injection counselling based on a validated checklist and ESA monitoring card, while the standard care group only received standard care. Result showed a total of 118 eligible patients with 68 of them in the standard care group and 50 patients in the intervention group with an average age of 50.8 (±14.57) and 49.4 (±13.69) years, respectively. Mean Hb showed significant improvement in both standard care and interventional groups with p
Many drugs used in paediatric are often not available in suitable dosage forms and have to be
extemporaneously prepared by pharmacists to make them suitable for the body weight, body
surface area, or age of the children. Phenobarbitone is the main anti-epileptic drug (AED) for
the treatment of seizure in paediatric patients. The objective of this study is to evaluate the
physicochemical and microbiological stability of an extemporaneously prepared
Phenobarbitone Oral Suspension using commercially available tablets and X-temp Oral
Suspension System. The Phenobarbitone Oral Suspension (10mg/ml) was stored at 4ºC and
30ºC / 75%RH protected from light and were examined at the interval of 0, 1, 2, 3 and 6
months. The content of Phenobarbitone was determined using a validated high-performance
liquid chromatography (HPLC) method. The visual appearance, odour, pH and specific
gravity remained fairly unchanged throughout the study period and the content of
Phenobarbitone remained above 98% of the original concentration throughout the course of
the study for both temperatures. The extemporaneous preparation was not susceptible to
microbial contamination. The results from the stability studies confirmed that X-temp Oral
Suspension is a suitable suspending vehicle for preparing extemporaneous liquid formulation
of Phenobarbitone Oral Suspension with the added advantage of alcohol-free, colourant-free
and sugar-free. Based on the data collected, the shelf-life of this liquid formulation is at least
6 months when stored at 4ºC (refrigeration) and 30ºC / 75%RH (room temperature).
The objective of this study is to look into the stability of Chloral Hydrate 40 mg per ml formulated as oral solution in X-temp Oral Suspension System in order to select proper storage conditions and establish beyond-use date. X-temp is a novel oral, flavoured sugar-free extemporaneous compounding vehicle to assist in the preparation of extemporaneous dosage forms.
The compounded solution of 40 mg/ml was prepared by dissolving chloral hydrate powder in X-temp vehicle. The solution was then packed in amber HDPE containers, and were stored at refrigeration 5 ± 3°C and room temperature 30°C. Physical, chemical and microbiological parameters were evaluated at predetermined time-points up to 180 days. Samples were tested using a validated stability–indicating assay. Chloral hydrate concentration was assayed by high-performance liquid chromatography (HPLC).
The stability results indicated that the solution remained unchanged in visual appearance or pH at both refrigeration and room temperature for up to 180 days. The HPLC results showed that all the stability studies maintained 90 – 100% of initial drug concentration. There was no substantial changes in the microbiological stability.
Chloral hydrate solution prepared in X-temp Oral Suspension System was stable for up to 180 days when stored at room temperature and refrigeration conditions. These results demonstrated that X-temp is a suitable vehicle for extemporaneous compounding for chloral hydrate.
The Falsified Medicines Directive (FMD) imposes strict serialisation requirements on pharmaceutical manufacturers, distributors and dispensers. This article outlines everything you need to know and what you need to do for a seamless serialisation process – before regulators remove your right to trade.
Pharmaceutical manufacturers are currently the main actors in a serial drama where getting their lines right is paramount. Well, four lines of data, to be precise; in (and next to) DataMatrix barcodes applied to every pack of prescription medicines. The introduction of serialisation, designed to ensure the authenticity and traceability of individual medicines, promises to improve patient safety and create exciting opportunities for digital health. But there is a twist in the plot. Failure to comply with the EU regulation that mandates it means you cannot legally ship your product. No barcode, no trade. That is when a serial drama turns into a tragedy. And time is running out to be ready.
The unfolding story of the Falsified Medicines Directive (FMD), which was first introduced in 2011, is into its final episodes. The denouement arrives on February 9, 2019, when the Directive is fully enforced and the penalties for non-compliance officially come into play. FMD is an attempt to prevent inauthentic, substandard or harmful medicines entering the supply chain. It imposes strict serialisation, traceability and verification requirements on pharmaceutical manufacturers and their associated wholesalers, distributors and contract manufacturers. In particular, it mandates companies to print a unique identifier on the packaging of prescription medicines. Furthermore, companies are not just responsible for the data that goes on the packaging, they are responsible for submitting it to the central data hub that will enable pharmacists to authenticate products before they dispense them. It is a complex undertaking that could be easily underestimated – but not if you understand some key steps. The implementation of serialisation is not an overnight task – it encompasses processes that have multiple touch-points across global organisations, partner networks and the wider supply chain. Yet despite this – and despite the enormous implications of getting it wrong – many companies are still some distance from being fit for purpose. Indeed, in some organisations, the Directive has not yet hit their radar. It needs to – because the clock is ticking. But all is not lost. Here are seven steps to successful serialisation.
An exploratory study to ascertain the public’s awareness of community pharmacy
and pharmacists in a selected subset of the Malaysian population was undertaken,
utilising an interviewer-administered structured questionnaire approach. A total
score was computed for each respondent, ranging from a possible minimum of 0 and
a maximum of 24. The scores achieved were arbitrarily categorised into poor (19) levels of general knowledge
regarding community pharmacy and pharmacists. The scores achieved ranged from
3 to 21, with an average “fair” score of 13.7. The results showed that 93.6% of the
respondents (n = 561) interviewed had heard of the term “pharmacist” before.
Interestingly, 17.5% of the respondents were of the opinion that pharmacists
worked on farms. A significant 77.4% perceived that a pharmacist served in a
doctor’s clinic. It was noted that 84.1% of those surveyed would go to doctors for
advice on medicine, while only 49.4% would seek a pharmacist. A majority (76.7%)
of the respondents interviewed chose to go to a doctor’s clinic for a screening test.
The study amplifies the need for a more aggressive projection of the pharmacist’s
image in the community in order to be recognized and accepted by the public as an
integral partner in the health care profession.
The Pharmacy value-added services (PVAS) has been implemented in Malaysian public hospitals to facilitate the collection of follow-up medications. In specific, PVAS include Integrated Drug Dispensing System, Medicine by Post, Drive-Through Pharmacy, and many more. While past studies examined the satisfaction towards PVAS and its impact on patients’ waiting time, little explored the awareness and the experience of patients towards each type of PVAS. This study aims to explore the patient’s awareness on PVAS, adoption of PVAS, their satisfaction towards PVAS, and willingness to adopt PVAS. This was a cross-sectional study conducted in January 2020. We invited the eligible patients or their family members to participate in the study. Respondents recruited at the Outpatient Pharmacy Department of Miri Hospital using convenient sampling. A questionnaire in the Malay language was developed and content validated to gather information on the demographic data, awareness on PVAS, adoption of PVAS, satisfaction towards PVAS, and willingness to adopt PVAS. A list of PVAS was included for the respondents to select the types they were aware of and used before. Results were presented as frequencies, percentages, mean and standard deviation. A total of 398 respondents participated in the study. Majority of the respondents (70.1%) were aware that PVAS offered in Miri Hospital. However, about a third of the respondents (31.4%) had experience using PVAS. The most commonly used PVAS was Appointment Card Dispensing System (49.6%) and that with the least usage was Local Partial Medication Supply Service (2.4%). The Drive-Through Pharmacy has the greatest satisfaction score, 4.40 (SD=0.70), whereas Call-and-Collect Service was the least satisfied, 3.88 (SD=0.91). Majority of the respondents (86.2%), specifically 95.8% of the experienced PVAS user and 90.1% of inexperienced group, were willing to adopt PVAS to collect their follow-up medications. The Drive-thru Pharmacy, which has the greatest awareness and satisfaction yet low usage, should be further promoted for greater adoption. Besides, such PVAS should be expanded to other healthcare facilities.
Pharmacists in Malaysia practise their profession in rugged terrains which demand
both professional skills and pioneering spirits. Many of the current pharmaceutical
standards, practices, and legislations need overhauling in order to meet the
aspiration of the nation in this new millennium. The Malaysian Pharmaceutical
Society has a vital role to play. The profession requires the greatest understanding
of the Malaysian Medical Association and the Government in this transition period.
The management of Valproic Acid (VPA) toxicity is mainly supportive treatment. Invasive management such as hemodialysis (HD) and hemoperfusion were only used in isolated cases where patient is highly VPA toxic, which results in coma. We described a case of mild VPA toxicity (VPA serum concentration 326.42mcg/mL), where the patient was successfully treated with two hours of low-flux HD with no complication. While the guideline of indication of HD in VPA toxicity has yet to be published, low-flux HD can be an effective treatment in cases of mild VPA toxicity, if other supportive measures failed or not available.
Introduction: All pharmaceutical products in Malaysia must be registered with the Drug Control Authority (DCA) whereas cosmetics must be notified with the National Pharmaceutical Regulatory Agency (NPRA). Availability of unregistered products and unnotified cosmetics in the market are longstanding issues affecting public safety and health. It is vital that all government healthcare personnel (GHP) as the front liners are equipped with the knowledge to properly advise the public on this issue.
Objective: This study aims to determine the level of knowledge towards registered products and notified cosmetics among various groups of GHP under the Ministry of Health facilities in Labuan.
Methods: This was a cross-sectional study performed from August to November 2017 using a validated 12 question questionnaire. Respondents were divided into 4 groups (doctors/dentist, pharmacist, nurse, allied healthcare professional) and results between the groups were analysed using Chi-square analysis. Respondent’s knowledge was given score and those who scored 9 marks and above were considered to have good knowledge. Those who scored 8 marks and below were considered to have poor knowledge.
Results: Only 40.2% Pharmacists have the highest score of good knowledge on registered products and notified cosmetics at 81.8% (n=18). The level of good knowledge among allied health professionals (AHP) stood at 42.9% (n=21), 36.4% of nurses (n=43) and 20% of doctors (n=6). However in total, only 40.2% (n=88) of the study population had good knowledge.
Conclusion: The level of knowledge towards registered products and notified cosmetics among doctors, pharmacist, nurses and allied health professional in Labuan is poor as only 40.2% have good knowledge. This study shows a significant association between the levels of knowledge among GHP varies between groups of profession. Pharmacist group has the highest score in knowledge in this study and thus should be another reference for the general public and patients when it comes to health-related matters. Further re-education should be conducted to improve the knowledge of GHPs in Labuan with regards to this subject.
Medication errors are more likely to occur during patient’s transition of care. There was very little information about impact of medication reconciliation activities done for patients with chronic kidney disease (CKD) Stage IV-V during admission stage in Malaysian Primary Hospitals. The objective of this study is to evaluate the impact of clinical pharmacist’s medication reconciliation activities during hospital admission of patients with CKD stage IV-V. This cross-sectional study was carried out in two multidisciplinary wards (male & female ward) in Hospital Raub, Pahang over 12 months with ethical approval. A clinical pharmacist was assigned to enroll potential study subjects in both wards. Patients over 18 years old who had previous history of CKD Stage IV-V were included in the study after obtaining informed consent. Medication reconciliation was carried out by the clinical pharmacist within 24 working hours during the admission of study subjects. All detected medication discrepancies were further classified as “intended” or “unintended” after discussion with the prescribing medical officer. The Severity Level of each unintended medication discrepancy was rated by a visiting medical specialist. Twelve patients with CKD stage V were recruited to the study. A total of 49 medication discrepancies were identified and most (89.8%) were found to be unintended. The most common unintended medication discrepancy identified was omission error. Most of the unintended medication discrepancies (59.1%) was rated as “No potential harm”, while 40.9% were rated as “Potential for monitoring and/or Intervention to preclude harm”. None of the unintended medication discrepancy was rated as “Potential harm”. In conclusion, medication discrepancies were common during admission of patients with late-stage chronic kidney disease in a primary hospital. Medication reconciliation performed by clinical pharmacist during admission has a potential role in preventing potential harms that may arise from unintentional medication discrepancies.
Introduction: In the context of pharmacy education worldwide and in Malaysia, the use of digital
technologies to promote higher level thinking and discussions is seen as preparing the millennials as
pharmacists in the 21st century. Together with leveraging on millennials' penchant for mobile
technology, gamified online quizzes as an assessment tool that help promote active and collaborative
learning in a Medicinal Chemistry course have been used. Objectives: This study investigates
students’ perception of the impact of gamified online quizzes on their learning in a Medicinal
Chemistry course. Method: This study employs mix method research comprising descriptive
analysis, content analysis from informal chats and researchers' observation to gather the findings for
the study. Three gamified online quizzes using Quizizz, were implemented outside classroom time,
in place of traditional quizzes. Multiple attempts were allowed within a stipulated time. As
interventions, post-quiz discussions were conducted during class time. Students completed an endof-
the-course survey. Results: Out of 63 respondents, more than 96% felt that the gamified online
quizzes enhanced their learning as they learned from the instant feedback, their mistakes and postquiz
discussions. Overall student performance based on the percentage and accuracy of answering
the quiz improved with time. Student qualitative comments on the survey, the course social media
(closed group) and informal chats supported the findings from the descriptive data analysis of the
study. Conclusions: From students’ perception, the gamified online quizzes were found to be
enjoyable and effective in enhancing active, peer learning in an undergraduate medicinal chemistry
course outside class time. For instructors, the online quiz served as an efficient tool for formative
assessment in a large classroom setting, and could replace traditional classroom quizzes.
Dikir Farmasi (DF) is a new effort to expand and intensify the dissemination of information about
the regulation of the legitimate use of drugs and cosmetics. This study was aimed to explore the
opinions of Pharmacy Enforcement Division staff and the general public regarding the quality and
impact of DF program as a health promotion tool in Malaysia. A qualitative study using semistructured
interviews and focus group discussions (FGDs) were conducted at the Pharmacy
Enforcement Department and three health clinics located at the city of Kota Bharu, Malaysia. The
interviews were audio recorded, translated and transcribed. Thematic analysis was performed to
identify the themes and sub-themes of the transcripts. Ethical approval was obtained from Ministry
of Health Malaysia. All respondents provided a written consent for participation. Nine pharmacy
officers and 23 general public participated in this study. Five main themes emerged from the
information gathered and analyzed: 1) language; 2) design; 3) content and delivery 4) costs and
benefits and 5) prospect of DF. Certain weaknesses of DF have been raised and the health authorities
could utilize this information for an improvement. Significant effort must be made to improve the
publicity and dissemination of DF to ensure that it reaches the target population. Certain weaknesses
of DF have been raised and the health authorities could utilize this information for an improvement.
Significant effort must be made to improve the publicity and dissemination of DF to ensure that it
reaches the target population.