Individualising a drug dosage regimen is more appropriate if it is based on pharmacokinetics data derived from local populations. In this study, we estimated valproic acid (VPA) and carbamazepine (CBZ) clearances in the Malaysian population from routinely collected therapeutic drug monitoring (TDM) data. We also evaluated the effects of gender, age, weight and concurrent antiepileptic drug (AED) therapy on VPA and CBZ clearance. Data was collected retrospectively from TDM forms of adult patients. Apparent drug clearance was estimated based on the standard steady state clearance equation. Mann-Whitney and KruskalWallis tests were used to evaluate gender and therapy differences, while Spearman’s Rank correlation was used to determine the associations of age and weight with clearance. One hundred thirty-two samples for VPA and 67 for CBZ were included in the analysis. Patients’ ages ranged from 15 to 72 years old. Mean VPA and CBZ clearances were found to be 0.36 l/kg/d and 1.60 l/kg/d, respectively. VPA clearance correlated positively but poorly with weight. Our results showed significant differences in (i) VPA clearance among male and female patients and (ii) VPA clearance between monotherapy and combination therapy. These findings provide a guide to initiate maintenance doses of VPA and CBZ in our local patients. Awareness of factors influencing drug clearance should help to optimise patients’ dosing regimens.
The objective of this research was to formulate an aerosol concentrate containing haruan (Channa
striatus) water extract that would produce a thin film when sprayed onto a wound and could be used for wound dressing. The aerosol concentrates were formulated with various polymer and plasticiser mixtures and tested in dispersion systems. The polymers evaluated were hydroxypropyl methylcellulose (HPMC), carboxymethylcellulose sodium (CMC Sodium), acacia, tragacanth, chitosan, gelatine and gelatine (bloom 151–160), all at concentrations of 2%. The plasticisers evaluated were polyethylene glycol (PEG) 400 and 4000, glycerine, propylene glycol, and triacetin. Films were prepared from film-forming dispersions by casting techniques. Film-forming dispersions were characterised in terms of pH, density, surface tension, rheological properties, particle size distribution, and tackiness. Based on these evaluations, HPMC was chosen as the best polymer. It produced a film with the expected qualities and was easy to reproduce in the form of dispersions or as thin transparent films. Glycerine was judged as the most appropriate plasticiser because it produced the concentrate having the desired qualities and properties expected from an aerosol concentrate.
The appropriateness of sampling times and indications for monitoring of serum drug concentrations for the purpose of therapeutic drug monitoring (TDM) were evaluated at three hospitals on the east coast of Malaysia. Appropriateness criteria for indication and sampling were adapted from previously published criteria and with input from local TDM pharmacists. Six drugs were chosen, namely gentamicin, digoxin, carbamazepine, phenobarbital, phenytoin, and valproic acid. A total of 265 TDM requests were evaluated. Appropriateness of the indication for TDM ranged from 77.4% to 82%, while that for sampling ranged from 34.2% to 62.1%. There were no significant differences between the three hospitals in both categories of appropriateness. Among different drug groups, the percentage of appropriate indication was found to be highest with antiepileptic drugs. Antiepileptic drugs, however, had the lowest rate of appropriate sampling. Overall, findings from the three hospitals showed very encouraging results with almost 80% of the requests considered as appropriately indicated. However, the percentage of appropriateness of sampling was lower, and thus may require further investigation.
The International Pharmaceutical Federation (FIP) adopted a set of Good Pharmacy Practice (GPP) guidelines in 1993 and recommended that the regulatory bodies of individual countries should adapt the guidelines in accordance with their resources. The Malaysian Pharmaceutical Society (MPS) introduced its benchmarking guidelines (BMG) in 2003 as a means to raise the professional standards of the community pharmacy practice in Malaysia. Therefore, this study aimed to determine the extent to which community pharmacies have adopted the BMG. A cross-sectional study was conducted using mail questionnaires, which were posted to all community pharmacies in Malaysia. A total of 371 questionnaires (29.2%) were returned. Only 51.0% of the respondents were aware of the BMG. The extent of compliance with the guidelines was 62.6+21.1% (mean + standard deviation), with a median of 65%. The type and ownership of the community pharmacies were significantly associated with compliance with certain aspects of the guidelines. The main problem in complying with the BMG was financial constraint, and this problem was more likely to occur with independent than with chain pharmacies. However, the respondents generally agreed that most aspects of the BMG could be achieved in less than five years. Since the level of awareness among community pharmacists regarding the BMG is low, the MPS should promote or publicise the BMG further. The BMG should be reviewed before being used as part of the criteria for the accreditation of community pharmacies, as proposed by the MPS to further improve the quality and standards of community pharmacies in Malaysia.
The aim of this study was to investigate the acute (one-day treatment) effect of a methanol extract of
Orthosiphon stamineus, Benth on glutathione-S-transferase (GST) activity in streptozotocin (STZ)-induced diabetic young male and female Sprague Dawley (SD) rats. The methanol extract of O. stamineus was administered orally (5, 31.25, 125 and 500 mg/kg) to diabetic rats, and the effect on GST activity was measured by the method of Habig et al. (1974). No lethality and no significant changes in body weight and water intake were observed in the treated group as compared to the control group. A significant increase in the activity of GST was observed in the liver S-9 cytosolic fraction of diabetic male SD rats treated with 125 mg/kg (P < 0.01) and 500 mg/kg (P < 0.01) of the methanol extract O. stamineus. Administration of 500 mg/kg (P < 0.01) of the methanol extract of O. stamineus to diabetic female SD rats increased GST activity when compared to the control group. This study indicates that the methanol extract of O. stamineus could affect the activity of GST in rat liver and the effect seen was dose-dependent.