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A higher dose of magnesium each day keeps dementia at bay
New research highlights the potential benefits of a diet high in magnesium and the role it plays in promoting good brain health
More magnesium in our daily diet leads to better brain health as we age, according to scientists from the Neuroimaging and Brain Lab at The Australian National University (ANU).
The researchers say increased intake of magnesium-rich foods such as spinach and nuts could also help reduce the risk of dementia, which is the seventh biggest killer globally.
The study of more than 6 000 cognitively healthy participants in the United Kingdom aged 40-73 found people who consume more than 550mg of magnesium each day have a brain age that is approximately one year younger by the time they reach 55 compared with someone with a normal magnesium intake of about 350mg a day.
“Our study shows a 41% increase in magnesium intake could lead to less agerelated brain shrinkage, which is associated with better cognitive function and lower risk or delayed onset of dementia in later life,” lead author and PhD researcher Khawlah Alateeq, from the ANU National Centre for Epidemiology and Population Health, said.
“This research highlights the potential benefits of a diet high in magnesium and the
role it plays in promoting good brain health.”
The number of people worldwide who will be diagnosed with dementia is expected to more than double from 57.4 million in 2019 to 152.8 million in 2050, placing a greater strain on health and social services and the global economy.
“Since there is no cure for dementia and the development of pharmacological treatments have been unsuccessful for the past 30 years, it’s been suggested that greater attention should be directed towards prevention,” study co-author Dr Erin Walsh, who is also from ANU, said. “Our research could inform the development of public health interventions aimed at promoting healthy brain ageing through dietary strategies.”
“The study shows higher dietary magnesium intake may contribute to neuroprotection earlier in the ageing process and preventative effects may begin in our 40s or even earlier,” Alateeq said.
“We also found the neuroprotective effects of more dietary magnesium appears to benefit women more than men and more so in post-menopausal than pre-menopausal women, although this may be due to the antiinflammatory effect of magnesium.”
57.4 million
The number of people worldwide who will be diagnosed with dementia is expected to more than double from 57.4 million in 2019 to 152.8 million in 2050
Unlocking the importance of magnesium for children's health
Apharmacist’s role in promoting children's health extends beyond simply dispensing medications. You are pivotal in educating parents and caregivers about the essential nutrients crucial for children's growth and development.
Magnesium plays a pivotal role in supporting children's overall health and well-being, influencing various physiological processes crucial for growth and development.1,2
UNDERSTANDING MAGNESIUM
Magnesium is a mineral that plays a crucial role in over 300 biochemical reactions in the body, ranging from energy production to muscle function and nerve signalling.1 While it's essential for individuals of all ages, its significance is particularly pronounced during childhood, a period of rapid growth and development.
IMPORTANCE OF MAGNESIUM FOR CHILDREN:
P Bone health: Magnesium is vital for the development and maintenance of strong bones in children. It works synergistically with calcium and vitamin D to promote bone mineralisation, making it indispensable for achieving optimal bone density during childhood and adolescence.1,2,3,4
P Muscle function: Adequate magnesium levels are essential for proper muscle function, including relaxation and contraction. This is particularly important for children engaged in physical activities and sports, as magnesium deficiency can lead to muscle cramps and impaired performance.1,2
P Energy metabolism: Magnesium plays a critical role in energy metabolism 2 by activating enzymes involved in the breakdown of carbohydrates and fats.5 Ensuring sufficient magnesium intake helps support children's energy levels, allowing them to thrive in their daily activities.
P Nervous system health: The nervous system relies on magnesium for neurotransmitter
regulation and nerve signal transmission. Sustaining optimal magnesium levels promotes cognitive function and emotional well-being, contributing to overall mental health. 2 Severe magnesium deficiency can cause a generalised tonic-clonic seizure.1
P Regulation of heart rhythm: Magnesium is involved in maintaining a steady heart rhythm by regulating the movement of other electrolytes like potassium and calcium across cell membranes.1
IDENTIFYING MAGNESIUM DEFICIENCY
Recognising the signs of magnesium deficiency in children is essential for early intervention. Symptoms may include muscle cramps, fatigue, irritability, poor appetite, and abnormal heart rhythms. However, since these symptoms are non-specific and can overlap with other health conditions, consulting a healthcare professional for proper diagnosis is imperative.1,2,5
PROMOTING MAGNESIUM INTAKE
Pharmacists are uniquely positioned to educate parents and caregivers on practical ways to promote magnesium intake in children: F Encourage a balanced diet rich in magnesium-containing foods such as green leafy vegetables, nuts, seeds, whole grains, and legumes.1,2,4,5
F Recommend paediatric-friendly magnesium supplements when dietary intake is inadequate or in cases of increased magnesium requirements due to growth spurts, intense physical activity, or medical conditions.
F Emphasise the importance of moderation, as excessive magnesium intake from supplements can lead to adverse effects.
Pharmacists have a unique opportunity to advocate for the importance of magnesium and empower parents and caregivers to prioritise its inclusion in children's diets and supplementation when necessary. PM
*References available on request
Power of dietary supplements: who needs them and why
Discover how dietary supplements can bridge nutritional gaps, enhance health, and address specific dietary needs
Dietary supplements have gained significant popularity recently. Registered dietitian, Shani Cohen, discusses their importance and who may benefit from them.
WHO SHOULD TAKE SUPPLEMENTS?
Patients who may benefit from dietary supplements, include:
• Those with unbalanced diets
• Individuals with dietary restrictions or intolerances (eg, vegans, lactose intolerance)
• People with nutritional deficiencies
• Athletes undergoing strenuous exercise with limited recovery time
• Pregnant or breastfeeding women
• Some vegetarians and vegans
• People with malabsorption issues
• Individuals consuming excessive alcohol.
IMPORTANCE AND EFFECTIVENESS
Supplements are crucial when treating deficiencies, medical conditions, or supporting health and wellness goals. Their effectiveness varies based on individual circumstances. Despite efforts to maintain a balanced diet, many fail to meet the recommended daily nutrient intake, particularly the 5-9 servings of fruits and vegetables. Supplements can bridge this gap, especially for those with malabsorption issues, gastrointestinal losses, increased nutrient requirements (eg, cancer or surgical patients, pregnant women).
COMMON SUPPLEMENTS
Popular supplements include multivitamins, calcium, and vitamin C. During pregnancy, iron and folic acid are vital, and vitamin D is beneficial during breastfeeding. Vegans
benefit from vitamin B12, only found in animal products. Vitamin C, an antioxidant, is believed to support the immune system and became popular during Covid-19.
RISKS OF SUPPLEMENTS
There is a lack of stringent regulation in supplement manufacturing and marketing, leading to potential safety and efficacy issues. Supplements may contain undisclosed substances, posing health risks like allergic reactions, toxicity from overdosing, and contamination. Toxicity from nutrients is rare through diet alone but possible through supplementation. Furthermore, supplements haven’t been tested in all age groups, including children and pregnant women, necessitating caution.
ADVICE FOR SAFE USE
Pharmacists should advise patients to:
• Maintain a balanced diet from all food groups
• Seek nutrition assessments from registered dietitians
• Understand drug-nutrient interactions
• Consult professionals before taking supplements to ensure correct dosages and safety.
ADDITIONAL CONSIDERATIONS
Many patients fail to meet the recommended daily nutrient intake, particularly the 5-9 servings of fruits and vegetables
There’s a misconception that supplements can offset poor dietary choices and modern lifestyle stresses. Ensuring supplement safety involves investigating manufacturing practices, company history, and product range. Certification verifying ingredient authenticity, amounts, sourcing, and manufacturing practices should be requested, with testing done for each product batch.
Centrum Select 50+
Developed for people aged 50+ and helps to support healthy ageing 1
Clinically shown to support cognitive health in older adults2
Daily intake of Centrum Select 50+ for three years may slow cognitive ageing by 60% compared with those taking a placebo.2
Support wellness with Centrum Select 50+
Heart health
B rain function
Zinc and B vitamins to help suppor t normal brain function B vitamins to promote hear t health
Eye health
Vitamins A , C and E, and lutein to help suppor t healthy eyes
Contains essential vitamins and minerals to keep your heart, brain, and eyes healthy.
References:
1. CENTRUM® SELECT 50+ (Tablets) Professional Information 25 May 2018
2. Baker LD et al Alzheimers Dement 2022 doi: 10 1002/alz 12767
3 Nicholas Hall’s Global CHC database, DB6 MAT Q4 2023 value date
0 Centrum Select 50+: For a list of ingredients refer to product labelling.Category D medicine – Health Supplement. This unregist ered medicine has not been evaluated by the SAHPRA for its quality, safety and intended use. Haleon South Africa (Pty) Ltd. 11 Hawkins Avenue, Epping Indu stria 1, Cape Town, 7450. Reg. No: 2014/173930/07. For full prescribing information refer to the patient information leaflet. For any further information, including safety, please contact us on 0800 007 018 or email mystory.za@haleon.com. Always read label before use. Trademarks are owned by or licensed to Haleon gro up of companies.
P ro mot io na l ma teri al numbe r : P M -ZA-C N T-24-00060
Multivitamins & memory improvement
As pharmacists, understanding the latest research on dietary supplements is crucial for advising patients effectively. A recent study titled Multivitamin Supplementation Improves Memory in Older Adults: A Randomised Clinical Trial provides valuable insights into the potential cognitive benefits of multivitamin and multimineral supplementation in older adults. This article summarises the key findings and implications of this study for clinical practice.
STUDY OVERVIEW
The study was part of the COcoa Supplement and Multivitamin Outcomes Study Web (COSMOS-Web) and involved 3 562 participants. These individuals were randomly assigned to receive either a daily multivitamin or a placebo over three years. The primary outcome measured was the change in episodic memory, specifically immediate recall performance on the ModRey test, after one year of supplementation.
KEY FINDINGS
Memory improvement
COGNITIVE ASSESSMENTS
Cognitive performance was assessed using a self-administered online battery that included neuropsychological tests. The ModRey task, sensitive to hippocampal function, was designated as the primary outcome measure. The study utilised intention-to-treat methods for statistical analyses, ensuring a robust evaluation of cognitive performance changes over the three years.
IMPLICATIONS FOR PRACTICE
The findings suggest that daily multivitamin supplementation may be a safe and effective strategy for enhancing cognitive health in older adults, particularly in improving memory recall. This has several implications for clinical practice:
F Participants taking the multivitamin exhibited significantly better immediate recall performance compared to those on the placebo.
F Improvements were noted at both the one-year mark and averaged over the three-year followup.
F The memory improvement from multivitamin supplementation was estimated to counteract about 3.1 years of age-related memory decline.
Impact on cardiovascular disease (CVD) patients
F Individuals with a history of cardiovascular disease (CVD) experienced greater benefits from multivitamin supplementation.
F Significant improvements in memory scores were observed in this subgroup compared to those without a history of CVD.
• Patient counselling: Pharmacists can consider recommending multivitamin supplements to older adults, especially those with a history of CVD, as part of a strategy to maintain cognitive health.
• Safety monitoring: While multivitamins are generally safe, pharmacists should monitor for potential side effects, such as gastrointestinal bleeding, and advise patients accordingly.
• Further research: The study emphasises the importance of micronutrients in cognitive health and calls for further investigation into specific nutrients that may contribute to these benefits. This study provides robust evidence supporting the cognitive benefits of multivitamin supplementation in older adults. As healthcare professionals, pharmacists play a crucial role in translating these findings into practice, ensuring that patients receive evidence-based advice on dietary supplements.
SOURCE: Yeung L, Alschuler DM, Wall M, et al. Multivitamin Supplementation Improves Memory in Older Adults: A Randomized Clinical Trial. The American Journal of Clinical Nutrition. 2023:118(1);273-282. ISSN 0002-9165. Available from: https://doi.org/10.1016/j.ajcnut.2023.05.011.
The memory improvement from multivitamin supplementation was estimated to counteract about 3.1 years of age-related memory decline
Each 1 ml contains 0,6 mg of ipratropium bromide and 0,5 mg of xylometazoline hydrochloride for symptomatic relief with 1:
• Sinus pressure
• Runny nose
• Blocked nose 3 IN
Reference: 1. OTRIVIN PLUS Nasal Metered-dose Spray (Solution) package insert February 2021.
2 OTRIVIN PLUS Nasal Metered-dose Spray (Solution). Each 1 ml contains 0,6 mg of ipratropium bromide and 0,5 mg of xylometazoline hydrochloride. (Preservative-free). Reg. no.: 46/16.1/0819. Applicant: Haleon South Africa (Pty) Ltd. 11 Hawkins Avenue, Epping Industria 1, Cape Town, 7450 Company reg. no.: 2014/173930/07. For full prescribing information refer to the professional information approved by the medicines regulatory authority. Always read label prior to use. For any further information, including safety and adverse reactions, please contact the Haleon Hotline on 0800 007 018 or mystory.za@haleon.com. Trade Marks are owned by or licensed to the Haleon group of companies. Promotion Number: PM-ZA-OTRI-24-00007.
Topical nasal decongestion: enhancing quality of life during the common cold
The common cold, an acute and mild upper respiratory condition, is the most frequent human disease. Adults typically experience at least one cold per year, with the frequency varying by age. Caused primarily by rhinoviruses, the common cold is self-limiting, lasting about 7-10 days. Symptoms include nasal congestion, cough, sore throat, sneezing, runny nose, and headaches, often leading to sleep disruption, fatigue, cognitive impairment, and reduced alertness. These symptoms significantly affect quality of life (QoL), impacting daily activities and work performance. Among these symptoms, nasal congestion is particularly troublesome. It peaks around the second and third days of illness and can cause sleep disturbances, leading to daytime somnolence and mood changes. Although no cure exists, treatments like topical decongestants, such as xylometazoline hydrochloride, can alleviate nasal congestion, allowing easier breathing.
IMPACT ON QUALITY OF LIFE
While previous studies have shown that topical decongestants improve QoL in allergic rhinitis, there was no research on their impact during the common cold. This study aimed to evaluate the effects of xylometazoline hydrochloride 0.1% nasal spray on the QoL of individuals with common cold-related nasal congestion.
STUDY DESIGN AND FINDINGS
This real-world, open-label study demonstrated that using xylometazoline hydrochloride significantly improves QoL factors from day one of treatment. The Wisconsin Upper Respiratory Symptom Survey (WURSS-21) scores showed a marked improvement in both symptom severity and QoL from day one, suggesting that nasal decongestion allows individuals to resume daily activities sooner than the natural course of the illness.
SLEEP QUALITY AND VITALITY
Nasal congestion often leads to poor sleep quality, causing fatigue, irritability, and daytime dysfunction. This study found that xylometazoline hydrochloride improved sleep quality and related QoL factors such as ‘sleep well’ and ‘snoring’ from day one. Improved sleep, in turn, enhanced vitality factors like energy, motivation, and alertness.
PHYSICAL ACTIVITY AND SOCIAL INTERACTION
Participants reported an increase in physical activities, such as walking and exercising, from day two of treatment. Improved breathing also positively affected social interactions and reduced feelings of self-consciousness, enhancing overall social engagement and reducing the negative emotional impact of the common cold.
SENSORY PERCEPTION AND NUTRITIONAL INTAKE
Xylometazoline hydrochloride also improved the senses of smell and taste from day one, which likely made eating more enjoyable and ensured better nutritional intake during the cold.
LIMITATIONS AND CONCLUSION
The study's single-arm, open-label design, which allowed for the use of concomitant medications, is a limitation. Nonetheless, the significant improvements in symptoms and QoL suggest that xylometazoline hydrochloride 0.1% effectively alleviates nasal congestion and enhances QoL during the common cold. This real-world evidence provides valuable insights for healthcare providers in managing common cold symptoms, emphasising the importance of symptomatic relief in improving patient QoL.
SOURCE: Hagen M, et al. A real-world study of quality of life following treatment with xylometazoline hydrochloride in individuals with common cold. Ther Adv Respir Dis. 2024 JanDec;18:17534666241228927. doi: 10.1177/17534666241228927. PMID: 38372128; PMCID: PMC10878222.
Caused primarily by rhinoviruses, the common cold is selflimiting, lasting 7-10 days
Boosting immunity: strategies for winter and beyond
Winter months often see a surge in patients seeking remedies for common illnesses. Beyond the wellknown cold and flu season, mid-year slumps in energy and overall well-being are also frequent concerns.
THE IMMUNE SYSTEM: A COMPLEX NETWORK
The human immune system is a marvel of cellular and molecular interactions, constantly working to defend the body against pathogens like bacteria, viruses, and parasites. While there's no single magic bullet to boost immunity, we can support its function through various strategies.
WHY SUPPORT THE IMMUNE SYSTEM?
A well-functioning immune system is crucial for:
Reduced incidence of infections: A stronger immune system can decrease the frequency and severity of common colds and flu.1 Faster recovery times: Enhanced immunity aids in quicker recovery from illnesses.1 Chronic disease prevention: A healthy immune system helps regulate inflammation, potentially reducing the risk of chronic conditions, contributing to better overall health. 2
KEY IMMUNE BOOSTERS TO CONSIDER
Macro- & micronutrients
• Vitamin C: Known for its antioxidant properties, vitamin C is crucial for immune function. It enhances the production of white blood cells and helps the body fight off infections1,2
• Vitamin D: Essential for immune regulation, vitamin D deficiency is common in winter due to reduced sunlight exposure. Supplementation can help maintain adequate levels1,2
• Vitamin E: Studies have found that vitamin E enhances T cell-mediated immune function in the face of age-related decline2
• Zinc: This mineral is vital for immune cell function and signalling. Zinc supplementation can reduce the duration of cold symptoms1,2,3
• Omega-3: Known for their anti-inflammatory properties, omega-3 fatty acids play a significant role in managing and reducing inflammation throughout the body, including the respiratory tract. 2
Herbal supplements
• Echinacea: Popular for its immuneboosting properties, Echinacea can reduce the chances of catching a cold and shorten the duration of symptoms1,4,5
• Elderberry: Rich in antioxidants, elderberry has been shown to reduce the severity and length of flu symptoms6,7
• Astragalus: An adaptogen that helps the body resist stress and boosts the immune system.8,9
Probiotics
Probiotics support gut health, which is closely linked to the immune system. A healthy gut microbiome can enhance immune responses and prevent infections.10
Ideally, the best way to obtain these nutrients is by eating a varied and balanced diet, but this may not always be feasible for many people, who might need to take supplements. Supporting the immune system optimally might necessitate consuming amounts of certain micronutrients that exceed the recommended dietary allowances (RDA). Keep in mind, infections and various stress factors can deplete micronutrient levels in the body. 2
While there's no guaranteed way to prevent every illness, supporting a healthy immune system can significantly improve overall well-being.
*References available on request
During winter, people are more susceptible to colds, flu, and other respiratory infections
Allergy-asthma connection: strategies to improve patient outcomes
Understanding the relationship between allergies and asthma is essential, as managing allergies can significantly help control asthma symptoms.
ALLERGIC ASTHMA
Allergic asthma is the most prevalent form of asthma1,2, triggered by allergens such as pollen, dust mites, mould spores, pet dander, and cockroach droppings. Exposure to these allergens causes the immune system to overreact, leading to airway inflammation and asthma symptoms.2,3
IMMUNOLOGICAL MECHANISMS
Both allergies and asthma involve the production of Immunoglobulin E (IgE) antibodies in response to specific allergens. These IgE antibodies bind to mast cells and basophils, releasing inflammatory mediators like histamines, leukotrienes, and cytokines, which contribute to allergic reactions and asthma symptoms.1,4,5
INFLAMMATION AND AIRWAY HYPERRESPONSIVENESS
Allergic reactions can cause inflammation and swelling of the airways, increasing their sensitivity and reactivity to triggers. This condition, known as airway hyperresponsiveness, is a hallmark of asthma, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing.3,5
ATOPIC MARCH
The ‘atopic march’ describes the progression of allergic diseases from early childhood, often starting with eczema, progressing to food allergies and allergic rhinitis, and eventually leading to asthma.6,7 This progression highlights the interconnectedness of allergic diseases and the importance of early intervention.
ENVIRONMENTAL FACTORS
Environmental factors play a significant role in both allergies and asthma. Exposure to allergens,
air pollution, tobacco smoke, and viral respiratory infections can exacerbate both conditions.8,9 Changes in lifestyle and environment, such as increased hygiene and reduced exposure to diverse microbial environments, have been linked to the rise in allergic diseases and asthma.10
MANAGEMENT AND TREATMENT
Effective management of allergies is crucial for controlling asthma symptoms. Pharmacists can play a pivotal role in advising patients on the following strategies:
F Identifying allergens: Encourage patients to work with an allergist to identify specific allergens and take steps to minimise exposure,3 such as using air purifiers11 and allergen-proof covers.3
F Medication management: Recommend appropriate medications like antihistamines, nasal corticosteroids, and leukotriene inhibitors.12,13 Allergy shots (immunotherapy) can also help reduce the severity of allergic reactions and asthma symptoms.13,14
F Environmental controls: Advise patients on regular cleaning to reduce dust mites, mould, and pet dander.2 Suggest using HEPA filters3,15,16 and maintaining indoor humidity levels between 45% and 50%.3
F Asthma action plan: Collaborate with patients and their healthcare providers to develop an asthma action plan that includes strategies for managing allergies.13
F Regular monitoring and review: Encourage patients to regularly review their management plan with their healthcare provider and keep a diary of symptoms, triggers, and medication use.
By taking a comprehensive approach to managing allergies, you can help patients significantly reduce their asthma symptoms and improve their quality of life.
*References available on request
40 %
Allergic asthma is the most common asthma phenotype and has been described in about 40-50% of children and adults with asthma2
Multiple action2
Close to allergens. Far from allergies. Optimal
Rapid onset antihistaminic action2
Long duration mast cell stabilising action2,4
Prevents inflammatory cytokine production1,2
The #1* Allergy eye drop that helps treat the signs and symptoms of ocular allergy.1-3
relief.1,2
• Patients ≥3 years old1 • 1 drop in affected eye BD1
QR code
*IQVIA TPM, South Africa, ATC4 S1G3 OCUL.A.-ALLERG.MULTI.ACTN, for the period MAT Dec 2023, Data in units, reflecting estimates of real-world activity. Copyright IQVIA. All rights reserved.
References: 1. Patanol® Eye Drops Professional Information, 11 November 2021. 2. Rosenwasser LJ, O’Brien T, Weyne J. Mast cell stabilization and anti-histamine effects of olopatadine ophthalmic solution: a review of pre-clinical and clinical research. Curr Med Res & Opin 2005;21(9):1377-1387. 3. Based on internal analysis by Adcock Ingram (Pty) Ltd using data from the following source: IQVIA TPM, South Africa, ATC4 S1G3 OCUL.A.-ALLERG.MULTI.ACTN, for the period MAT Dec 2023, Data in units, reflecting estimates of real-world activity. Copyright IQVIA. All rights reserved. 4. Kaliner MA, Oppenheimer J, Farrar JR. Comprehensive review of olopatadine: the molecule and its clinical entities. Allergy Asthma Proc 2010;31(2):112-119.
S2 PATANOL® Eye Drops, solution. Reg. No.: 33/15.4/0189. Contains 1,11 mg/mL olopatadine hydrochloride equivalent to 1 mg/mL olopatadine, preserved with benzalkonium chloride 0,01 % (m/v). For full prescribing information, refer to the Professional Information approved by the South African Health Products Regulatory Authority (SAHPRA). Holder of Certificate of Registration: Novartis South Africa (Pty) Ltd. Magwa Crescent West, Waterfall City, Jukskei View, 2090. Tel. +27 11 347 6600. Co. Reg. No.: 1946/020671/07. Novartis Adverse Drug Reaction Reporting: Email: patientsafety.sacg@novartis.com. Web: https://novartis.com/ report. Tel: 0861 929 929. Marketed and Distributed by Adcock Ingram Limited. Co. Reg. No.: 1949/034385/06. Private Bag X69, Bryanston, 2021, South Africa. Customer Care: 0860 ADCOCK / 232625. www.adcock.com FA-11225667. Expiry date: 14 August 2026.
Allergic conjunctivitis & itchy eyes
While OTC medications can provide relief, pharmacists play a crucial role in accurately assessing symptoms, differentiating from other conditions, and appropriately guiding patients
Itchy eyes are a common complaint in pharmacies, often associated with allergic conjunctivitis and affecting millions of individuals worldwide, leading to discomfort and impairment in quality of life.
UNDERSTANDING ALLERGIC CONJUNCTIVITIS
Allergic conjunctivitis, also known as hay fever eyes, is an inflammatory response in the conjunctiva (eye's surface) triggered by allergens like pollen, dust mites, or pet dander. The body releases histamines, causing:
P Intense itching: The hallmark symptom, often leading to rubbing, which can worsen irritation.
P Redness: Dilated blood vessels in the conjunctiva cause the whites of the eyes to appear red.
P Watery discharge: The body attempts to flush out the allergen, leading to excessive tearing.
P Swollen eyelids: Inflammation and fluid buildup can cause puffy eyelids.
Differentiating from Other Conditions
While allergic conjunctivitis is common, it's crucial to differentiate it from other conditions:
P Viral and bacterial conjunctivitis (pink eye): These are contagious, often presenting with one eye affected initially, with a thick, yellow, or green discharge.
P Dry eye: This can cause irritation and itching, but usually lacks redness and discharge.
PHARMACIST INTERVENTION
Pharmacists can effectively manage allergic conjunctivitis by:
P Assessing symptoms: Asking about the nature of itchiness, discharge, and presence of other allergies helps identify the cause.
P Recommending OTC medications: Depending on severity, pharmacists can suggest:
F Artificial tears: Lubricate dry, irritated eyes.
F Antihistamine eye drops: Block histamine action, reducing itching and redness.
F Mast cell stabilisers: Prevent the release of histamines for long-term management.
P Educating patients on:
F Allergen avoidance: Identifying and minimising exposure to triggers.
F Proper medication use: Instructing on appropriate application and avoiding overuse.
F Consulting an ophthalmologist: If symptoms worsen, persist for more than a week, or involve vision changes.
Additional Considerations:
P Age: Be cautious with children, especially infants, as their eyes are more delicate. Refer to a doctor for appropriate guidance.
P Concurrent medications: Ensure OTC medications don't interact with any existing prescriptions.
P Underlying conditions: If the patient has known allergies or eye conditions, advise consulting their doctor before using any OTC medication.
By understanding allergic conjunctivitis, differentiating it from other conditions, and offering appropriate guidance and education, pharmacists can significantly improve patient care and eye health outcomes.
Antihistamine eye drops, like olopatadine, are commonly recommended as first-line therapy to relieve itching and redness
Inflammation of the eyelids
Red and swelling of conjuctiva
Conjuctiva
Cornea Pupil Iris Lens
Eyelid
Understanding and addressing eye strain is essential for guiding patients toward effective relief methods and promoting eye health
Essential tips for relieving eye strain
Eye strain, medically known as asthenopia, is a common condition characterised by tired, uncomfortable eyes, often occurring after prolonged focus on tasks like reading or using digital devices. As pharmacists, understanding and addressing eye strain is essential for guiding patients toward effective relief methods and promoting eye health.
UNDERSTANDING EYE STRAIN AND ITS SYMPTOMS
Asthenopia is essentially fatigue of the eyes, resulting from intense use over extended periods. It's prevalent among individuals engaged in activities requiring considerable visual concentration, such as staring at computer screens, reading for long hours, or driving long distances. Common symptoms include headaches, blurred vision, dry or watery eyes, sore or burning sensations, light sensitivity, and, in some cases, difficulty focusing.1
EFFECTIVE REMEDIES AND LIFESTYLE ADJUSTMENTS
There are several methods to relieve and prevent eye strain, primarily involving changes in daily habits. Pharmacists can recommend the following strategies:
or working environments are well-lit to prevent the eyes from straining; lighting should be placed to avoid glare on screens and reading material.3
• Digital device adjustments: Advise on the importance of adjusting screen brightness and contrast to match ambient light levels, which significantly reduces strain on the eyes.1,3,4
• Use of artificial tears: Consider recommending over-the-counter lubricating eye drops to alleviate dryness and keep eyes moist, especially for individuals in environments with low humidity.1,3
THE ROLE OF PHARMACISTS IN MANAGING EYE STRAIN
Pharmacists serve as accessible healthcare professionals capable of providing valuable advice and solutions for eye strain:
F Education: Educate patients about the importance of regular breaks from screens and the potential for long-term damage if eye strain is ignored, emphasising the 2020-20 rule.1,2,3
• 20-20-20 rule: Encourage the practice of this rule, which involves taking a 20-second break to view something 20 feet away every 20 minutes spent on digital devices. This simple technique helps relax the eyes.1,2,3
• Eye exercises: Suggest exercises such as focusing on a nearby object before shifting to a distant one. This practice helps reduce fatigue by varying the focal length of the eyes.1,4
• Proper lighting: Ensure that reading
F Product recommendations: Guide patients towards appropriate products, such as blue light filtering glasses or prescribed computer glasses for those regularly using screens 4 and OTC artificial tears to help keep eyes lubricated.1,3,4
F Diagnostics and referral: Identify symptoms indicative of deeper issues requiring professional eye examinations. Referral to optometrists for vision problems detected through preliminary screening can be vital. 2
Through these strategies and patient education, pharmacists can significantly alleviate the discomfort associated with eye strain, contributing to enhanced patient well-being and overall eye health.
*References available on request
Decoding glaucoma
Glaucoma is a complex group of eye conditions characterised by damage to the optic nerve, which is responsible for transmitting visual information from the eye to the brain. The damage often occurs due to elevated intraocular pressure (IOP), leading to progressive vision loss and potentially irreversible blindness.1,2,3,4 Globally, glaucoma affects an estimated 60 million individuals and stands as the leading cause of permanent vision impairment. 4
Symptoms of glaucoma are typically absent in the early stages, making it a stealthy adversary to eye health. However, as the condition progresses, symptoms may manifest, including a gradual worsening of vision.1,2,3,4 Monitoring for signs of elevated intraocular pressure and variations in pressure levels are essential for early detection and management.
THERE ARE TWO PRIMARY TYPES OF GLAUCOMA:
P Primary Open-Angle Glaucoma (POAG): Often referred to as the "thief of sight," POAG is insidious in its onset. Patients may experience no pain or discomfort, and vision loss tends to be so gradual that individuals may not even notice it until significant damage has occurred. This chronic condition arises when the drainage of aqueous fluid from the eye becomes inefficient, resulting in a buildup of intraocular fluid and increased pressure that damages the optic nerve. Regular eye exams are crucial for early detection, particularly for individuals with optic nerves sensitive to normal eye pressure.1,2,3,4
P Primary Closed-Angle Glaucoma (PCAG): Unlike POAG, PCAG involves the blockage of the angle where aqueous humour drains from the eye. This blockage typically occurs due to the iris obstructing the drainage angle, leading to a closed angle. PCAG is less common than POAG but still poses a significant risk of vision loss if left untreated. It shares
Damage to optic nerve
Abnormal preassure inside
the asymptomatic nature of POAG in its early stages, emphasising the importance of routine eye examinations for early detection.1,2,3,4
Various risk factors contribute to the development and progression of glaucoma, including age, family history, certain medical conditions like diabetes and hypertension, ocular disorders, and long-term use of corticosteroids.1,2,3,4
Treatment strategies for glaucoma aim to slow disease progression by reducing intraocular pressure, thereby preserving vision. Pharmacological interventions such as carbonic anhydrase inhibitors, prostaglandin analogues, beta-blockers, alpha-agonists, and cholinergics agonists are commonly prescribed to manage intraocular pressure.5,6,7 When medication alone is insufficient, non-pharmacological approaches like laser trabeculoplasty or trabeculotomy may be recommended to enhance aqueous humour outflow.1,2
Understanding glaucoma involves recognising its insidious nature, identifying risk factors, and implementing timely interventions to preserve vision and mitigate the risk of irreversible blindness. Regular eye examinations and proactive management strategies play pivotal roles in combating this sightthreatening condition.
*References available on request
Glaucoma can be challenging to diagnose because symptoms often appear at a late stage of the disease
Scalp infections 101
Understanding the various types of scalp infections, their causes, symptoms, and treatment options is essential for providing optimal care to patients
Scalp infections are common and can be caused by a variety of factors, including bacteria, fungi, and parasites. Pharmacists play an important role in the aprevention and treatment of scalp infections, as they are often the first point of contact for patients with these conditions.
COMMON TYPES OF SCALP INFECTIONS
Some of the most common types of scalp infections include:
P Folliculitis: This is an inflammation of the hair follicles. It can be caused by bacteria, such as Staphylococcus aureus, or by fungi, such as Malassezia furfur.
P Seborrheic dermatitis: This is a chronic skin condition that causes red, flaky patches on the scalp and other areas of the body. It is often caused by an overgrowth of the yeast Malassezia furfur.
P Tinea capitis: This is a fungal infection of the scalp, also known as ringworm of the scalp. It is most common in children and is highly contagious.
P Pediculosis capitis: This is a parasitic infection of the scalp, also known as head lice. It is caused by tiny insects that live on the scalp and feed on human blood.
SYMPTOMS
Symptoms of scalp infections can vary depending on the underlying cause. However, some common symptoms include itching, redness, flaking, scaliness, bumps, pus-filled sores, and hair loss.
DIAGNOSIS
Scalp infections are typically diagnosed by a physical exam and medical history. In some cases, a doctor may order a skin biopsy or culture to confirm the diagnosis.
TREATMENT OPTIONS
The choice of treatment depends on the type of scalp infection and the causative agent.
P Fungal infections: Antifungal shampoos (e.g., ketoconazole), creams, or oral antifungal medications (e.g., terbinafine) are commonly prescribed.
P Bacterial infections: Topical antibiotics (e.g., mupirocin) or oral antibiotics (e.g., cephalexin) may be necessary.
P Viral infections: Antiviral medications, such as acyclovir, may be prescribed for herpes simplex dermatitis.
P Parasitic infestation: Topical permethrin and pyrethrin formulated with piperonyl butoxide are the pediculicides of choice in Pediculosis capitis. Wet combing should be considered for children younger than two years.
P Supportive Care: Recommending gentle cleansing, proper hair care, and managing symptoms like itching can improve patient comfort.
PATIENT EDUCATION
Pharmacists play a crucial role in patient education. It is essential to convey the following key points to patients:
P Follow medication instructions: Emphasise the importance of completing the full course of prescribed medications
P Hygiene: Stress the significance of proper scalp hygiene and avoiding sharing personal items like combs and hats to prevent reinfection
P Regular follow-up: Encourage patients to follow up with their healthcare provider to monitor treatment progress
P Avoid self-diagnosis and treatment: Patients should be advised against self-diagnosis and using OTC medications without consulting a healthcare professional.
By educating patients about scalp infections and providing them with appropriate medications, pharmacists can help to improve patients' outcomes..
Scalp infections are common and can be caused by a variety of factors, including bacteria, fungi, andparasites
Decoding SPF: the science behind sun protection
Sun Protection Factor (SPF) is a crucial term in dermatology and skincare, especially for pharmacists who often guide patients in choosing the right sunscreen
WHAT DOES SPF FACTOR MEAN?
SPF stands for Sun Protection Factor, measuring how well a sunscreen protects the skin from UVB rays, which cause sunburn and contribute to skin cancer. The SPF number indicates how much longer it takes for untanned skin to start reddening with sunscreen compared to without it. For example, if it takes 10 minutes to redden without sunscreen, SPF 30 theoretically allows 300 minutes (30 times longer) of protection. However, this is an approximation influenced by factors like sun intensity, location, skin type, and application amount.1,2,3
Higher SPF values provide more protection, but no sunscreen blocks 100% of UV rays. For instance, SPF 15 blocks about 93% of UVB rays, SPF 30 blocks about 97%, SPF 50 blocks about 98%.1
It’s important to note that SPF only measures UVB protection. For comprehensive protection, recommend broad-spectrum sunscreens that protect against both UVB and UVA rays, which cause skin aging and contribute to skin cancer. Proper application and reapplication are crucial for effective protection.1,2,3
SPF 30 VS SPF 50
The primary difference between SPF 30 and SPF 50 sunscreens lies in their UVB protection levels:
P SPF 30: Blocks about 97% of UVB rays.
P SPF 50: Blocks about 98%. 4
The difference in effectiveness is minimal (1%)
– SPF 30 theoretically allows 300 minutes of protection, while SPF 50 allows 500 minutes. However, real-world factors like swimming, sweating, and not reapplying sunscreen reduce effectiveness. Proper application and reapplication are essential. Higher SPF ratings can give a false sense of security, leading to longer sun exposure without reapplying, increasing skin damage risk. Use additional sun protection methods like hats, sunglasses, and UV-protective clothing.3,4
DEBUNKING THE MYTH ABOUT CHEMICAL FILTERS IN SUNSCREEN
Chemical sunscreens, often misunderstood, are just as effective and safe as their mineral counterparts. Both zinc oxide and chemical filters like avobenzone provide broad-spectrum protection against UV radiation.5 The term ‘chemical’ is a misnomer, as all sunscreens, including ‘natural’ ones, are composed of chemicals. Modern chemical sunscreens are formulated to be photostable and non-irritating, making them suitable for various skin types. The myth that chemical filters are harmful is largely unfounded, as extensive research and regulatory reviews ensure their safety and efficacy. By understanding these aspects of SPF and sunscreen, you can better educate and assist your patients in making informed decisions about sun protection.
*References available on request
90 %
Exposure to ultraviolet radiation is estimated to be associated with 80%–90% of skin cancers7
Helps prevent Actinic Keratosis
and Non-melanoma Skin Cancer
SOURCE: National Institutes of
Understanding melanoma: what patients need to know
Educating patients about melanoma, its risks, and early warning signs is crucial for early detection and timely intervention
Melanoma is a cancer originating from melanocytes, skin colourproducing cells. It primarily occurs on sun-exposed skin but can develop in melanocyte-rich areas like the eyes, mucous membranes, palms, soles, and beneath fingernails. Melanoma's unique characteristic is its potential to spread to other body parts, making it the deadliest skin cancer.
RISK FACTORS
P Sunlight: UV radiation from the sun is the primary skin cancer risk factor. Sunlight can cause skin damage leading to cancer.
P Sunburn: A history of sunburn elevates melanoma risk, regardless of age. Multiple sunburns in a lifetime increase the risk further.
P Sunscreen: Assessing sunscreen's impact on melanoma risk is challenging. Some users may extend sun exposure, believing they're fully protected. The best protection combines shade, clothing, and sunscreen. Shade and clothing are more effective. Sunscreen should complement, not replace, sun safety measures.
P Sunlamps and tanning booths: Artificial UV radiation sources, like sunlamps and tanning booths, increase the risk of skin damage and cancer, particularly for those under 30.
IDENTIFYING MELANOMA
Recognising melanoma's warning signs is crucial:
P Asymmetry: Melanoma spots are often uneven.
P Border: Irregular, ragged borders are a red flag.
P Colours: Melanoma may have multiple colours.
P Diameter: A mole larger than a pencil eraser may be concerning.
P Evolution: Changes in size, colour, or bleeding in a mole warrant attention.
WHO IS AT RISK?
Melanoma risk factors result from genetic and environmental factors:
P Family history: Those with a personal or family history of melanoma face higher risk.
P Skin type: Lighter skin is more prone, but all skin types can be affected.
P Phenotypic characteristics: Features like hair and eye colour, freckling, and time spent outdoors contribute to risk. Understanding risk factors and recognising warning signs empowers patients to protect themselves and seek prompt medical attention if they notice concerning changes.
*References available on request
Melanoma's unique characteristic is its potential to spread to other body parts, making it the deadliest skin cancer
Dry skin relief
Moisturising relief for skin prone to psoriasis and eczema.
SOURCE: National Institutes of Health
Spotlight on psoriasis: preventing patches of itchy, sore skin
Psoriasis is a chronic skin disorder that affects more than 6.7 million US adults. In SA 2.9% of the population is estimated to suffer from psoriasis. Symptoms vary but are usually recognised by itchy or sore patches of thick, red skin with silvery scales. While there's no cure, treatment often helps manage the symptoms.
Psoriasis occurs when skin cells rise to the surface too quickly and build up into thick patches, or plaques. Normally, skin cells mature as they rise from below the surface, but in psoriasis, these cells pile up before maturing properly.
Psoriasis begins in the immune system, which normally protects the body against infection. In psoriasis, the immune system becomes overactive, causing redness, swelling, and the rapid build-up of skin cells. Plaques most often appear on the elbows, knees, or scalp, but they can affect any skin-covered region, including the face, nails, and genitals.
Dr Joel Gelfand, a dermatologist at the University of Pennsylvania, notes, “Patients can have a lot of symptoms like itching, cracking, and bleeding that can disrupt their sleep and social relationships.” People with moderate to severe psoriasis may feel self-conscious, leading to depression or social isolation.
Some people with psoriasis also experience joint inflammation, known
2.9% of the SA population is
as psoriatic arthritis, which produces arthritis-like pain. Psoriasis, especially severe cases, is linked to other disorders such as heart conditions, obesity, high blood pressure, and diabetes.
While it can occur at any age, psoriasis typically first appears in young adulthood. Many people with psoriasis have a family history of the disorder. Researchers have identified certain genes linked to the disease, though the process is not fully understood. Importantly, psoriasis isn't contagious; you can't ‘catch’ it by touching someone who has it.
Psoriasis can be hard to diagnose because it can resemble other skin diseases. As a result, doctor may need to examine a skin sample under a microscope. For an accurate diagnosis, it’s often best to see a primary care doctor or a dermatologist.
There are many treatments for psoriasis, including creams, light therapy, and medications taken orally or by injection.
“Treatment decisions in psoriasis need to be highly individualised and tailored toward the patient’s clinical condition and underlying health status, as well as their preferences and goals,” said Dr Gelfand.
Psoriasis symptoms may briefly worsen or flare. These flares can occur due to stress, traumatic events, smoking, heavy alcohol use, and being overweight. Managing these factors can help in reducing flares and maintaining better control over the condition.
Visibly reduces 64 % blemishes by up to
First results from 7 days*
The psychosocial burden of acne in teens
Acne vulgaris, commonly known as acne, is a prevalent skin condition that affects individuals of all ages, but commonly targets teenagers during puberty. Beyond its physical manifestations, acne can exert a significant psychosocial burden on adolescents, impacting their self-esteem, social interactions, and overall mental well-being.1
UNDERSTANDING THE PSYCHOSOCIAL IMPACT
Acne doesn't just affect the skin; it affects the psyche as well. For many teenagers, the appearance of acne lesions can lead to feelings of embarrassment, self-consciousness, and even depression. Adolescence is a time of significant social development, and the presence of acne can hinder teenagers' ability to interact confidently with their peers. Studies have shown that adolescents with acne are more likely to experience social withdrawal, bullying, and a diminished quality of life compared to their peers without acne. 2,3
FACTORS CONTRIBUTING TO THE PSYCHOSOCIAL BURDEN
OF ACNE INCLUDE:
P Body image concerns: Adolescents often place a high value on physical appearance, and acne can significantly impact their body image perception. Persistent acne can lead to dissatisfaction with one's appearance, contributing to low self-esteem and negative self-image. 4
P Social stigma: Acne is sometimes unfairly stigmatised as a result of misconceptions and societal beauty standards. Teenagers with acne may feel judged or ostracised by their peers, leading to social isolation and feelings of inadequacy.5
P Impact on mental health: The emotional toll of acne should not be underestimated. Many teenagers experience heightened levels of anxiety, depression, and other psychological distress due to their acne,
which can affect their overall mental health and well-being. 2,3
SUPPORTING TEENAGERS WITH ACNE
You have the opportunity to provide valuable support and guidance to teenagers struggling with acne. Here are some strategies to consider:
P Educate about acne: Offer comprehensive education on the causes, triggers, and treatment options for acne. Empower teenagers with knowledge about proper skincare routines, the importance of gentle cleansing, and the role of OTC and prescription medications in managing acne.
P Provide empathetic counselling: Create a safe and supportive environment for teenagers to discuss their concerns about acne. Listen actively, validate their feelings, and offer encouragement and reassurance. Empathise with their struggles and let them know that they are not alone in dealing with acne.
P Promote self-care practices: Encourage teenagers to prioritise self-care activities that promote overall well-being, such as regular exercise, adequate sleep, healthy eating habits, and stress management techniques. These practices can help alleviate some of the psychological distress associated with acne.
P Address post-acne hyperpigmentation: Postacne hyperpigmentation is a common sequela of acne characterised by darkened patches or spots on the skin. While it does not pose any health risks, it can contribute to feelings of self-consciousness and dissatisfaction with one's appearance. Acne induced postinflammatory hyperpigmentation (PIH) contributes to and prolongs the mental burden of acne.6,7,8 Pharmacists can recommend skincare products containing ingredients that help fade hyperpigmentation and promote skin healing.9 Additionally, advise teenagers to use sunscreen daily to prevent further darkening of hyperpigmented areas.9
*References available on request
For many teenagers, the appearance of acne lesions can lead to feelings of embarrassment, self-consciousness, and even depression
SOURCE: Specialist Forum
Adherence key to acne improvement
Acne vulgaris is a common, chronic skin disease that often requires prolonged treatment. Good adherence to medication and adjuvants are associated with higher clinical improvement
Acne vulgaris, primarily appearing on exposed areas like the face and chest, can lead to scarring and significantly affect a patient's life quality. Adherence to prescribed medication greatly influences treatment effectiveness, yet studies reveal low adherence rates, hindering therapy success, especially with combined topical and systemic treatments.
Tailoring treatment plans to individual patient needs, preferences, and expectations is essential.
TYPE OF ACNE
Mild
Moderate
Severe
Recurrent or nonresponsive to treatment
Considering potential adverse effects and providing alternatives to improve tolerability, such as skin barrier repair therapies, can enhance adherence. Additionally, fostering a strong relationship with patients is crucial, offering support and motivation, particularly for chronic conditions impacting self-esteem and quality of life.
Specialist dermatologist, Dr Rakesh Newaj recommends the following treatment for mild to severe acne:
PROPOSED TREATMENTS
Topical treatment with a retinoid cream is effective for comedonal acne. It can be combined with other topical creams like benzoyl peroxide. Other topicals like antibiotics, azelaic acid, topical dapsone or salicylic acids may be effective. Patients can benefit from chemical peels as an add-on treatment.
A combination approach is advised for moderate acne. Patients will benefit from topicals as well as oral treatments. If there are many pustules, an oral antibiotic together with topical retinoids and benzoyl peroxide can help most cases. In females, where a hormonal association is suspected (acne worsening perimenses), the use of cyproterone acetate with topical therapy is advised In patients who are forming scars or are very disturbed by their pimples, the use of oral isotretinoin should be considered early Keratolytic chemical peels will assist most patients.
Severe cases are best referred to dermatologists. However, the use of isotretinoin must be considered as one of the first options. Where there are many cysts and severe inflammation, a short course of low dose steroids can help to prevent scarring. Some cysts need to be drained or injected with steroids.
Patients that cannot tolerate isotretinoin need to be dealt with through the use of alternative therapy, like chemical peels, lasers and photodynamic therapy.
One should reconsider the diagnosis if there is no response to treatment. Several conditions like rosacea, trichoepitheliomas or syringomas can form lesions on the face, that look similar to acne.
One should also ascertain if the patient adhered to treatment or taking certain medications that aggravate acne (steroids, psychiatric medications etc).
Severe stress, poor social habits, obesity (insulin resistance), heavy make-up and over-zealous cleansing/scrubbing of the face do aggravate acne.
Short courses or low-doses of isotretinoin are becoming more popular in the maintenance of acne.
Acne vulgaris, primarily appearing on exposed areas like the face and chest, can lead to scarring and significantly affect a patient's life quality
RINGWORM FACT FILE
Ringworm of the body is a common fungal infection, also known as tinea corporis.1
Symptoms typically appear between 4 and 14 days after the skin comes in contact with the fungi that cause ringworm.2
SYMPTOMS:1
REST.
• A scaly ring-shaped area, typically on the buttocks, trunk, arms and legs
• May itch
• A clear or scaly area inside the ring, perhaps with a scattering of red bumps
• Slightly raised, expanding rings
• A round, flat patch of itchy skin
• Overlapping rings
HOW IT’S SPREAD:1
Ringworm is contagious and it can spread in the following ways:
• Human-to-human: direct skin-to-skin1 contact with an infected person
• Animal-to-human: direct contact with an infected animal, or while petting/grooming dogs and cats
• Object-to-human: through contaminated clothing, towels, linens, combs and brushes
THE SOLUTION: COVAREX® CREAM!
• Works fast3
• Safe for use by the whole family (babies and toddlers included)3
• Covarex® cream is made using EMZALOID™ Technology, ensuring rapid absorption3
• Essential fatty acids help restore the skin’s protective barrier and help reduce inflammation4
• Affordable5
Topical fungal infections Basic guidelines and the benefits of Emzaloid technology
Topical fungal infections, such as those affecting the skin, nails, and mucous membranes, are common and can significantly impact patients' quality of life. As pharmacists, understanding the treatment guidelines for these infections is crucial for providing optimal patient care.
COMMON TOPICAL FUNGAL INFECTIONS AND THEIR TREATMENT
Dermatophytosis (tinea infections)
P Tinea pedis (athlete's foot): Topical antifungals such as terbinafine, clotrimazole, or miconazole are firstline treatments. For severe cases, oral antifungals like terbinafine or itraconazole may be prescribed.1
P Tinea corporis (ringworm): Similar to tinea pedis, topical antifungals are effective. Oral antifungals are reserved for extensive or resistant cases.1
P Tinea cruris (jock itch): Topical antifungals such as terbinafine and clotrimazole are recommended. Keeping the area dry and clean is also crucial for treatment success.1
P Tinea unguium/onychomycosis (toenail fungus): Oral terbinafine or itraconazole is preferred due to the poor penetration of topical agents into the nail bed.1
Candidiasis
P Cutaneous candidiasis (nappy rash): This condition, often caused by Candida albicans, affects the skin and is commonly found in moist, warm areas of the body. Topical antifungals such as clotrimazole, miconazole, or nystatin are effective. In more severe cases, oral fluconazole may be necessary. 2,3
P Oropharyngeal candidiasis (thrush):
Topical agents like nystatin, miconazole, or clotrimazole troches are commonly used. Fluconazole is the preferred oral agent for more severe cases. 2
P Vulvovaginal candidiasis: Topical azoles (eg clotrimazole, miconazole) or oral fluconazole are effective. For recurrent infections fluconazole is preferred. 2,4
EMZALOID TECHNOLOGY IN ANTIFUNGAL THERAPY
Emzaloid technology represents a significant advancement in the treatment of fungal infections. This innovative technology enhances the delivery and efficacy of antifungal agents through several mechanisms:
F Faster absorption: Emzaloid-based formulations are absorbed through the skin and mucous membranes much faster than traditional oral medications, which can take up to several hours to reach their full effect.5,6
F Improved efficacy: Emzaloidbased formulations deliver a higher concentration of the API to the target tissue, resulting in improved efficacy.5,6
F Reduced side effects: By encapsulating antifungal agents in emzaloid particles, the technology ensures targeted delivery to the site of infection, reducing systemic side effects.5,6,7
Pharmacists play a vital role in the management of fungal infections by providing appropriate treatment recommendations and patient education. Staying updated with the latest treatment guidelines and advancements, such as Emzaloid technology, ensures that pharmacists can offer the best possible care to their patients.
*References available on request
%
While treatments have advanced significantly, common invasive fungal infections like candida albicans still carry a 20%-40% mortality rate1
BACTERIAL SKIN INFECTION EMERGENCY?
NEW SUPIROBAN CREAM TO THE RESCUE!
SUPIROBAN™, SA’s #1 topical antibacterial treatment, is now available in a CREAM formulation.1
SUPIROBAN™ CREAM is as EFFECTIVE compared to other oral and topical antibacterial agents commonly used for skin infections.2
SUPIROBAN™ CREAM promotes PATIENT COMPLIANCE. Creams are perceived as easier to apply than ointments: No greasy mess! No stained clothing!2
The MOST AFFORDABLE mupirocin cream available.3
TWO size options: 15 g tube for cuts, grazes, small areas. 30 g tube for bed sores, burn wounds, post-operative home use.4
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Tel: +27 (0)11 564 3900. www.glenmarkpharma.com. 475/10/2024. New vehicle. Same tried and trusted efficacy.
Mupirocin: effective solution for secondary bacterial infections
Mupirocin is a topical antibiotic derived from Pseudomonas fluorescens, widely recognised for its effectiveness in treating secondary bacterial infections, particularly those involving the skin.1,2
MECHANISM OF ACTION AND EFFECTIVENESS
Mupirocin works by inhibiting bacterial protein and RNA synthesis through reversible binding to bacterial isoleucyl-tRNA synthetase. This unique mechanism ensures minimal crossresistance with other antibiotics.1
P Broad spectrum against gram-positive bacteria: Mupirocin is particularly effective against Staphylococcus aureus, including methicillin-resistant strains (MRSA), and Streptococcus pyogenes. It is commonly used for treating secondary infections in conditions like eczema, wounds, and other skin lesions.1
P Impetigo and other skin infections: Mupirocin is frequently used to treat impetigo, a common superficial skin infection. It is also effective for other skin and skinstructure infections such as secondarily infected eczema or infected skin wounds due to susceptible strains of S. aureus or S. pyogenes.1
CLINICAL EVIDENCE
Systematic reviews have concluded that topical mupirocin is as effective, if not more so, than oral antibiotics for treating impetigo and other superficial skin infections. 2,3 However, there is an increasing concern about resistance. Studies have shown that resistance rates can be significant, necessitating prudent use and ongoing monitoring to maintain its effectiveness. 4
KEY BENEFITS OF MUPIROCIN CREAM
to apply, making it convenient for patients to use. Its formulation allows for smooth application without causing discomfort. 2
P Quick absorption: The cream is quickly absorbed into the skin, ensuring that the active ingredient starts working promptly to combat bacterial infections.
P Affordability: Mupirocin is an affordable option for treating bacterial skin infections, making it accessible to a wide range of patients.
ADVERSE REACTIONS
The most frequently reported adverse reactions to topical mupirocin include skin irritation, burning, stinging, pain, and pruritus. However, mupirocin allergy is very rare, and due to its unique structure, it does not appear to crossreact with other antibiotics.1
PRACTICAL APPLICATION IN PHARMACY
Pharmacists play a crucial role in guiding patients on the proper use of mupirocin. Educating patients about the correct application techniques can enhance the effectiveness of the treatment. For instance, advising patients to clean the affected area before applying the cream can help in better absorption and efficacy. Additionally, you should inform patients about the importance of completing the full course of treatment to prevent the development of resistance. Mupirocin is a highly effective topical antibiotic for treating secondary bacterial infections of the skin, particularly those caused by S. aureus and S. pyogenes. Its unique mechanism of action and low potential for cross-resistance make it a valuable option in dermatological practice. However, the increasing rates of resistance highlight the need for judicious use and regular surveillance to ensure its continued efficacy.1
Topical mupirocin is as effective, if not more so, than oral antibiotics for treating impetigo and other superficial skin infections2,3
P Ease of application: Mupirocin cream is easy
*References available on request
Chronic wound management
The pharmacist's crucial role in collaborative healthcare teams
Chronic wound management requires a multifaceted and collaborative approach, with pharmacists serving as vital members of the healthcare team. Chronic wounds pose a significant healthcare challenge, affecting millions of individuals globally. These wounds, often resistant to timely healing, can lead to complications and a diminished quality of life for patients.
UNDERSTANDING CHRONIC WOUNDS
Chronic wounds, including diabetic ulcers,1 venous ulcers,2 and pressure sores,3 result from various factors such as impaired circulation, 2 diabetes,1 and prolonged immobility.3 Unlike acute wounds, chronic wounds tend to progress through distinct phases, making their management complex and demanding a comprehensive approach. 4
CHALLENGES IN CHRONIC WOUND MANAGEMENT
Pharmacists, as integral members of healthcare teams, play a crucial role in the effective management of chronic wounds
P Complex and multifactorial aetiology: Chronic wounds often have multiple underlying causes. Underlying conditions like diabetes,
vascular disease, and malnutrition contribute to impaired healing, making management complex and requiring a holistic assessment to address contributing factors.5,6,7
P Infection control: Open wounds are susceptible to bacterial invasion, leading to serious complications like cellulitis and sepsis. Controlling infections in chronic wounds is challenging due to the presence of biofilms and the potential for antibiotic resistance.6
P Impaired healing processes: Chronic wounds exhibit impaired cellular and molecular processes, hindering the normal progression of wound healing.6
P Patient adherence: Patient adherence to prescribed wound care regimens is crucial but can be challenging due to factors like pain,8 mobility issues,8 and socioeconomic factors.9
P Pain and reduced quality of life: Chronic wounds can be debilitating, causing pain, discomfort, and affecting patient mobility and social interaction.
P High costs: Long-term wound care demands a variety of dressings, therapies, and management resources, putting strain on patients’ budgets.
PHARMACIST'S ROLE IN CHRONIC WOUND MANAGEMENT
P Medication management: Pharmacists are instrumental in optimising drug therapies that may influence wound healing, such as antibiotics, analgesics, and medications targeting underlying conditions like diabetes.1
P Wound dressing selection: Pharmacists can assist in choosing appropriate wound dressings based on the wound type, stage, and characteristics, considering factors like moisture balance and infection control.
P Education and counselling: Pharmacists play a key role in educating patients on proper wound hygiene, dressing application, and red flag signs of infection. Emphasising the importance of adherence to prescribed treatments, and addressing concerns or misconceptions empowers patients for selfmanagement.
P Collaborative care planning: Actively participating in interdisciplinary healthcare
teams, pharmacists contribute to care planning, ensuring a cohesive approach that addresses the diverse needs of patients with chronic wounds.
P Monitoring and assessment: Regular monitoring of medication therapy and wound progress allows pharmacists to identify potential issues early on, facilitating timely adjustments to promote healing and prevent complications.
P Patient advocacy: Pharmacists advocate for patients by addressing barriers to adherence, facilitating communication between healthcare providers, and promoting patient engagement in their care. Connecting patients with wound care specialists, community support services, and financial assistance programmes alleviates burdens and improves outcomes.
*References available on request
Pharmacists’ role in chronic wound management
While OTC medications can provide relief, pharmacists play a crucial role in accurately assessing symptoms, differentiating from other conditions, and appropriately guiding patients
Pharmacists are often the first point of contact for patients with wounds. They can assess the wound, identify potential causes, and offer advice on OTC medications or dressings suitable for initial care. This accessibility is especially important for patients who might hesitate to see a doctor for minor concerns.
UNDERSTANDING CHRONIC WOUNDS
Chronic wounds, including pressure ulcers, diabetic foot ulcers, venous leg ulcers, and arterial ulcers, result from various underlying conditions such as diabetes, peripheral vascular disease, immobility, and aging. These wounds are characterised by impaired healing processes, often involving inflammation, infection, and tissue necrosis. Effective management requires a comprehensive understanding of wound aetiology, patient factors, and evidence-based treatment modalities.
MEDICATION MANAGEMENT
Many chronic wounds can be linked to underlying conditions like diabetes or poor circulation. Pharmacists play a crucial role in reviewing patients' medication profiles to identify medications that may impede wound healing or contribute to wound complications. Collaboration with healthcare teams is important to optimise medication regimens, ensuring that prescribed drugs do not exacerbate wound-related issues.
WOUND DRESSING SELECTION
With in-depth knowledge of wound dressings, including their composition, properties, and indications, pharmacists are perfectly positioned to assist healthcare providers and patients in selecting appropriate dressings based on wound characteristics, such as size, depth, exudate levels, and presence of infection. Pharmacists are also key in educating patients on proper dressing application techniques and maintenance.
ANTIBIOTIC STEWARDSHIP
In cases of infected chronic wounds, pharmacists play a critical role in promoting antibiotic stewardship. It’s important to review antimicrobial prescriptions, ensure appropriate selection, dosing, and duration to minimise the risk of antibiotic resistance and adverse effects. Pharmacists can also provide guidance on wound cultures and susceptibility testing to optimise antibiotic therapy.
PAIN MANAGEMENT
Chronic wounds can cause significant pain and discomfort, impacting patients' overall well-being. Collaborate with healthcare teams to develop personalised pain management strategies, which may include analgesics, topical agents, or adjuvant therapies. Monitor patients for adverse effects and drug interactions, adjusting treatment regimens as needed to optimise pain control.
PATIENT EDUCATION
Pharmacists play a vital role in patient education, empowering individuals to participate actively in their wound care. Provide comprehensive counselling on wound management techniques, hygiene practices, lifestyle modifications, and medication adherence. It’s important to also address patients' concerns, misconceptions, and expectations, fostering collaboration and shared decision-making.
COLLABORATIVE CARE
Effective chronic wound management relies on interdisciplinary collaboration among healthcare professionals, including physicians, nurses, wound care specialists, and pharmacists. Actively engage in care coordination, participating in interdisciplinary rounds, case conferences, and treatment planning sessions. By sharing expertise and insights, you contribute to holistic patient care and optimise treatment outcomes.
Chronic wounds pose a significant healthcare challenge globally, affecting millions of individuals and often leading to prolonged suffering, impaired quality of life, and substantial economic burden
The power of moist wound healing
Moist wound healing is an advanced wound care technique that emphasises maintaining an optimal moisture balance in the wound environment. This method accelerates healing, reduces pain, and minimises scarring compared to traditional dry wound healing methods.1,2,3
THE SCIENCE BEHIND MOIST WOUND HEALING
The concept of moist wound healing was first introduced by Dr George D Winter in the 1960s. His research demonstrated that wounds kept in a moist environment healed more quickly than those exposed to air.3,4,5 The key principles of moist wound healing include:
P Reduced inflammation: Moisture helps control the inflammatory response, reducing the likelihood of chronic inflammation and associated complications.1,3
CLINICAL APPLICATIONS
Pharmacists should be knowledgeable about the various clinical scenarios where moist wound healing is beneficial:
P Acute wounds: Surgical incisions, lacerations, and abrasions.7
P Chronic wounds: Diabetic foot ulcers, pressure ulcers, and venous leg ulcers.7,8
P Burns: Partial thickness burns where moisture can accelerate healing and reduce pain.9
Moist wound healing is 3-5 times quicker than the healing of wounds that are allowed to dry out
P Optimal hydration: Maintaining moisture helps preserve the physiological function of the wound bed.5,6
P Temperature regulation: A moist wound environment retains the warmth necessary for cellular activities involved in healing. 3
P Protection from infection: Moist wound dressings act as a barrier to external contaminants while also managing exudate.3,4
P Reduced pain and scarring: Keeping nerve endings moist minimises pain and leads to less scab formation and scar tissue development.3,4
MECHANISMS OF MOIST WOUND HEALING
P Cell proliferation and migration: Moisture facilitates the migration of epithelial cells across the wound surface, enhancing re-epithelialisation.1,3,6
P Autolytic debridement: Moisture aids in the body’s natural process of shedding dead tissue.3,4
P Collagen synthesis: A hydrated environment supports fibroblast activity and collagen production, crucial for tissue repair.3,4
PATIENT EDUCATION AND COUNSELING
Pharmacists can offer valuable guidance on the application and maintenance of moist wound healing:
P Wound assessment: Educate patients on recognising signs of infection and the importance of regular wound monitoring.
P Dressing selection and application: Provide instructions on selecting the appropriate dressing and how to apply and change it correctly.
P Moisture balance: Emphasise the importance of maintaining the right moisture level – not too wet and not too dry.
P Pain management: Discuss pain management strategies, including the use of appropriate analgesics and the painreducing benefits of moist wound healing.
P Signs of complications: Instruct patients on when to seek medical advice if signs of complications, such as increased redness, swelling, or unusual discharge, appear.
Moist wound healing represents a significant advancement in wound care, offering numerous benefits over traditional methods. PM
*References available on request
Managing traumatic wounds & infection control
Traumatic wounds, caused by blunt or sharp force trauma, require proper management to prevent complications and promote optimal healing
Traumatic wounds, resulting from incidents such as cuts, lacerations, or punctures, are common occurrences in both everyday life and clinical settings. Effective management of these wounds is crucial to prevent infection and ensure proper healing.
WOUND ASSESSMENT
• Initial presentation: Upon presentation, assess the wound for size, depth, location, bleeding, and presence of foreign objects
• Wound classification: Classify the wound based on the type of tissue injury (eg. abrasion, laceration, puncture) and contamination level (clean, contaminated, dirty, infected)
• Tetanus status: Ensure the patient's tetanus vaccination is up to date.
WOUND MANAGEMENT
• Cleaning and irrigation: Clean the wound with sterile saline, clean water, or an irrigation solution to remove debris and reduce bacterial load
• Debridement: Carefully remove devitalised tissue to promote healing and prevent infection
• Haemostasis: Control bleeding with direct pressure or elevation
• Closure: Depending on the wound type and severity, closure with sutures, staples, or dressings may be necessary. Pharmacists can advise on appropriate dressings based on the wound stage (eg alginates for exudate management, hydrogels for moist wound healing).
INFECTION PREVENTION
• Antibiotics: Pharmacists can dispense prophylactic antibiotics in high-risk cases (eg deep wounds, bites)
• Patient education: Educate patients on proper wound care techniques, signs and symptoms of infection (eg redness, swelling, pus), and the importance of medication adherence.
• Vaccination: Advise on appropriate vaccinations, such as tetanus booster, to prevent future infections.
PHARMACIST INTERVENTIONS
• Pain management: Recommend pain medication based on severity
• Referral: Refer patients to a physician for complex wounds, signs of infection, or if closure is necessary.
PATIENT EDUCATION
• Proper wound care: Educate patients on proper wound cleaning and dressing techniques. Emphasise the importance of hand hygiene before and after wound care
• Signs of infection: Teach patients to recognise signs of infection and seek prompt medical attention if needed
• Product selection: Guide patients in selecting appropriate wound care products based on the type and condition of the wound.
ADDITIONAL CONSIDERATIONS
• Underlying cause: If the underlying cause of the wound is not addressed, it will not be appropriately managed which can impact wound healing
• Chronic conditions: Be aware of underlying medical conditions (eg diabetes) that can impede wound healing
• Nutritional support: Advise on a balanced diet or nutritional supplements to support healing. Pharmacists play a key role in supporting patients with traumatic wounds. By effectively assessing wounds, recommending appropriate management strategies, and educating patients on infection control, you can significantly improve patient outcomes.
*REFERENCE: Nagle SM, Stevens KA, Wilbraham SC. Wound Assessment. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482198/
Tetanus vaccination can be a lifesaver
It’s important that parents, home gardeners, and those who work with soil and animals should be aware of the need to stay up to date with regular tetanus vaccinations. “The speed of onset of tetanus was recently highlighted when a keen home gardener developed symptoms just five days after working with compost with their bare hands,” said Dr Pete Vincent of Netcare Medicross Tokai.
TETANUS FREQUENTLY ASKED QUESTIONS
WHEN SHOULD PATIENTS CONSULT A MEDICAL PROFESSIONAL IF THEY HURT THEMSELF?
Dr Vincent stressed that patients who haven’t had a tetanus inoculation within the past ten years or can’t remember when last they had one, should seek medical attention straight away. Particularly if the wound is dirty, deep, has foreign objects in it, or was caused by contact with an animal. “This also applies if there has been any contact with soil or anything potentially contaminated with animal or human faeces, rust, or saliva. A contaminated wound will require a consultation with a doctor even if your tetanus shot is up to date,” said Dr Vincent. “If you’re diabetic or immunocompromised, these would also be reasons to go to your doctor as soon as possible to be safe.”
WHERE ARE THE BACTERIA THAT CAUSE TETANUS FOUND?
Tetanus is caused by a bacterium called Clostridium tetani. Its spores live in soil and
faeces, often in a dormant state, until they find a suitable place to grow. They can enter the body through a break in the skin, from even the smallest wound, cut, or burn. “The bacterium is found in compost, manure, and dust and can be present in the blood and body fluids of infected animals,” Dr Vincent added.
HOW SERIOUS IS TETANUS?
“Tetanus has an incubation period of seven to ten days. It releases a toxin which affects the nerves associated with muscles.” Dr Vincent stressed that tetanus can be potentially fatal. “Don’t take a chance on it. It can result in death, even in healthy people.”
WHY IS TETANUS ALSO CALLED LOCKJAW?
Tetanus often begins with slight spasms in the jaw and face muscles, which can cause the jaw to lock in place.
WHAT OTHER SEVERE SYMPTOMS OF TETANUS DO SUFFERERS EXPERIENCE?
Dr Vincent explained that during the resulting muscle spasms, a person with tetanus can experience severe breathing problems. “The spasms can be so severe that they even have the potential to cause broken bones. A person with tetanus can develop pneumonia or a pulmonary embolism, which can lead to death. Tetanus can also be fatal when the spasms damage the nerves that control breathing, the heart or other organs.”
Unmasking endometriosis and empowering action
Endometriosis occurs when tissue similar to the uterine lining (endometrium) implants outside the uterine cavity. These endometrial growths respond to menstrual hormones, leading to a range of symptoms that can vary in severity from woman to woman. While some women may experience debilitating pain and infertility, others may have milder symptoms or remain asymptomatic. It's important to note that the presence or absence of symptoms does not necessarily correlate with the severity of the disease.
SYMPTOMS
P Pelvic pain: The most common symptom of endometriosis is pelvic pain, which can vary in intensity. Women may experience this pain before and during menstruation, during or after sexual intercourse, and during urination or bowel movements.
symptoms such as diarrhoea, constipation, cramping, and nausea, especially during menstruation.
P Backache: Some women may experience backache, particularly during menstruation, when endometrial tissue implants on the intestine.
P Other Symptoms: Additional symptoms may include heavy or irregular periods, painful intercourse (dyspareunia), rectal bleeding, blood in urine, bloating, coughing up blood (rare), shortness of breath (rare), and leg or hip pain.
PHARMACIST'S ROLE
Pharmacists play a vital role in supporting women with endometriosis by:
Endometriosis,
P Dysmenorrhea: Pain before and during menstruation, known as dysmenorrhea, is a hallmark symptom of endometriosis. This pain typically occurs a few days before menstruation begins and can be particularly severe during the heaviest flow.
P Heavy or irregular periods: Women with endometriosis may experience excessively heavy bleeding, prolonged periods, or unpredictable bleeding patterns.
P Infertility: Endometriosis can also lead to infertility due to various factors, including anatomical distortion, tubal blockage, impaired hormonal function, and ovarian damage.
P Gastrointestinal symptoms: Women with endometriosis may experience gastrointestinal
WHEN TO REFER TO A DOCTOR
P Identifying potential symptoms: During consultations, actively listen to patients describing pelvic pain, menstrual irregularities, or fertility concerns. Consider endometriosis as a potential cause, especially if symptoms align with the key indicators.
P Educating patients: Provide accurate and accessible information about endometriosis, its symptoms, and management options. Share reliable resources and encourage open communication with physicians.
P Counselling on medication: Offer informed advice on OTC pain relievers (NSAIDs) and consider potential interactions with other medications. Dispense prescribed hormonal therapies (e.g., birth control pills, GnRH agonists) with clear instructions and support regarding side effects.
P Advocating for early diagnosis: Encourage patients to discuss their concerns with physicians and emphasise the importance of seeking timely diagnosis and management.
Women experiencing symptoms suggestive of endometriosis should be encouraged to seek medical attention promptly. You can play a crucial role in educating women about the importance of consulting a healthcare professional if they experience:
• Persistent pelvic pain or discomfort
• Painful menstruation interfering with daily activities
• Difficulty becoming pregnant after trying for an extended period
• Gastrointestinal symptoms associated with menstruation
• Any other concerning symptoms mentioned above.
Weight loss related to PCOS
Patients with polycystic ovary syndrome (PCOS) often have a hard time losing weight
Dr Candice Morrison, gynaecologist and obstetrician at Wijnland Fertility Unit spoke to Pharmacy Magazine about weight loss related to PCOS.
Phamacy Magazine: Losing weight for patients with PCOS can be quite difficult, why is this the case?
Dr Candice Morrison: PCOS is a fascinating endocrine/metabolic disorder that may affect up to 10% of women of reproductive age. It includes androgen excess, ovulatory and menstrual dysfunction, and metabolic dysfunction. PCOS is a complex disorder influenced by environmental factors (e.g. diet and the development of obesity) and genetic variants.
PM: What are some of the factors that contribute to weight gain in patients with PCOS?
Dr Morrison: The prevalence of obesity worsens insulin resistance, which influences the severity of the disorder and worsens the metabolic features of PCOS. The condition is also associated with a greater propensity for obesity and weight gain so it’s difficult to say what comes first the PCOS or the obesity. Fat cells also increase insulin levels further causing a vicious cycle. The prevalence of obesity in patients with PCOS varies widely with the population studied which suggests that environmental factors and diet play a role in the prevalence of obesity.
In insulin resistance, glucose is not taken up by the cells leading to high levels of circulating glucose but the glucose can’t get into the cells where it’s needed, so the cells are literally
PCOS is a fascinating metabolic disorder that may affect up to 10% of women of reproductive age
starving leading to strong cravings for sugar and carbohydrates.
With the hormonal imbalances and abnormal insulin levels in some women with PCOS, levels of appetite regulating hormones ghrelin, cholecystokinin, and leptin have shown to be impaired. Which leads to sugar cravings and increased appetite.
Women with PCOS are also more likely to engage in disordered eating, binge eating, and bulimia. Women with PCOS are often told to lose weight but not guided on how and end up doing extreme calorie restrictive diets which can lead to binge eating.
PM: Why are lifestyle changes and weight loss important for patients with PCOS?
Dr Morrison: Diet and lifestyle interventions are key in managing PCOS. Even modest weight loss (5-10% reduction can have a positive effect). Weight loss can restore ovulatory cycles and improve menstrual disorders. Weight loss can improve the patient’s metabolic parameters and decrease the risk of developing type 2 diabetes and cardiovascular disease.
PM: What are the health benefits associated with weight loss for these patients?
Dr Morrison: Weight loss decreases the serum androgen concentrations, and this can result in an improvement in the patient’s acne and hirsutism.
Exercise in the form of high intensity exercise training for 30 min, five times a week can also have a positive effect.
Understanding female sexual health: a pharmacological perspective
Sexual health is an integral part of overall well-being, and it's essential to recognise that the needs and complexities of female sexuality may differ from those of males.
THE COMPLEXITY OF FEMALE SEXUALITY
Female sexuality encompasses a spectrum of physical, emotional, and psychological factors. Unlike men, whose sexual response is often linear and primarily focused on physical arousal, women's sexual desire and satisfaction can be influenced by various interconnected factors:
PSYCHOLOGICAL
FACTORS1
P Emotional intimacy
P Stress and anxiety
P Body image and self-esteem
P Past experiences and traumas
Sexual health is an integral part of overall well-being, and it's essential to recognise that the needs and complexities of female sexuality may differ from those of males
P Relationship dynamics
HORMONAL INFLUENCES1
P Fluctuations in oestrogen and progesterone levels throughout the menstrual cycle
P Hormonal changes during pregnancy, childbirth, and menopause
P Hormonal contraceptives and their impact on libido
PHYSICAL HEALTH1
P Chronic illnesses such as diabetes, hypertension, and autoimmune disorders
P Medications that affect sexual function (e.g., antidepressants, antihypertensives)
P Pelvic floor disorders and musculoskeletal issues
P Neurological conditions affecting sexual sensation and response
PHARMACOLOGICAL CONSIDERATIONS FOR FEMALE SEXUAL HEALTH
Pharmacists play a crucial role in addressing the pharmacological aspects of female sexual health. While there isn't a one-size-fits-all solution, several medications and interventions can support sexual well-being in women:
P Hormone Replacement Therapy (Hrt)
• For menopausal women experiencing symptoms such as vaginal dryness, low libido, and dyspareunia, HRT can help alleviate discomfort and improve sexual function.1,2
• Oestrogen-based vaginal creams, rings, or tablets can restore vaginal moisture and elasticity, enhancing comfort during sexual activity. 1,2,3
P Phosphodiesterase Inhibitors
• Although commonly associated with male erectile dysfunction, phosphodiesterase inhibitors like sildenafil and tadalafil have shown promise in treating female sexual arousal disorder (FSAD) by increasing genital blood flow and enhancing arousal. However further studies are required. 4,5,6
P
Topical Treatments
• Topical preparations containing vasodilators, such as alprostadil or sildenafil, can be applied directly to the genital area to improve blood flow and sensitivity, potentially enhancing sexual pleasure and orgasm intensity. 4
P Psychological Interventions
• Counselling, sex therapy, and cognitivebehavioural techniques can address underlying psychological barriers to sexual satisfaction, including relationship issues, body image concerns, and past traumas.1
P Lifestyle
Modifications
• Encouraging healthy lifestyle habits, including regular exercise, balanced nutrition, stress management, and adequate sleep, can support overall well-being and indirectly improve sexual health.1
Understanding and addressing the multifaceted nature of female sexuality requires a holistic approach that integrates pharmacological interventions with psychological support and lifestyle modifications because successful treatment is unlikely through pharmacological treatment alone. Treatment should be individualised, taking into account the severity of symptoms, effect on quality of life, potential adverse effects, and personal preferences.
*References available on request
Menopause can impact mental well-being
Menopause, a reality for most women around the age of 51, on average, can increase their risk of depression and anxiety. The mental health impacts of menopause rank in the top five challenges that women encounter along with the more wellknown physical symptoms such as weight gain and hot flushes.
Menopause can also start early, any time from the age of 30, or only in the mid-50s or even later.
About 4 in 10 women have mood changes during perimenopause when the reproductive years end and the body naturally transitions to menopause, causing women to experience irritability, low energy, trouble concentrating and being tearful and moody.
However, according to a recent study, only 59% of South Africans consider themselves knowledgeable about menopause.
Dr Joanna Taylor, specialist psychiatrist and member of SASOP (South African Society of Psychiatrists), said the most widely spoken about symptoms are the physical, such as hot flushes, night sweats, low libido and weight gain. The mental health symptoms of menopause are rarely discussed, yet they are as common as the physical symptoms and are among the top five complaints raised by menopausal women.
“The risk of depression and anxiety increases during menopause due to hormonal changes, leading to feelings of hopelessness, lack of interest in life, being tearful, and increased worry, which can impact one’s day-to-day life, concentration, sleep patterns, and ability to take care of oneself.
“Women with a history of
depression and anxiety are more prone to depressive symptoms during menopause,” Dr Taylor said.
“It’s important to recognise that menopause is universal for all women and should never feel disabling. The symptoms of menopause will eventually ease, however most women find them difficult to manage and require treatments to offer relief.
“Some might go through menopause with little disruption whilst others experience the prolonged agony of dwindling libido, hair loss, and headaches. But there is no need to suffer in silence. There are treatment options that can support this new phase of life.”
Dr Taylor said that one’s age, genetics, and type of menopause play a significant role in determining the best course of treatment.
For women to support their mental well-being during menopause Dr Taylor recommends:
Exercise :Daily movement of at least 30 minutes will release endorphins which reduce stress and promote positive emotions.
Diet: A Mediterranean-style diet can assist in decreasing inflammation, hot flushes, and night sweats. Avoid foods high in sugar and fat, and rather increase the intake of fruit, vegetables, whole grains and lean protein.
Sleep: Make sure to get 7-9 hours of sleep to better deal with challenges, improve decision-making, and overall mood.
Socialise: Isolation increases the symptoms of depression and anxiety. Spend time with friends and family, and talk to other menopausal women to share struggles and solutions.
Optimising postnatal nutrition
Ensuring optimal postnatal nutrition is crucial for aiding maternal recovery and facilitating infant growth and development via breastfeeding
Following childbirth, a woman's body undergoes significant physiological changes, making adequate nutrition vital to aid recovery, and supplement against further nutrient deficiencies while breastfeeding. A thorough understanding of postnatal nutrition is crucial to providing comprehensive healthcare advice.
NUTRITIONAL NEEDS POSTPARTUM
Macronutrients:
P Protein: Crucial for tissue repair 1,2 and milk production.3 Encourage sources like lean meats, fish, eggs, legumes, and dairy products. 4
iodine-rich foods like dairy, eggs, and seafood, or consider supplementation if dietary intake is insufficient. 4,20,21,22
SUPPLEMENTATION
CONSIDERATIONS:
A personalised assessment of dietary habits and potential deficiencies is crucial before recommending supplements.
Postnatal vitamins can prevent nutritional gaps that might harm new mothers and their infants
P Carbohydrates: Provide energy for recovery and breastfeeding. Emphasise whole grains, fruits, vegetables, and legumes for sustained energy levels. 4,5
P Healthy fats: Essential for hormone regulation6,7 and brain development8 in infants. Include sources like avocados, nuts, seeds, and olive oil. 4,6
Micronutrients:
P Iron: Important for replenishing iron stores depleted during childbirth and may help prevent postpartum anaemia. Recommend iron-rich foods such as lean meats, beans, lentils, spinach, and fortified cereals. Supplementation may be necessary based on individual needs.9,10
P Calcium and vitamin D: Essential for bone health, particularly important during breastfeeding to ensure adequate calcium transfer to the baby. Encourage dairy products, fortified foods, and safe sun exposure for vitamin D synthesis.11,12,13
P Vitamin B12 and folate: Crucial for energy production and neurological function. Recommend fortified foods, leafy greens, legumes, and lean meats.14,15,16
P Omega-3 fatty acids: Support infant brain development and may help with postpartum depression. Advise sources like fatty fish (e.g., salmon, sardines), flaxseeds, and walnuts.17,18,19
P Iodine: Crucial for thyroid function and infant development. Recommend
P Prenatal vitamins: The World Health Organization recommends breastfeeding women continue taking a prenatal vitamin for the duration of breastfeeding to replenish nutrient stores depleted during pregnancy and support breastfeeding. 23
P Iron supplements: Recommend iron supplements for women with diagnosed or at risk for postpartum anaemia, particularly if dietary intake is insufficient.9
P Omega-3 supplements: Consider omega-3 supplements, especially for women who do not regularly consume fatty fish, to support infant brain development and may help with postpartum depression.17,18,19
P Vitamin D supplements: Depending on individual needs and sun exposure, vitamin D supplementation may be necessary to ensure adequate levels for both mother and baby.24
DIETARY RECOMMENDATIONS
P Hydration: Encourage adequate fluid intake, primarily water, to support milk production and prevent dehydration.
P Balanced meals: Promote regular, balanced meals containing a variety of nutrients to support postpartum recovery and breastfeeding.
P Meal timing: Encourage frequent, smaller meals and snacks to maintain energy levels and stabilise blood sugar.
P Mindful eating: Emphasise the importance of mindful eating to foster healthy eating habits and aid digestion.
Optimising postnatal nutrition is essential for maternal recovery and supporting infant growth and development through breastfeeding.
*References available on request
Navigating contraception: special considerations for women with health issues
By understanding the unique needs and considerations of women with certain health conditions, you can ensure that patients receive the most appropriate and effective contraceptive care.
When considering contraceptive options for women with health conditions, it's crucial to take into account their specific health issues and how they might interact with various contraceptive methods.1
Here are some general considerations for women with certain health conditions:
CARDIOVASCULAR DISEASES (INCLUDING HYPERTENSION)
Contraceptive options:
Progestin-only methods: These include progestinonly pills (POPs), injectables, and implants. They are generally safer for women with cardiovascular diseases as they do not contain oestrogen, which can increase the risk of thrombosis.1,2,3,4
Non-hormonal methods: Copper IUDs are a highly effective non-hormonal option that do not carry the same risks as hormonal methods.1,3,5
Considerations:
Women with cardiovascular diseases or risk factors for cardiovascular disease should avoid combined hormonal contraceptives (CHCs) that contain oestrogen and progestin due to the increased risk of thrombosis.1,2,3,4
BREAST CANCER
Contraceptive options:
Non-hormonal methods: The copper IUD is often considered the best option for women with current or past breast cancer.3,6,7
Progestin-only methods: These may be considered in certain situations based on the time since cancer treatment and other factors.7
Considerations:
Hormonal methods could potentially stimulate cancer growth, so non-hormonal methods are preferred.
DIABETES
Contraceptive options:
Progestin-only methods: These include progestin-only pills, injectables, and implants.3,9 Non-hormonal methods: Copper IUDs are a suitable option.3,8,9
Considerations:
Women with diabetes without vascular disease can generally use all forms of contraception.9 However, those with complications or long-standing diabetes should avoid CHCs due to the increased risk of cardiovascular disease.3,8
OBESITY
Contraceptive options:
All methods: Obesity itself is not a contraindication to any specific contraceptive method. However, because obesity is felt to be an independent risk factor for venous thromboembolus, Abou-Ismail et al. recommend “alternative non-hormonal contraceptive methods such as progestin-only contraception or IUD”.3 Copper IUD: Recommended for emergency contraception in women with a higher body mass index (BMI).10
Considerations:
Combined hormonal methods may have a slightly increased risk of thrombosis in obese women.11 The efficacy of emergency contraception pills may be reduced in women with a higher BMI.10
When considering contraceptive options, it’s crucial to thoroughly discuss patient’s individual situations. Help them weigh the risks and benefits of each option, taking into account their health status, preferences, and any potential interactions with existing medications or conditions.6
By understanding the unique needs and considerations of women with certain health conditions, you can ensure that patients receive the most appropriate and effective contraceptive care.
*References available on request.
60% of SA women aged 15-49 use some form of contraception 60%
Tibolone’s clinical efficacy in treating menopausal symptoms
Menopause is a significant phase in a woman's life marked by the cessation of menstrual periods and a decline in ovarian function. This transition often brings a variety of symptoms which affects more than 95% of women, including vasomotor symptoms (hot flashes and night sweats), mood swings, and urogenital atrophy, which can significantly impact quality of life.1,2 Tibolone, a synthetic steroid, has emerged as a popular choice for hormone replacement therapy (HRT) due to its unique pharmacological profile and clinical benefits. 2
PHARMACOLOGY OF TIBOLONE
vaginal dryness and reducing urogenital atrophy.2
Bone health: Postmenopausal women are at increased risk of osteoporosis due to declining oestrogen levels. Tibolone helps in preventing bone loss and contributes to bone density improvement, reducing the risk of fractures. 4,5,7
Mood and sexual function: Due to its androgenic properties, Tibolone has a positive effect on mood and sexual function. It can improve libido and reduce depression or anxiety associated with menopause. 2,4,5,6
SAFETY AND SIDE EFFECTS
Tibolone is a synthetic steroid that mimics the activity of oestrogen, progesterone, and androgens, making it a multifunctional hormone therapy. Unlike conventional HRTs that contain oestrogen or a combination of oestrogen and progesterone, Tibolone provides a comprehensive approach by being metabolised into three major metabolites which contribute to its estrogenic, progestogenic, and androgenic effects. This unique action helps in alleviating a broad spectrum of menopausal symptoms while also offering benefits like mood stabilisation and libido enhancement. 2,3,4,5,6
CLINICAL EFFICACY IN TREATING MENOPAUSAL SYMPTOMS
Vasomotor symptoms: Tibolone is highly effective in reducing the frequency and severity of hot flashes and night sweats. 2,5 Studies have shown that Tibolone achieves significant reductions in these symptoms, comparable to traditional oestrogen-based HRTs. 4,5,6
Urogenital health: Tibolone helps in maintaining urogenital health by improving
While Tibolone is generally well-tolerated, it is not devoid of side effects. Common adverse effects include vaginal bleeding, breast tenderness, and gastrointestinal disturbances. The risk of myocardial infarction, 8 venous thromboembolism and breast cancer with tibolone is generally lower compared to conventional HRT. 2 Pharmacists should counsel patients on these potential risks and advise regular monitoring.
PATIENT COUNSELING TIPS
Adherence: Encourage patients to adhere to prescribed dosages and discuss any side effects experienced.
Lifestyle modifications: Advise on lifestyle changes such as diet, exercise, and smoking cessation to complement the therapy. Regular check-ups: Recommend regular follow-ups with healthcare providers to monitor the therapy's effectiveness and adjust dosages if necessary.
A versatile and effective option for managing menopausal symptoms, tibolone offers benefits that extend beyond simple hormone replacement.
*References available on request
Tibolone’s unique pharmacological profile,combining estrogenic, progestogenic, and androgenic properties, sets it apart from traditional hormone replacement therapy
Heartburn, a burning chest pain rising from the stomach, is the most common symptom of erosive reflux oesophagitis
Beyond heartburn: erosive reflux oesophagitis
Erosive oesophagitis, a complication of gastroesophageal reflux disease (GORD), presents a significant concern for pharmacists due to its prevalence and potential for complications.
UNDERSTANDING EROSIVE REFLUX OESOPHAGITIS
Erosive reflux oesophagitis arises when stomach acid consistently backs up into the oesophagus, eroding its lining. This leads to inflammation, irritation, and the characteristic symptom of heartburn – a burning sensation in the chest. Several factors contribute to erosive reflux oesophagitis, including:
P Lower oesophageal sphincter (LES) dysfunction: The LES, a muscular valve, fails to close properly, allowing reflux.
P Increased stomach acid production: Certain medications, caffeine, and spicy foods can stimulate acid production.
P OTC medications:
F Antacids: Neutralise stomach acid, providing rapid relief for mild heartburn. However, their effect is short-lived and may not be suitable for long-term use.
F H2 receptor antagonists: These medications reduce acid production, offering longer-lasting relief than antacids. They are suitable for frequent heartburn sufferers.
P Lifestyle modifications: Advise patients on lifestyle changes that can significantly improve symptoms:
P Hiatal hernia: Part of the stomach pushes through the diaphragm, weakening the LES.
HEARTBURN: A KEY SYMPTOM
Heartburn, a burning chest pain rising from the stomach, is the most common symptom of erosive reflux oesophagitis. However, other symptoms like chest pain, difficulty swallowing, and regurgitation can also occur. It's crucial to differentiate heartburn from angina (chest pain related to heart problems) to ensure proper diagnosis and treatment.
PHARMACIST INTERVENTION FOR HEARTBURN RELIEF
Pharmacists play a vital role in managing heartburn and potentially preventing erosive reflux oesophagitis through the following strategies:
F Dietary modifications: Avoiding fatty, spicy, and acidic foods, while eating smaller and more frequent meals, can reduce reflux.
F Weight management: Losing excess weight can decrease pressure on the abdomen, improving LES function.
F Smoking cessation: Smoking weakens the LES and worsens reflux.
F Referral for diagnosis and treatment: If symptoms are severe, persistent, or do not respond to OTC medications, pharmacists should refer patients to healthcare providers for further evaluation and potential prescription medication (e.g., Proton Pump Inhibitors) or additional diagnostic procedures.
By understanding erosive reflux oesophagitis and its link to heartburn, pharmacists can significantly impact patient care through appropriate OTC medication selection, crucial lifestyle advice, and timely referrals. This collaborative approach ensures effective management of heartburn, potentially preventing the progression of erosive oesophagitis and improving patient well-being.
*References available on request
Heartburn: prevention & treatment over the holidays
The holiday season is a time of joy, celebration, and often, overindulgence. For many, this period can also bring about an unwelcome guest: heartburn. As pharmacists, it is crucial to understand the prevention and treatment of heartburn to better assist patients during this festive time.
WHAT IS HEARTBURN?
Technically, heartburn is a symptom of gastroesophageal reflux disease (GERD), a chronic medical condition caused by the flow of contents in the stomach into the oesophagus. Heartburn is a burning sensation in the chest, just behind the breastbone. It is caused by stomach acid rising into the oesophagus, a condition known as acid reflux .1,2,3
CAUSES OF HEARTBURN DURING THE HOLIDAYS
Several factors contribute to the increased incidence of heartburn during the holidays:
P Overeating: Large meals can increase stomach pressure, leading to acid reflux. 2
P Rich and fatty foods: Foods high in fat can relax the lower oesophageal sphincter (LES), allowing stomach acid to escape into the esophagus. 2,3,5
P Alcohol: Alcohol can also relax the LES and increase stomach acid production.1,2,3,5
P Caffeine and carbonated beverages: These can irritate the oesophagus and increase acid production.1,2,3,5,7
P Stress: The holidays can be stressful, and stress can exacerbate heartburn symptoms. 2,6
PREVENTION STRATEGIES
P Eat smaller meals: Encourage patients to eat smaller, more frequent meals rather than large ones. 2,3,5,7
P Avoid trigger foods: Advise patients to
avoid foods and beverages that trigger their heartburn, such as spicy foods, chocolate, caffeine, and alcohol. 2,3,5
P Stay upright after eating: Recommend that patients avoid lying down for at least two to three hours after eating.1,2,5,6
P Elevate the head of the bed: For those who experience nighttime heartburn, elevating the head of the bed can help prevent acid reflux.1,5
P Manage stress: Encourage stress-reducing activities such as exercise, meditation, or spending time with loved ones.6
TREATMENT OPTIONS
P Antacids: These can provide quick relief by neutralising stomach acid.1 Examples include calcium carbonate and magnesium hydroxide. 2,4
P H2 blockers: These reduce acid production and provide longer relief than antacids.1,2 Examples include famotidine, cimetidine, and nizatidine.5,7
P Proton pump inhibitors (PPIs): These are more potent acid reducers and are used for frequent heartburn.1,2 Examples include omeprazole and esomeprazole. 4
P Alginates: These form a barrier that floats on top of the stomach contents, reducing acid reflux.2
WHEN TO REFER TO A DOCTOR
While OTC treatments can be effective, there are times when patients should be referred to a doctor:
F If heartburn occurs more than twice a week. 2,3
F If symptoms persist despite treatment. 2,3
F If there are signs of complications such as difficulty swallowing, weight loss, or persistent vomiting. 2,3
By providing patients with practical advice and effective treatments, pharmacists can help ensure that the holidays remain a time of joy and celebration, free from the discomfort of heartburn.
*References available on request
Heartburn that is more frequent or interferes with a patient’s daily routine may be a symptom of a more serious condition that requires medical care
Symptoms of gout typically include sudden and intense joint pain, swelling, redness, and heat in affected areas, commonly the big toe
Gout: triggers, risks, & treatment
Gout, a metabolic disorder often inherited, manifests as recurrent acute joint inflammation known as gouty arthritis. This inflammation arises from the deposition of uric acid (urate) crystals in and around joints, primarily in the extremities. While some individuals with elevated blood urate levels (hyperuricaemia) may not develop gout, certain factors predispose individuals to this painful condition. These factors include excess alcohol consumption, high blood pressure, certain medications, kidney problems, and a range of triggers such as injury, dehydration, overeating, certain foods, and surgery.
The primary cause of gout is the crystallisation of urate due to its elevated levels in the bloodstream. This process occurs more readily in individuals with impaired uric acid excretion mechanisms or those with conditions such as obesity, diabetes, or kidney disease. Additionally, dietary factors play a role, with certain foods exacerbating urate levels, particularly purine-rich foods like red meat and seafood.
Symptoms of gout typically include sudden and intense joint pain, swelling, redness, and heat in affected areas, commonly the big toe. If left untreated, gout can progress to chronic joint symptoms, leading to joint deformity and the formation of urate deposits called tophi. Chronic gout sufferers may also develop kidney stones, further complicating the condition.
Risk factors for gout include genetic predisposition, middle age (for men), high
blood pressure, certain medications like diuretics, obesity, excessive alcohol intake, and underlying conditions such as cancers or haemolytic anaemia.
Diagnosis of gout involves a combination of clinical evaluation, blood tests to assess urate levels, and imaging studies such as X-rays to detect characteristic joint lesions. Confirmation is often achieved through the identification of urate crystals in joint fluid or tissue samples.
Treatment aims to alleviate acute symptoms, prevent recurrent attacks, and reduce urate levels in the body. Acute attacks are typically managed with medications like colchicine, nonsteroidal antiinflammatory drugs (NSAIDs), or corticosteroids. For chronic management, drugs that lower urate production or enhance excretion, such as allopurinol or urinary alkalinisers, are prescribed. Surgical interventions may be necessary in severe cases, such as arthrocentesis to remove fluid from affected joints or extracorporeal lithotripsy for kidney stones.
Preventative measures include lifestyle modifications like dietary changes, maintaining hydration, weight control, and avoiding alcohol. Regular monitoring and adherence to medication regimens are crucial for preventing gout flare-ups and associated complications.
In conclusion, gout is a complex disorder influenced by genetic, lifestyle, and environmental factors. Pharmacists play a vital role in educating patients about triggers, risks, and treatment options to effectively manage this debilitating condition and improve quality of life.
Ulric Acid Cristals
Swollen Joint Inflamination
Gout: a joint affair with serious implications
Gout can easily be misunderstood as simply being a reaction to overindulging in food and alcohol. But it is important to be aware that, while closely linked to what we ingest, gout is a type of arthritis affecting the joints and can be a red flag for related conditions. “Early intervention is therefore key to managing overall health better,” advised Dr Cathelijn Zeijlemaker, Medical director at Netcare Medicross.
CAUSE & RISKS
If there’s a build-up of uric acid – a chemical formed by the breakdown of purines, a natural substance found in certain foods and drinks –gout can occur. While purines are important for building body proteins, when the body has too much uric acid, sharp crystals can form and build up inside the joints causing pain and swelling, Dr Zeijlemaker explained.
“The most common cause of gout is the kidneys not removing enough uric acid from your blood, which may indicate the potential for kidney disease. Gout can also occur with certain cancers and cancer treatments, or with a diet high in purines. In addition, trauma or stress are noted triggers of gout attacks. Age and sex are also factors in developing gout, which typically affects men between 30 to 50 years of age,” she said.
Additional common risk factors include conditions such as obesity and taking certain medications including aspirin, diuretics, and others. Kidney disease, lead poisoning, and psoriasis are also linked to gout, as are
rapid weight loss, dehydration, the frequent consumption of alcohol, and beverages sweetened with fructose.
MANAGING GOUT HOLISTICALLY
Careful management of weight and diet is foundational to keeping gout under control Dr Zeijlemaker explained. “While there is no cure for gout the condition can be kept in remission with allopurinol, a medication that decreases the uric acid produced by the body in conjunction with a healthy lifestyle. Proper management of any other pre-existing conditions should also be adhered to.
“When a gout attack does occur a two-phased approach is recommended, first to address the pain and inflammation of the acute attack and thereafter to prevent the development of chronic gout and any future attacks. Medication to reduce pain and swelling will be prescribed and may include NSAIDs. Other treatments may be colchicine tables or steroids. If this is not suitable an injection with steroids into the joint may be considered. Additionally, an ice pack applied to the affected joint may also assist to relieve the pain.
“If left untreated, the consequences of gout can be dire leading to joint damage that may require surgery while complications in the kidneys can introduce an entirely new set of concerns. However, the good news for the many people living with this condition is that if diagnosed and treated early on in conjunction with healthy lifestyle choices, you can lead a normal, active life,” she concluded.
Gout can easily be misunderstood as simply being a reaction to overindulging in food and alcohol
Dr Cathelijn Zeijlemaker, Medical Director at Netcare Medicross.
Acute rheumatic fever decoded
Acute Rheumatic Fever (ARF) is a significant illness resulting from an autoimmune response to infection with Group A Streptococcus (GAS), particularly following a throat infection like pharyngitis or skin infections like impetigo. It primarily affects children between the ages of five and 15 and can lead to severe complications if not managed appropriately. Pharmacists play a crucial role in the prevention, identification, and management of this condition.
ETIOLOGY AND PATHOPHYSIOLOGY
ARF occurs when the immune system mounts an aberrant response to GAS infection. The antibodies generated to fight the streptococcus bacteria also target the body’s tissues, including the heart, joints, skin, and brain. This cross-reactivity can lead to inflammation and tissue damage, particularly affecting the heart valves, a condition known as rheumatic heart disease (RHD).
CLINICAL PRESENTATION
It's important to be aware of the varied clinical manifestations of ARF, which can appear weeks after the initial GAS infection. The major clinical features include:
P Carditis: Inflammation of the heart, which can present as murmurs, pericarditis, or heart failure.
P Polyarthritis: Migratory inflammation of large joints, which is often the most common first symptom.
P Chorea: Also known as Sydenham's chorea or St Vitus' dance, characterised by involuntary movements, muscle weakness, and emotional instability.
P Erythema marginatum: A non-itchy rash with a distinctive ring-like appearance.
P Subcutaneous nodules: Painless lumps under the skin.
Minor manifestations include fever, arthralgia (joint pain), increased acute phase reactants (like ESR and CRP), and a prolonged PR interval on electrocardiogram.
DIAGNOSIS
The diagnosis of ARF relies on the revised Jones Criteria, which requires evidence of preceding GAS infection and the presence of major and minor clinical features. Supporting evidence for recent GAS infection includes a positive throat culture or rapid antigen test, or elevated streptococcal antibody titres.
MANAGEMENT
The management of ARF consists of eradicating the GAS infection, symptom relief, and preventing recurrence. Here’s what pharmacists need to know:
P Antibiotic therapy
V Primary prophylaxis: Penicillin remains the treatment of choice for eradicating GAS. For penicillin-allergic patients, alternatives include cephalosporins, clindamycin, or macrolides.
V Secondary prophylaxis: Continuous antibiotic prophylaxis is essential to prevent recurrent ARF and subsequent RHD. Benzathine penicillin G administered intramuscularly every three to four weeks is preferred.
P Anti-inflammatory treatment
V Aspirin or naproxen is often used to reduce joint inflammation.
V In severe cases, corticosteroids may be indicated to manage carditis.
P Heart failure management
V For patients with heart involvement, managing cardiac failure via standard heart failure protocols may be required.
ROLE OF PHARMACISTS
Pharmacists should ensure adherence to antibiotic prophylaxis schedules and educate patients and caregivers about the importance of preventing recurrent GAS infections. They should be vigilant about potential drug interactions and side effects of long-term antibiotics and antiinflammatory medications.
Reference: Centers for Disease Control and Prevention. Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). 1 March 2024. Available from: https://www.cdc.gov/group-a-strep/ hcp/clinical-guidance/acute-rheumatic-fever.html
50%
Carditis is the major cardiac manifestation of acute rheumatic fever. It occurs in 50% to 70% of first episodes and is associated with valvulitis
HELPS TO REDUCE THE SYMPTOMS OF
Once a day dosage
Starts working from 5 days
Navigating osteoarthritis with innovative solutions
More than medication, the power of supplements in managing osteoarthritis
Osteoarthritis (OA) is a disease of the entire joint, involving not only the joint lining but also cartilage, ligaments, and bone. “It is characterised by breakdown of the cartilage, bony changes of the joints, deterioration of tendons and ligaments, and various degrees of inflammation of the synovium1,” explained Elzohry AAM et al
The disorder is “categorised by joint pain, swelling, and stiffness that leads to activity limitations, participation restrictions, sleep interruption, fatigue, and depressed or anxious mood, and ultimately loss of independence and reduced quality of life,” March L et al. reported. “Having a significant impact on day-to-day functioning and, although the levels of pain and disability may fluctuate, OA has no known cure or spontaneous remission and is associated with irreversible structural damage and progression over time2 .”
SIGNS & SYMPTOMS
P Joint pain typically in the hands, knees, feet, neck, hips, and spine
P Several minutes of stiffness in a joint after getting out of bed or sitting for a long time
P Mild swelling or tenderness in one or more joints2
There are several health supplements that support healthy joints and help reduce the symptoms of osteoarthritis such as joint pain and stiffness. Two examples include:
P Boswellia Serrata (Indian frankincense): An Ayurvedic remedy that can prevent the production of inflammatory substances in the joints. Current evidence, based on three RCTs, suggest that Boswellia Serrata might have some beneficial effects in treating patients with knee OA, and that this effect might last for a period after cessation of treatment 4 ,” said Macfarlane GJ et al. A 2022 study of a patented type of Boswellia Serrata had 47.6% reduction in WOMAC stiffness and 24.8% reduction in WOMAC pain on day five, with an overall reduction of 64.9% in WOMAC stiffness and 50.5% WOMAC pain after 30 days5
“Presently there are no drugs approved that can prevent, stop, or even restrain progression of OA. Moreover, the available medications that promise to mitigate the pain of OA have several risk/benefit considerations. Because of these treatment-related adverse events and the paucity of other effective treatments, there is an urgent need for clinical studies of new and existing agents that might intervene in the pathophysiology and progression of OA3 ,” March L et al stressed.
P Avocado-soybean unsaponifiables (ASU): “Several studies have found that ASU can reduce the production/action of various joint inflammatory substances which can prevent the destruction of joint cartilage and help in its repair4 ,” Macfarlane GJ et al . reported. “Evidence suggests that three months intake of 300mg/day ASU is safe and effective in reducing pain and problems associated with walking and other activities of daily living in some patients with OA 4 .” Through ongoing research and collaboration, pharmacists can help shape a future where osteoarthritis patients experience less pain and greater independence, supported by evidence-based supplements.
*References available on request
The global prevalence of hip and knee OA is approaching 5% and is destined to increase as the population ages3
Knee joint
Hip joint
UTIs & diabetes: managing risks and complications
Urinary tract infections (UTIs) are a common concern for patients with diabetes, posing significant risks and complications.1,2 Pharmacists play a crucial role in managing these risks and ensuring optimal patient outcomes.
UNDERSTANDING THE LINK
Diabetes, particularly poorly controlled diabetes, increases the risk of UTIs. Elevated blood glucose levels can lead to glycosuria, which provides a nutrient-rich environment for bacterial growth in the urinary tract. Additionally, diabetes can impair the immune system, making it harder for the body to fight off infections.1,2 According to a review published in the Journal of Diabetes Research, individuals with diabetes are more susceptible to recurrent UTIs and complications such as pyelonephritis and urosepsis.
RISK FACTORS
Several factors contribute to the increased risk of UTIs in diabetic patients:
P Hyperglycaemia: High blood sugar levels can promote bacterial growth.2,4
P Neuropathy: Diabetic neuropathy can affect bladder function, leading to incomplete emptying and urinary stasis.3,4
P Immune dysfunction: can impair the immune response, reducing the body's ability to combat infections.2
P Glycosuria: The presence of glucose in the urine provides a breeding ground for bacteria.
MANAGING RISKS
Pharmacists can play a pivotal role in
managing the risks associated with UTIs in diabetic patients:
P Blood glucose control: Emphasise the importance of maintaining optimal blood glucose levels. Educate patients on the use of medications, diet, and lifestyle modifications to achieve this goal.
P Hydration: Encourage adequate fluid intake to promote regular urination and flush out bacteria from the urinary tract.
P Hygiene practices: Advise patients on proper hygiene practices, including wiping from front to back and urinating after sexual activity.
P Medication adherence: Ensure patients adhere to their prescribed medications, including antibiotics for UTI treatment and diabetes management drugs.
COMPLICATIONS AND MONITORING
Untreated or recurrent UTIs can lead to severe complications, including kidney infections and sepsis.5 Pharmacists should educate patients on recognising UTI symptoms such as frequent urination, burning sensation, and cloudy urine. Prompt medical attention is crucial if symptoms persist.6
Managing UTIs in diabetic patients requires a multifaceted approach involving blood glucose control, proper hygiene, and patient education. Pharmacists are in a unique position to provide comprehensive care and support, helping to mitigate risks and prevent complications. By staying informed and proactive, pharmacists can significantly improve the quality of life for diabetic patients prone to UTIs.
*References available on request
Patients with diabetes face a more than 2 times higher risk of UTI by drug-resistant uropathogens2
Conquering obesity with lifestyle & phentermine
Obesity is a complex and multifaceted health issue that affects millions of people worldwide. With over twothirds of women in SA, 30% of men, and a significant proportion of children facing obesity or overweight conditions, it was reported that weight-related diseases have eclipsed TB and HIV as leading causes of morbidity and mortality in SA earlier this year.1
As healthcare professionals, pharmacists are uniquely positioned to provide support and guidance to individuals struggling with obesity. This article focuses on the critical aspects of lifestyle modification, healthy eating, exercise, and accountability, with a special emphasis on the role of phentermine in obesity management.
UNDERSTANDING OBESITY
Obesity is not just a cosmetic concern but a medical problem that increases the risk of diseases such as heart disease, diabetes, high blood pressure, and certain cancers.2 The root causes of obesity can be complex, involving genetic, behavioural, metabolic, and hormonal influences.3
LIFESTYLE MODIFICATIONS
The cornerstone of obesity management, lifestyle modification involves a sustained change in daily habits and behaviours, focusing on diet and physical activity. Pharmacists can play a crucial role in guiding patients through these changes by providing education, resources, and continuous support.
1. Eating healthily
• Balanced diet: Encourage a diet rich in fruits, vegetables, whole grains, and lean proteins. It's important to reduce the intake of high-calorie, low-nutrient foods 4,5
• Portion control: Educating patients on appropriate portion sizes can help prevent overeating 6
• Consistency: Maintaining a regular eating schedule can prevent binge eating 7 and promotes better metabolism8,9
2. Exercising regularly
• Tailored recommendations: Based on the
patient’s physical condition and preferences, you can recommend specific types of exercises, such as walking, swimming, or cycling
• Building routine: Help patients incorporate physical activity into their daily routine, starting with small, achievable goals.
3. Accountability
• Self-monitoring: Encourage the use of food diaries or apps to track dietary intake and physical activity
• Regular check-ins: Offer regular follow-up appointments to discuss progress, challenges, and adjust plans as needed.
THE ROLE OF PHENTERMINE
Phentermine is a prescription medication that acts as an appetite suppressant. It is typically used for a short period (a few weeks) in a regimen of weight reduction based on exercise, behaviour change, and calorie restriction, however recent studies have found longer duration of phentermine use to be associated with clinically significant greater weight loss without increase in risk for cardiovascular events or death.10 It is classified as a Schedule IV drug due to its potential for abuse and dependence, however the rate of misuse appears to be low.10,11,12
Mechanism of Action
Phentermine stimulates the release of brain chemicals that will help reduce the sensation of hunger, making it easier to adhere to a strict diet.12
PHARMACISTS' ROLE
• Counselling: Before dispensing phentermine, pharmacists should counsel patients on the proper use of the medication, potential side effects, and the importance of adhering to prescribed dosages
• Screening: It’s crucial to screen for contraindications such as history of cardiovascular diseases, uncontrolled hypertension, or history of drug abuse
• Monitoring: Regular monitoring of weight loss and side effects is important to assess the effectiveness and safety of the treatment.
*References available on request
Obesity remains a significant health concern in SA, with trends indicating an increase in obesity rates among both adults and children
Phentermine and diabetes: implications for weight loss and glycaemic control
Phentermine is a prescription weight loss medication that works by suppressing appetite and increasing metabolism. It is commonly used in combination with lifestyle modifications, such as diet and exercise, to help people achieve and maintain weight loss. Diabetes is a chronic metabolic disease that is characterised by high blood sugar levels. It can lead to several serious health complications, including heart disease, stroke, blindness, and kidney failure.
PHENTERMINE AND WEIGHT LOSS
Phentermine has been shown to be effective for weight loss in both people with and without diabetes. In a clinical trial of 130 patients with type 2 diabetes, those randomised to phentermine-topiramate ER lost 9.4% of baseline weight, compared to 2.7% weight loss in those assigned to placebo.
PHENTERMINE AND GLYCEMIC CONTROL
In addition to promoting weight loss, phentermine may also help to improve glycaemic control in people with diabetes. In the same clinical trial mentioned above, patients randomised to phenterminetopiramate ER had a greater reduction in HbA1c (a measure of long-term blood sugar control) than those assigned to placebo.
Phentermine is generally not recommended for people with uncontrolled high blood pressure, heart disease, or glaucoma. It should also be used with caution in people with diabetes who are taking insulin or other medications that can lower blood sugar levels.
CONCLUSION
Phentermine is an effective weight loss medication that may also help to improve glycaemic control in people with diabetes. However, it is important for patients to talk to their doctor to see if phentermine is right for them and to discuss any potential risks or side effects.
ADDITIONAL CONSIDERATIONS FOR PHARMACISTS
• When counselling patients with diabetes who are considering phentermine, it is important to emphasise the importance of close monitoring of blood sugar levels. Patients should be instructed to check their blood sugar levels more frequently than usual, especially when they first start taking phentermine.
SAFETY CONSIDERATIONS
Phentermine is generally safe for most people, but it can cause some side effects, such as dry mouth, insomnia, and constipation. It is important to note that phentermine can interact with other medications, so it is important for patients to talk to their doctor before starting treatment.
• Pharmacists should also be aware that phentermine can interact with several other medications, including insulin and other diabetes medications. It is important to review the patient's medication list carefully before starting phentermine treatment.
• Pharmacists should also educate patients about the potential side effects of phentermine and advise them to contact their doctor if they experience any unusual symptoms. Overall, phentermine can be a safe and effective weight loss medication for people with diabetes, but it is important to use it under the supervision of a healthcare professional.
*References available on request
In addition to promoting weight loss, phentermine may also help to improve glycaemic control in people with diabetes
Role of pharmacists in hypertension management
As September marks World Heart Month, the global spotlight turns towards cardiovascular health, with hypertension emerging as one of the most critical areas of focus. Hypertension is a significant public health issue in SA, affecting more than 40% of adults.1 This prevalence is notably higher than the global average of 1.28 billion (approximately 15%) reported by the World Health Organization.2
HYPERTENSION & ASSOCIATED CARDIOVASCULAR RISK
Often referred to as the ‘silent killer’, hypertension is a major risk factor for cardiovascular diseases (CVDs), including heart attacks, strokes, and heart failure.3 Elevated blood pressure exerts excessive force against the walls of arteries, leading to various pathophysiological changes that significantly increase the risk of cardiovascular events. 4,5 Effective management of hypertension is crucial in reducing the risk of these cardiovascular events, involving a combination of lifestyle modifications and pharmacological treatment. 4,6
BENEFITS OF FDC PRODUCTS IN TREATING HYPERTENSION
Fixed-dose combination (FDC) products offer several clinical advantages in the management of hypertension, particularly in improving blood pressure control and patient compliance. By combining two or more antihypertensive agents into a single pill, FDCs simplify the medication regimen, which significantly enhances patient adherence.5,8 Combinations like perindopril/ amlodipine have shown superior outcomes in controlling blood pressure compared to monotherapy or separate pills.5,9
SIDE EFFECTS OF ANTIHYPERTENSIVES
Antihypertensive drugs, while effective, are associated with various side effects that can impact patient compliance and quality of life. Common side effects include persistent dry cough, dizziness, fatigue, and headaches.10 Managing these side effects involves close monitoring and
communication between patients and healthcare providers. FDC products, such as perindopril/ amlodipine, offer additional benefits in managing side effects by lowering the incidence of peripheral oedema and cough associated with monotherapy.5,9
PATIENT EDUCATION ON DIET, EXERCISE & LIFESTYLE MODIFICATION
Non-pharmacological approaches to hypertension management are essential in controlling blood pressure (BP) and improving overall cardiovascular health. These strategies include dietary modifications, regular physical activity, and lifestyle changes.6,11 Pharmacists play a vital role in counselling patients on these lifestyle modifications, providing personalised advice, setting realistic goals, and offering resources such as educational materials and support groups. While lifestyle changes can improve BP and overall CV risk, the majority of patients will require pharmacotherapy.11,12
IMPORTANCE OF PATIENT ADHERENCE TO TREATMENT
Medication adherence in hypertensive patients is a critical factor in achieving optimal health outcomes. To improve adherence, strategies such as using FDC products, patient education, and regular follow-up appointments are essential. Pharmacists can educate patients about the importance of adherence, potential side effects, and the long-term benefits of controlling blood pressure.13
HOME-BASED BLOOD PRESSURE MONITORING
Home-based blood pressure (BP) monitoring is a valuable tool for self-management of hypertension. Regular home monitoring allows patients to track their BP more frequently and in a less stressful environment, leading to improved BP control and early detection of hypertension. Pharmacists play a crucial role in educating patients on accurate home monitoring techniques and interpreting results, contributing to better hypertension management and overall cardiovascular health.6,14
*References available on request
%
Hypertension is a significant public health issue in SA, affecting more than 40% of adults1
Managing gout & cardiovascular disease
Recent studies have highlighted a significant connection between gout and cardiovascular disease, underscoring the importance of comprehensive management strategies that involve pharmacists1
Patients with gout are more likely to suffer from hypertension, diabetes, and chronic kidney disease, all of which are risk factors for cardiovascular disease.1,2,3 The inflammatory processes and metabolic abnormalities associated with gout may contribute to the development and progression of cardiovascular disease. 4
P Inflammation: Gout is characterised by intense inflammation, which can contribute to the development of atherosclerosis, where plaque builds up inside the arteries, leading to cardiovascular disease. Chronic inflammation is a known risk factor for atherosclerosis and other cardiovascular conditions. 4
P Hyperuricaemia: Elevated uric acid levels, a hallmark of gout, have been independently associated with an increased risk of cardiovascular events. Hyperuricemia can lead to endothelial dysfunction, oxidative stress, and inflammation, all of which are implicated in the pathogenesis of cardiovascular disease. 4
physical activity, and avoiding alcohol and purine-rich foods, can help manage gout and reduce cardiovascular risk. You can also inform patients about the signs and symptoms of gout and cardiovascular disease, emphasising the importance of early detection and treatment.5
P Medication management: Assisting in the management of medications used to treat gout and cardiovascular disease includes ensuring appropriate use of urate-lowering therapies (eg, allopurinol, febuxostat) and anti-inflammatory medications (eg, NSAIDs, colchicine) for gout,5 as well as antihypertensives, statins, and antiplatelet agents for cardiovascular disease.6,7 Monitor for potential drug interactions and adverse effects, ensuring safe and effective therapy.
P Comorbidities: Patients with gout often have comorbid conditions such as hypertension, obesity, and diabetes, which are wellestablished risk factors for cardiovascular disease. The presence of these comorbidities can exacerbate the risk of cardiovascular events in patients with gout. 2
THE ROLE OF THE PHARMACIST
Pharmacists play a crucial role in patient education, medication management, and collaboration with other healthcare providers to optimise patient outcomes.
P Patient education: Educating patients about the importance of lifestyle modifications, such as maintaining a healthy diet, engaging in regular
P Collaboration with healthcare providers: Work closely with physicians, nurses, and other healthcare providers to develop and implement comprehensive care plans for patients with gout and cardiovascular disease. This collaborative approach can help ensure all aspects of the patient's health are addressed, leading to better overall outcomes.
P Monitoring and follow-up: Provide ongoing monitoring and follow-up for patients with gout and cardiovascular disease. This includes regular assessment of uric acid levels, blood pressure, lipid profiles, and other relevant parameters. You can also provide support and encouragement to patients, helping them adhere to treatment plans and make necessary lifestyle changes. 2
Pharmacists, with their expertise in medication management and patient education, are wellpositioned to play a key role in the care of patients with gout and cardiovascular disease.
*References available on request
The connection between gout and cardiovascular disease highlights
the need for integrated management strategies that address both conditions
Effective seizure control* with once-daily dosing1,4
Enhanced efficacy/tolerability ratio vs. LEV-IR5 and straightforward IR to eXtended-Release dose conversion1,5
Convenience
IR – immediate-release; LEV - levetiracetam; SA - South Africa
*As adjunctive therapy in partial onset seizures 4
LEVESEIZE ® XR is indicated as monotherapy in the treatment of partial onset seizures with or without secondary generalisation in patients from 16 years of age with newly diagnosed epilepsy.1
LEVESEIZE ® XR is indicated as adjunctive therapy1:
In the treatment of partial onset seizures with or without secondary generalisation in adults and children over 16 years of age with epilepsy
• In the treatment of myoclonic seizures in adults and adolescents from 12 years of age with juvenile myoclonic epilepsy
• In the treatment of primary generalised tonic-clonic seizures in adults and children from 16 years of age with idiopathic generalised epilepsy
References: 1. Leveseize ® XR 500 mg, 750 mg, 1000 mg and 1500 mg tablets professional information, 12 July 2022. 2. Data on file. United States Patent US 8,535,717 B2. 3. Wrap Matrix™. Accessed Oct 14, 2022. Available from https://www.sparc.life/delivery-technologies/wrap-matrix 4. Peltola J, Coetzee C, Jiménez F, et al. Once-daily extended-release levetiracetam as adjunctive treatment of partial onset seizures in patients with epilepsy: A double-blind, randomized, placebo-controlled trial. Epilepsia 2009;50(3):406-414. 5. Sonmezturk HH, Azar NJ. Levetiracetam extended release as adjuvant therapy for the control of partial-onset seizures. J CNS Disease 2011;3:17-25.
Classification: A 2.5 Anticonvulsants, including antiepileptics. For full prescribing information please refer to the professional information approved by the South African Health Products Regulatory Authority. Applicant: Ranbaxy Pharmaceuticals (Pty) Ltd., a Sun Pharma company. 14 Lautre Road, Stormill Ext.1, Roodepoort, 1724. Tel: +27 11 495 0100. Fax: +27 11 495 0150. www.sunpharma.com.
One pill, once a day: transforming epilepsy treatment with Levetiracetam XR
Epilepsy is a chronic neurological disorder characterised by recurrent seizures, significantly impacting a patient's quality of life. Effective management often requires long-term medication adherence to prevent breakthrough seizures.1 Levetiracetam, a widely used anticonvulsant, has recently become available in an extended-release (XR) formulation in SA, offering a once-daily dosing option that can improve patient compliance and outcomes.2
IMPORTANCE OF MEDICATION ADHERENCE
Epilepsy affects millions worldwide, and its management typically involves antiepileptic drugs (AEDs) to control seizures. Consistent medication adherence is crucial in preventing breakthrough seizures, which can lead to severe consequences, including injury, hospitalisation, and even sudden unexpected death in epilepsy (SUDEP). However, the complexity of multiple daily dosing schedules can be a barrier to adherence for many patients.1
BENEFITS OF ONCE DAILY EXTENDED-RELEASE LEVETIRACETAM
The introduction of levetiracetam extendedrelease marks a significant advancement in epilepsy treatment in SA. This once-daily dosing option offers several benefits over the traditional twice-daily IR formulation:
1. Improved patient compliance: The simplicity of a once-daily dosing regimen enhances patient adherence, reducing the likelihood of missed doses and breakthrough seizures. Studies have shown that patients are more likely to stick to a once-daily regimen compared to multiple daily doses.1,2
2. Consistent plasma concentrations: Levetiracetam extended-release ensures consistent plasma drug levels throughout
the day, minimising the peaks and troughs associated with IR formulations and providing more stable seizure control.1,2
3. Reduced adverse events: Clinical studies indicate that levetiracetam extended-release is well-tolerated, with fewer treatment-emergent adverse events (TEAEs) compared to the IR formulation. This includes a lower incidence of cognitive impairment and weight gain, which are common concerns with AEDs. 2
4. Ease of switching: Transitioning from a twice-daily IR formulation to a once-daily XR formulation is straightforward. Patients can switch to levetiracetam extendedrelease with minimal disruption to their treatment regimen, making it an attractive option for both new and existing patients.2
CLINICAL EVIDENCE
A randomised, double-blind, multicentre trial compared the efficacy and safety of levetiracetam extended release (1000mg once daily) to the IR formulation (500mg twice daily) in adults with uncontrolled partial epilepsy.
The study found that both formulations were equally effective in reducing seizure frequency, with a responder rate of 58.6% for both groups. However, the XR group had a higher seizure freedom rate (27.6% vs 13.8% for IR) and showed significant improvements in quality of life.1
The availability of levetiracetam extendedrelease in SA offers a promising option for patients with epilepsy, providing effective seizure control with the convenience of once-daily dosing. This formulation not only improves patient compliance but also enhances quality of life by reducing the burden of multiple daily doses. Pharmacists play a crucial role in educating patients about the benefits of levetiracetam extended release and supporting them in making the switch to this innovative treatment option.
*References available on request
The introduction of levetiracetam extendedrelease marks a significant advancement in epilepsy treatment in SA
Seasonal affective disorder: A winter risk factor
As days become shorter and the weather gets colder, the incidence of SAD increases
Seasonal affective disorder (SAD) has been described as an episode of depression that occurs annually at the same time each year. Most often, people experience it in autumn as the days get shorter. However, it can also occur during the summer months.
While SA has a relatively mild climate, we do experience weather changes in winter that might trigger depressive feelings. In the west of the country, days become colder, rainy, and gloomy, while on the highveld, the weather gets dry, pale, and dusty.
and professional lives. It’s important to identify possible SAD, have it checked and get treatment if you need it.”
TIPS FOR PATIENTS
P While winter is cold, exercise is still critical for good mental health. Schedule 30-60 minutes of daily exercise to boost your emotional well-being.
SAD symptoms tend to recur around the same time every year and are not related to obvious external stressors like a break-up, a bereavement, or being unemployed
SAD has been described as a specifier of depression, or a pattern in which depression occurs. SA has an extremely high rate of depression, so it’s important to be aware of the symptoms of SAD and to encourage patients to seek help if they experience any.
SAD SYMPTOMS
P Feelings of hopelessness or sadness
P Thoughts of death or suicide, suicide attempts, fear of dying
P Restlessness, irritability, or anger
P Difficulty concentrating, remembering things, or making decisions
P Loss of interest or pleasure in hobbies and favourite activities
P Hypersomnia, also known as oversleeping
P A change in appetite, especially an excessive craving for sweet or starchy foods
P Weight gain
P Low energy
P Avoiding social situations.
“SAD symptoms tend to recur around the same time every year and are not related to obvious external stressors like a break-up, a bereavement, or being unemployed,” said Dr Marisa Roets, psychiatric specialised nurse manager at Life Poortview. “Usually, SAD symptoms are mild, but for some, they can be debilitating, and affect their personal
P Eating a healthy, balanced diet is also critical to emotional wellness and making people less susceptible to SAD. Eat nutritious, whole foods and avoid processed, fatty meals.
P The amount of sunlight you are exposed to can also be a contributing factor to SAD. Try to get out of the house and enjoy the sunshine for at least 15-30 minutes a day.
P Get enough sleep, and take the time to rest, recover, and rejuvenate after hard work or stress.
P Maintain a healthy schedule and routine in you daily life, as it creates a sense of familiarity and balance.
P Make an effort to engage with family, friends, and loved ones. Supportive relationships can reduce unwanted stressors and provide you with emotional stress.
P Get professional mental-health support. Depression is one of the most treatable mental health conditions.
“Seasonal affective disorder commonly begins in young adulthood and is more common in women,” said Dr Roets. “It is believed to be hormone related as it increases after puberty and decreases post-menopause.”
Dr Roets said that for those susceptible to depression, SAD can trigger an ongoing depression that lasts long after the season has ended. It is therefore important that people remain aware of their emotional and mental well-being, particularly during vulnerable times in the year.
Spotting Alzheimer's early: 7 reasons why it matters
Alzheimer's disease is a progressive neurodegenerative disorder that affects millions of people worldwide. Characterised by a slow loss of cognitive function and memory, early detection and prevention are crucial in managing the disease and improving the quality of life for those affected. 1,2
THE POWER OF EARLY DIAGNOSIS
1. Improved quality of life: Early diagnosis allows individuals and their families to access support services, educational resources, and interventions at a stage when these can have a significant impact. It enables individuals to maintain their independence and quality of life for as long as possible.1,3
2. Access to treatments: While there is no cure for Alzheimer's disease, treatments are available that can help manage symptoms. Early detection means these treatments can be started sooner, potentially slowing the progression of cognitive decline. This includes pharmacological treatments that target specific aspects of the disease process, as well as non-pharmacological interventions aimed at supporting cognitive function and managing behavioural symptoms.1,4
3. Opportunity for lifestyle adjustments: Recognising Alzheimer's early allows individuals to make lifestyle changes that may help slow disease progression. This includes engaging in physical activity, adopting a healthier diet, staying socially connected, and participating in cognitive stimulation activities.1,4
4. Planning for the future: An early diagnosis provides individuals and their families with the opportunity to make important decisions about financial planning, healthcare, living
arrangements, and end-of-life care while the individual can still participate in these discussions.1,3,4
5. Participation in clinical trials:
Early detection opens the door for participation in clinical trials, which is essential for the development of new treatments. Individuals diagnosed early in the disease process can contribute to research that may lead to breakthroughs in Alzheimer's care and prevention.1,3,4
6. Reducing healthcare costs: Early diagnosis and intervention can potentially reduce the financial burden on families and healthcare systems by delaying the need for more intensive care and support services. 4,5
7. Emotional and social benefits: Early diagnosis can reduce anxiety for individuals and their families by explaining symptoms. It also allows families to connect with support groups and networks, which can be invaluable sources of information and emotional support.3,4
Early detection is essential in managing Alzheimer's disease. By recognising the signs early and adopting a healthy lifestyle, patients can potentially slow the progression of the disease and improve their quality of life. Pharmacists play a crucial role in educating patients about these measures and supporting them in their journey.
*References available on request.
“To
Sleep... Perchance to Dream”
William Shakespeare
NEW ZILSUN MR
ZILSUN MR
tartrate
Good Night . Great Day.
For decreased sleep latency and improved sleep maintenance
Zolpidem MR significantly reduces the number of awakenings up to 5 hours post-dose2
With Zolpidem MR there is no evidence of relevant next-day residual effects1
Maintains sleep architecture: Respects the overall sleep architecture, without disturbance of stage 3/4 and REM sleep3
On discontinuation of ZILSUN limited to the first night
Insomnia: the importance of sleep & treatment options
Insomnia is a common sleep disorder that affects millions of people worldwide. It is characterised by difficulties in falling asleep, staying asleep, or waking up too early and not being able to go back to sleep.1,2,3,4
THE NEED FOR PROPER SLEEP
Sleep is a vital component of health, playing a crucial role in physical and mental well-being. It is during sleep that the body repairs itself, and the brain processes information and consolidates memories.2,4 Lack of proper sleep can lead to a range of health problems, including weakened immune function, weight gain5, and increased risk of chronic conditions such as heart disease and diabetes.2
THE ROLE OF REM SLEEP IN THE SLEEP CYCLE
The sleep cycle consists of multiple stages, including non-REM (Rapid Eye Movement) and REM sleep. Each stage plays a vital role in brain recovery and cognitive functions. REM sleep is essential for memory consolidation, learning, and emotional regulation. Insufficient REM sleep can negatively impact mental and physical health, leading to issues such as mood disorders and impaired cognitive function. 4,6
conditions, such as depression and anxiety. Poor sleep can exacerbate these conditions, creating a vicious cycle where mental health issues and sleep problems feed into each other. Addressing insomnia can significantly improve the symptoms of related illnesses and enhance overall quality of life. 2
TREATMENT OPTIONS
There are various treatment options for insomnia, including behavioural therapies and medications. Cognitive-behavioural therapy for insomnia (CBT-I) is a highly effective treatment that focuses on changing sleep habits and addressing thoughts and behaviours that contribute to sleep problems.1,2,3 Medications, such as short or intermediateacting benzodiazepine receptor antagonists (BzRAs), ramelteon, sedating antidepressants, or other sedating agents such as antiepileptic drugs and atypical antipsychotics, can also be used to manage insomnia, particularly when behavioural therapies are not sufficient.1,2,3,6,7
IMMEDIATE-RELEASE VS EXTENDED-RELEASE FORMULATIONS
WHEN TO SEEK A PRESCRIPTION FROM A DOCTOR
If your patient experiences persistent insomnia that affects their daily functioning, it is essential to encourage them to seek further medical advice. A doctor can help determine the underlying cause of their sleep problems and recommend appropriate treatment. Prescription medications can assist in falling asleep, staying asleep, and improving overall sleep quality.6
THE RELATIONSHIP BETWEEN SLEEP AND OTHER ILLNESSES
Insomnia is often linked to other health
Sleeping tablets come in different formulations, including immediate-release and extendedrelease. Immediate-release formulations are designed to help individuals fall asleep quickly. They are beneficial for those who have difficulty initiating sleep. On the other hand, extended-release formulations are designed to help individuals fall asleep and stay asleep throughout the night. They are suitable for those who have trouble maintaining sleep.7 Insomnia is a complex condition that requires a comprehensive approach to treatment. Proper sleep is essential for overall health and addressing sleep problems can significantly improve quality of life.
*References available on request
Whether through behavioural therapies or medications, there are various options available to help achieve restful and restorative sleep
Depression in men: the unseen crisis
Psychiatric disorders, especially anxiety and major depressive disorders (MDD), significantly impact global health, affecting millions. The 2019 Global Burden of Diseases study reported that anxiety disorders impacted around 374 million people, while MDD affected approximately 246 million. The Covid-19 pandemic exacerbated these issues in sub-Saharan Africa, with anxiety cases rising by 21% and depression by 23%. Although women generally report higher prevalence rates, men often experience more severe symptoms but are less likely to seek help due to societal norms surrounding masculinity.
Hegemonic masculinity influences how men express mental health struggles, leading to ‘restrictive emotionality,’ where men are socialised to suppress emotions and avoid discussing feelings. This cultural expectation can worsen mental health issues. Gender differences in the experience of anxiety and depression are also shaped by biological factors; for instance, anxiety disorders often manifest in girls during middle childhood, while MDD typically begins in puberty, particularly in females due to hormonal changes.
may respond differently to antidepressants, with some studies suggesting men respond better to certain medications, while women may respond more favourably to others. However, findings are inconsistent, necessitating further research. Experts advocate for gender-sensitive assessment strategies in mental healthcare, encouraging emotional expression among men and improving treatment access. Awareness campaigns aimed at changing societal expectations around masculinity could facilitate help-seeking behaviour.
The efficacy of antidepressants can vary by sex, with some studies showing differential responses based on the medication. For instance, Vermeiden et al found that men showed better responses to imipramine, while premenopausal women responded better to fluvoxamine. However, other studies found no significant sex differences in the effectiveness of various antidepressants.
The types of anxiety disorders also vary by gender. Women are more prone to panic attacks, generalised anxiety disorder (GAD), and social anxiety disorder (SAD), often reporting physical symptoms and social fears. Conversely, men may experience anxiety related to social consequences and are more likely to engage in externalising behaviours, such as substance abuse. Treatment disparities exist, with men receiving less adequate care for depression, contributing to higher suicide rates among men, especially in older age groups. While women may report more suicide attempts, men are more likely to complete suicide, highlighting the need for tailored mental health strategies.
Research indicates that men and women
In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants. For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants. When selecting an antidepressant, individual patient characteristics should be considered, and a combination of pharmacotherapy and psychotherapy is often more effective than medication alone. Maintenance treatment is crucial to reduce relapse risk, particularly for those with a history of multiple episodes or severe symptoms, as recurrence rates are notably high.
Reference: Bosman R. Men: a different depression? Specialist Forum. Medical Academic. Available from: https://www.medicalacademic.co.za/mens-health/ men-a-different-depression/
This Movember, we explore the complex interplay of gender differences in the prevalence, expression, and treatment of anxiety and major depressive disorders, and the unique challenges men face in seeking mental healthcare
