Understanding the latest research on dietary supplements is crucial for advising patients effectively.
30 Heartburn: prevention & treatment over the holidays
The holiday season is a time of joy, celebration, and often, over indulgence.
31 Managing gout & cardiovascular disease
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. Pharmacists
The connection between gout and cardiovascular disease highlights the need for integrated management strategies that address both conditions.
33 Depression in men
Scan the QR code to sign up to receive a digital copy of the latest issue of Pharmacy Magazine every month
Pharmacists
are key in establishing a future free from tobacco and nicotine dependence
Pharmacists have a crucial role to play in tobacco and nicotine use cessation in order to reduce the heavy burden of non-communicable diseases, the International Pharmaceutical Federation (FIP) said recently in a new statement of policy.
The policy statement, recently adopted by the FIP Council, makes recommendations for pharmacists, pharmaceutical organisations, pharmacy educators, governments, policy makers, regulatory agencies and healthcare funders to facilitate and support roles for the pharmacy profession in supporting the cessation of tobacco and nicotine use. It updates the 2003 FIP policy statement and builds on a joint statement by FIP and the World Health Organization which was adopted in May 2024.
“Use of tobacco remains a significant public health issue. Recognising the preventable nature of the harms of tobacco and tobacco-related products, this statement highlights pharmacists' roles and further potential in reducing diseases and premature deaths linked to their use. Pharmacists are uniquely positioned to influence public health through patient education, personalised support and pharmacological interventions. They can enhance cessation success rates through identifying individuals who use tobacco and nicotine, assessing their readiness to quit, and providing structured cessation programmes,” said
Mr Lars-Åke Söderlund, FIP vice president and cochair of the policy committee. Through the updated policy statement, FIP urges pharmaceutical organisations to actively support tobacco cessation services in pharmacies by developing guidelines and implementation tools. Pharmacists should take a more active role preventing people from ever starting tobacco use and are encouraged to utilise digital technologies to increase the uptake of effective cessation treatments, the federation said.
INTERESTING TOPICS IN THIS MONTH’S ISSUE INCLUDE:
• Pharmacy in universal health care (page 13)
• 5 tips before dispensing NSAIDs (page 15)
• Integrated sun protection for the SA population (page 17)
• The stress-glucose connection (page 21)
• Depression in men (page 33)
CROSSWORD CHALLENGE
Congratulations to the winner of Crossword #67 Telana van der Merwe
For your chance to win a R500 Woolworths voucher don’t miss this month’s crossword puzzle on page 34.
WORDS TO LIVE BY
“Sunsets are proof that endings can be beautiful.”
– Beau Taplin
PROVEN
PROVEN
*As demonstrated in cardiovascular outcomes trials
† Results apply to Ozempic® 0,5 mg and 1 mg plus standard of care vs. placebo plus standard of care in adults with T2D and established ASCVD.
References: 1. OzempicR Approved Professional Information, 17 February 2023. 2. Rodbard HW, Lingvay I, Reed J, et al. Semaglutide Added to Basal Insulin in Type 2 Diabetes (SUSTAIN 5): A Randomized, Controlled Trial. J Clin Endocrinol Metab 2018;103(6):2291-2301.
3. Lingvay I, Catarig AM, Frías JP, et al. Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes (SUSTAIN 8): a double-blind, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol 2019;7(11):834-844. 4. Capehorn MS, Catarig AM, Furberg JK, et al. Efficacy and safety of once-weekly semaglutide 1.0 mg vs once-daily liraglutide 1.2 mg as add-on to 1-3 oral antidiabetic drugs in subjects with type 2 diabetes (SUSTAIN 10). Diabetes Metab 2020;46(2):100-109. 5. Marso SP, Bain SC, Consoli A, et al. SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375(19):1834-1844. 6. Davies MJ, Aroda VR, Collins BS, etal. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022;45(11):2753-2786.
Abbreviated Professional Information
Scheduling status: S4 Name of the medicine: Ozempic® Qualitative and quantitative composition: Semaglutide 1,34 mg/ml. Therapeutic indication: Ozempic® is indicated: a) for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise • as monotherapy when metformin is considered inappropriate due to intolerance or contraindications. • as combination therapy with oral anti-diabetic medicines (metformin, thiazolidinediones, sulphonylurea), basal insulin with or without metformin and pre-mix insulin. b) to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease. Posology and method of administration: Ozempic® starting dose is 0,25 mg once weekly. After 4 weeks, the dose should be increased to 0,5 mg once weekly. After at least 4 weeks with a dose of 0,5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycaemic control. Ozempic® is to be administered once weekly at any time of the day, with or without meals. Ozempic® is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. The injection site can be changed without dose adjustment. Ozempic® should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2 days (>48 hours). When Ozempic® is added to existing sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy, the current dose of SGLT2 inhibitor can be continued unchanged. Contraindications: Hypersensitivity to semaglutide or to any of the excipients, a
personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), pregnancy and lactation. Special warnings and precautions for use: Ozempic® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Ozempic® is not a substitute for insulin. Acute pancreatitis has been observed with the use of Ozempic®. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, Ozempic® should be discontinued; if confirmed, Ozempic® should not be restarted. Patients treated with Ozempic® in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia. The risk of hypoglycaemia can be lowered by reducing the dose of sulfonylurea or insulin when initiating treatment with Ozempic®. Risk of Thyroid C-cell Tumours: Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist have been reported in the post marketing period; the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans. Interaction with other medicines and other forms of interaction: In vitro studies have shown very low potential for Ozempic® to inhibit or induce CYP enzymes and to inhibit drug transporters. The delay of gastric emptying with Ozempic® may influence the absorption of concomitantly administered oral medicines. The potential effect of Ozempic® on the absorption of co-administered oral medicines was studied in trials at Ozempic® 1 mg steady state exposure. Fertility, pregnancy and lactation: Ozempic® is contraindicated during pregnancy and lactation. Undesirable effects: The most frequently reported adverse reactions with Ozempic® in clinical trials were gastrointestinal disorders, including nausea, diarrhoea and vomiting. Adverse reactions by system organ class and absolute frequencies identified in all phase 3a trials listed here as Very common (≥1/10): Hypoglycaemia when used with insulin or sulfonylurea, nausea, diarrhoea; Common (≥1/100 to <1/10): Hypoglycaemia when used with other OADs, decreased appetite, dizziness, diabetic retinopathy complications, vomiting, abdominal pain, abdominal distension, constipation, dyspepsia, gastritis, gastrooesophageal reflux disease, eructation, flatulence, cholelithiasis, fatigue, increased lipase, increased amylase, weight decreased; Uncommon (≥1/1,000 to <1/100): hypersensitivity, dysgeusia, increased heart rate, injection site reactions, hypersensitivity, acute pancreatitis; Rare (≥1/10,000 to <1/1,000): anaphylactic reaction.Frequency unknown: angioedema. Overdose: There is no specific antidote for overdose with Ozempic®. In the event of overdose, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. A prolonged period of observation and treatment for these symptoms may be necessary, taking into account the long half-life of Ozempic® of approximately 1 week. Reg. No.: 53/21.13/0497. For full prescribing information, refer to the Professional Information approved by the Medicines Regulatory Authority.
Nordisk (Pty) Ltd. Reg. No.: 1959/000833/07. 150 Rivonia Road, 10 Marion Street Office Park, Building C1, Sandton, Johannesburg, 2196, South Africa. Tel: (011) 202 0500. Fax: (011) 807 7989. www.novonordisk.com.24910T. ZA24RZG00044 August 2024.
More girls started puberty early during the Covid-19 pandemic
Risk factors may include unhealthy pandemic-related lifestyle changes
The number of girls diagnosed with precocious puberty increased during the Covid-19 pandemic due to potential risk factors such as increased screen time and less physical activity, according to a new study published in the Journal of the Endocrine Society.
The number of girls referred to paediatric endocrinologists for precocious puberty has increased significantly over the last two years, potentially due to the Covid-19 pandemic. Precocious puberty is when children's bodies begin to change into adult bodies too soon. They start to develop physical changes before the age of eight such as breasts buds in girls and bigger testes in boys. Covid-19 has also been linked to endocrine diseases such as obesity, which is a known contributor to early puberty in girls.
“Our study confirms the rise in precocious puberty diagnoses during Covid-19 and identifies contributing factors such as poor eating and exercise habits, too much screen time and impaired sleep,” said study author Dr Mohamad Maghnie (University of Genoa and the Giannina Gaslini Institute in Genoa, Italy). “We found an increase in weight gain among girls diagnosed with precocious puberty during the pandemic, and
rapid increase in body weight is associated with advanced pubertal development.”
The researchers evaluated the incidence of precocious puberty before and after the Covid-19 pandemic in 133 girls from Italy. They also examined the possible relationship between Covid-19 and pandemic-related lifestyle changes.
They found 72 cases of precocious puberty before the Covid-19 pandemic (January 2016-March 2020) and 61 cases between March 2020 and June 2021. That equates to four new cases per month.
The researchers also found girls diagnosed with precocious puberty during the Covid-19 pandemic tended to have higher body mass index (BMI) scores than girls who did not. These girls spent an average of two hours per day using electronic devices, and 88.5% of them stopped any physical activity.
“The role of stress, social isolation, increased conflicts between parents, economic status and the increased use of hand and surface sanitisers represent potentially further interesting hypotheses as to why early puberty is increasing in youth,” Dr Maghnie said. “Although, the consequence of biological adaptation cannot be entirely ruled out.”
Researchers found girls diagnosed with precocious puberty during the Covid-19 pandemic tended to have higher BMI scores than girls who did not
SOURCE: The Menopause Society
Women entering menopause later in life at greater risk for asthma
New study suggests role of natural and synthetic oestrogen in increasing risk of asthma
Many studies suggest that an earlier age at menopause is more detrimental to a woman's health, leading to an increased risk for adverse health conditions such as heart disease, diabetes, osteoporosis, and depression, among others. However, a new study is linking a later age at natural menopause with a greater risk for asthma.
Asthma is a common, chronic disease affecting more than 300 million people worldwide. The prevalence of asthma has been increasing over recent years. Adult-onset asthma is typically more severe and more difficult to treat than childhood asthma.
Multiple studies have suggested a possible link between asthma and sex hormones. Most notable is the fact that adult-onset asthma is more common in women than men. In childhood, asthma is more prevalent in boys. After puberty, however, asthma occurs more often in girls. Women also tend to have more severe asthma and are less likely to have remission of the disease.
Some studies have found a peak incidence of asthma at around 40 years, which is commonly the age of the menopause transition, whereas other studies found a peak at the average age at menopause, which is 51 years. Both natural oestrogen and synthetic oestrogen, such as used in hormone therapy, offer similar risk profiles. Women
using hormone therapy were shown to have a 63% increased risk of asthma, whereas women who stopped hormone therapy were two times more likely to quit asthma treatment. Higher body mass index also is shown to be a risk factor for women, but not men, because fat produces oestrogen.
Unfortunately, research on the association between menopause and asthma incidence is limited and has yielded conflicting results. That is why this newest study, based on 10 years of follow-up data from more than 14 000 postmenopausal women, was designed to investigate the association between the age at natural menopause and incidence of asthma in non-smoking postmenopausal women. The study researchers found that women with early menopause (between 40 and 44 years of age) are at a reduced risk of asthma, which led them to suggest a role of oestrogen with asthma risk.
"This study highlights sex-based differences in asthma, with women at a greater risk for asthma than men in adulthood. It also showed that women with later onset of menopause are at greater risk than those with early onset of menopause. Clinicians should be aware of this link and should monitor women with later age at natural menopause for asthma symptoms," said Dr Stephanie Faubion, medical director for The Menopause Society.
63%
Women using hormone therapy were shown to have a 63% increased risk of asthma
The evolution of medical packaging
The medical industry has witnessed significant advancements in packaging over the years, driven by the need for safety, compliance, and sustainability. The evolution of medical packaging is a testament to the industry's commitment to improving patient outcomes and ensuring the integrity of medical products.
EARLY DEVELOPMENTS
In the early days, medical packaging was rudimentary, often consisting of simple glass bottles and metal containers. These early forms of packaging were primarily designed to protect the contents from contamination and physical damage. However, they lacked the sophistication needed to address the growing complexities of the medical field.
INTRODUCTION OF PLASTICS
The mid-20th century marked a significant shift with the introduction of plastics. Plastics revolutionised medical packaging by offering lightweight, durable, and cost-effective solutions. Polyethylene and polypropylene became popular materials due to their versatility and ability to form airtight seals. This era also saw the advent of blister packs, which provided individual packaging for tablets and capsules, enhancing dosage accuracy and patient compliance.
ADVANCEMENTS IN STERILISATION
Sterilisation became a critical focus in the evolution of medical packaging. The development of sterilisable materials and techniques, such as gamma irradiation and ethylene oxide sterilisation, ensured that medical products remained sterile until use. This was particularly important for surgical instruments, syringes, and other medical devices.
SMART PACKAGING
The 21st century has ushered in the era
of smart packaging. Innovations such as RFID (Radio Frequency Identification) tags and QR codes have transformed medical packaging into interactive tools. These technologies enable real-time tracking of products, ensuring their authenticity and providing valuable information to healthcare providers and patients. Smart packaging also plays a crucial role in combating counterfeit drugs, a growing concern in the global pharmaceutical industry.
SUSTAINABILITY AND ECO-FRIENDLY SOLUTIONS
In recent years, there has been a growing emphasis on sustainability in medical packaging. The industry is increasingly adopting eco-friendly materials and practices to reduce its environmental footprint. Biodegradable plastics, recyclable materials, and minimalistic packaging designs are becoming more prevalent. Studies have shown that sustainable packaging not only benefits the environment but also enhances brand reputation and consumer trust.
FUTURE TRENDS
Looking ahead, the future of medical packaging is likely to be shaped by advancements in nanotechnology and personalised medicine. Nanotechnology holds the promise of creating packaging that can interact with its contents at a molecular level, providing enhanced protection and functionality. Personalised medicine, which tailors treatments to individual patients, will require packaging solutions that can accommodate small, customised batches of drugs and medical devices.
The evolution of packaging in the medical industry reflects the sector's ongoing commitment to innovation, safety, and sustainability. As technology continues to advance, medical packaging will undoubtedly play a pivotal role in enhancing patient care and ensuring the integrity of medical products.
The 21st century has ushered in the era of smart packaging
AUTHOR: ICPA deputy chairperson, Dr Sham Moodley
Pharmacy in universal health care
Achieving Universal Health Coverage (UHC) in SA necessitates substantial improvements in healthcare infrastructure, expansion of preventive healthcare at the community level, effective use of technology and innovation, implementation of collaborative care models, and rigorous measurement of both performance and quality of care to ensure positive health outcomes. This vision places pharmacists and their teams, alongside other primary healthcare professionals, at the forefront of a reimagined healthcare model, writes ICPA deputy chairperson, Dr Sham Moodley
The imperative to enhance healthcare services is deeply rooted in the South African Constitution and aligns with the 1948 WHO Constitution, which defines health as a fundamental human right.1 Universal, equitable access to high-quality primary healthcare, regardless of race, gender, income, or geographical location, is a priority for all citizens. Achieving this goal, however, requires a financial model that emphasises affordability and sustainability, ensuring that the healthcare system remains efficient and maintains strict cost control.
Political debates surrounding this issue are likely to persist and may ultimately reach the Constitutional Court, reflecting the strength of SA’s democratic principles and the independence of its legal system. However, this process alone will not address the fundamental question: “What changes are necessary to guarantee equitable access to quality, affordable healthcare in SA? This critical issue has been brought to the forefront of public discourse by the Independent Community Pharmacy Association (ICPA) on behalf of the organised pharmacy sector. Community pharmacies have the potential to serve as pivotal institutions, delivering essential health promotion programmes aimed at combating the prevalence of preventable diseases.
The epidemic of noncommunicable diseases (NCDs) accounts for approximately half
of all deaths in SA, with 20 million adults classified as overweight or obese. 2 When coupled with high levels of alcohol consumption, smoking, and the prevalence of HIV and tuberculosis infections, these health challenges underscore the necessity for each sector to assess its potential contributions – whether within individual professional domains or through collaborative initiatives.3
At a recent workshop attended by prominent community pharmacists, participants identified a basket of services that could address these issues at the primary care level. These services span acute and chronic care, as well as pharmaceutical services, offering practical strategies to enhance health literacy, immunisation coverage, medication management, public health promotion, disease prevention and management, and point-of-care solutions. The workshop also highlighted gaps in pharmacists' confidence and competency, underscoring the need for standardised protocols and remuneration frameworks to better integrate pharmacists into primary healthcare (PHC).
The pharmacy sector holds a distinct advantage in possessing a workforce of knowledgeable, skilled, and competent pharmacists, pharmaceutical scientists, and educators. By expanding pharmaceutical services, the profession is well-positioned to support the healthcare system’s objectives and advance towards achieving universal health coverage (UHC).
*References available on request
What changes are necessary to guarantee equitable access to quality, affordable healthcare in SA?
pain management Education
5 tips before dispensing NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are approved for use as antipyretic, antiinflammatory, and analgesic agents. These effects make NSAIDs useful for treating muscle pain, dysmenorrhea, arthritic conditions, pyrexia, gout, migraines, and used as opioidsparing agents in certain acute trauma cases.
Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. One way to tackle this is to ensure that patients understand how to take their NSAIDs in the safest way possible. When pharmacists dispense nonsteroidal anti-inflammatory drugs (NSAIDs), they should take several precautions to ensure patient safety and optimise therapy.
Pharmacy Magazine spoke to pharmacist and ICPA COO, Ahmed Bayat, who shared five tips that pharmacists should keep in mind when dispensing NSAIDs to ensure patient safety and optimise therapy.
1. ASSESS PATIENT'S MEDICAL HISTORY
P Kidney and liver function: NSAIDs can cause kidney damage, especially in patients with pre-existing kidney or liver conditions. Always ask about the patient's history of kidney or liver disease.
P Cardiovascular risk: NSAIDs may increase the risk of heart attack or stroke, especially in patients with a history of heart disease, hypertension, or high cholesterol. Consider recommending alternative pain relief options if the patient is at high cardiovascular risk.
2. EVALUATE GASTROINTESTINAL (GI) RISK
P NSAIDs can cause GI irritation, ulcers, and bleeding. Ask about the patient's history of GI problems and concurrent use of medications like corticosteroids or anticoagulants, which
may increase GI risks.
P Recommend a proton pump inhibitor (PPI) for patients at high risk of GI complications, especially if NSAIDs must be used long-term.
3. REVIEW CONCURRENT MEDICATIONS
Check for potential drug interactions with the patient's current medications. NSAIDs can interact with:
P Antihypertensives: NSAIDs may reduce the effectiveness of blood pressure medications, including ACE inhibitors and diuretics.
P Anticoagulants: Increased risk of bleeding when taken with warfarin or newer anticoagulants (eg, rivaroxaban, dabigatran).
P SSRIs/SNRIs: Concomitant use with antidepressants can increase the risk of GI bleeding.
4. EDUCATE ON PROPER USE & DOSING
P Lowest effective dose: Encourage patients to use the lowest effective dose for the shortest duration to minimise adverse effects.
P Take with food: Advise patients to take NSAIDs with food or milk to reduce GI irritation.
P Avoid alcohol: Warn patients against excessive alcohol consumption while using NSAIDs to reduce the risk of GI issues.
5. COUNSEL ON SIGNS OF ADVERSE EFFECTS
Educate patients on recognising early signs of NSAID-related adverse effects:
P GI symptoms
P Cardiovascular symptoms
P Kidney issues.
These steps help ensure NSAIDs are used safely and effectively, tailored to each patient’s health status.
NSAIDs are useful for treating muscle pain, dysmenorrhea, arthritic conditions,
pyrexia,
gout,
migraines,
and used as opioidsparing agents in certain acute trauma cases
Ahmed Bayat, ICPA CEO
KuraFlo® – so much more than Seasonal
Hay fever, allergies, dry coughs, asthma… these are the conditions that are most experienced during Spring and Summer seasons. Because of the heat and humidity, there is a lack of air movement which can cause pollutants like dust and pollen to be trapped in the airways. And although flu is prevalent in cold weather, we are also still susceptible to flu because of sudden temperature changes in Summer when we move from air-conditioned rooms to outdoor heat, or sudden rainstorms.
With a higher salt quantity in the product than that of the body, hypertonic saline draws fluid from the inflamed, swollen lining of the nose, sinuses, larynx and bronchi to help open the airways. This then helps wash out those trapped particles.
In addition, we have also launched our new anti-inflammatory, antibacterial, antiseptic Skin Healing Cream to help for those skin irritations, rashes, mosquito bites, cuts and sunburn.
Helping you Breathe Better & now Feel Better too!
Integrated sun protection for the SA population
Sun protection is a critical aspect of healthcare, particularly in regions with high UV radiation levels like SA. As pharmacists, you play a pivotal role in educating and advising patients on effective sun protection strategies.
UNDERSTANDING
UV RADIATION AND ITS RISKS
SA's geographical location results in high levels of ultraviolet (UV) radiation throughout the year. UV radiation is a major risk factor for skin cancer, including melanoma and non-melanoma skin cancers. It also contributes to premature skin aging and other skin disorders. It’s important to understand the types of UV radiation:
• UVA (320-400 nm): Penetrates deeply into the skin, causing aging and long-term skin damage.
• UVB (290-320 nm): Causes sunburn and is directly linked to skin cancer.
KEY SUN PROTECTION STRATEGIES
1. Broad-spectrum sunscreens:
F SPF 30 or higher: Recommend sunscreens with a Sun protection factor (SPF) of at least 30. Broad-spectrum sunscreens protect against both UVA and UVB radiation.
F Water-resistant formulations: For patients engaging in outdoor activities or swimming, water-resistant sunscreens are essential.
F Application and reapplication: Advise patients to apply sunscreen generously 15 minutes before sun exposure and reapply every two hours, or more frequently if swimming or sweating.
2. Protective clothing:
F UPF-rated clothing: Encourage the use of clothing with an ultraviolet protection factor (UPF) rating. UPF-rated garments provide an additional layer of protection against UV radiation.
F Hats and sunglasses: Wide-brimmed hats and UV-blocking sunglasses protect the face, neck, and eyes from harmful rays.
3. Seeking shade:
F Avoid peak sun hours: Advise patients to seek shade, especially between 10am and 4pm, when UV radiation is at its peak.
F Use of umbrellas and shelters: Encourage the use of umbrellas, tents, or other shelters when spending extended periods outdoors.
4. Behavioural changes:
F Regular skin checks: Educate patients on the importance of regular skin self-examinations and professional skin checks for early detection of skin changes or abnormalities.
F Sun protection for all skin types: Emphasise that sun protection is crucial for all skin types, including darker skin tones, which can also suffer from UV damage and skin cancer.
ROLE OF PHARMACISTS
As accessible healthcare professionals, pharmacists are in a prime position to:
• Provide personalised advice: Offer tailored sun protection advice based on individual patient needs, skin types, and lifestyles.
• Recommend products: Stock and recommend a range of sun protection products, including sunscreens, protective clothing, and accessories.
• Educate the community: Participate in community outreach programmes to educate the public about sun safety and the importance of regular skin checks.
• Cultural practices: Be mindful of cultural practices and preferences that may influence sun protection behaviours. Tailor advice to be culturally sensitive and practical.
By staying informed and proactive, pharmacists can significantly contribute to reducing the incidence of skin cancer and other UV-related skin conditions.
SOURCE: Tod B, Whitaker D, Visser W, Isaacs T, Jacobs T, Wiid K, Dlova NC, Wright CY. Integrated sun protection advice for the South African population. Int J Dermatol. 2024 Mar;63(3):277-287. doi: 10.1111/ijd.16980. Epub 2023 Dec 20. PMID: 38124402. Available from: https:// onlinelibrary.wiley.com/doi/10.1111/ijd.16980.
There is a need for ongoing public education campaigns to raise awareness about the risks of UV radiation and the importance of sun protection
Experience the freedom* with a 2-in-1 insulin co-formulation providing basal and mealtime control1-5
Targets both FPG and PPG for HbA1c control1,3,6,7
Ryzodeg® offers lower rates of nocturnal hypoglycaemia3,6,7
Once- or twice-daily dosing with main meal(s)1
# Image is for illustrative purposes only.
* with flexibility in dose timing when dosed with main meal(s). FPG: fasting plasma glucose; PPG: post-prandial plasma glucose; HbA1c: glycated haemoglobin.
References: 1 Ryzodeg® Professional Information August 2022. 2. Vijan S, et al. J Gen Intern Med. 2005;20(5):479–482. 3. Fulcher G, et al. Comparison of InsulinDegludec/Insulin Aspart and Biphasic Insulin Aspart 30 in Uncontrolled, Insulin-Treated Type 2 Diabetes: A Phase 3a, Randomized, Treatto-Target Trial. Diabetes Care. 2014;37:2085-89. 4. Haahr H, et al. Clin Pharmacokinet. 2017;56(4):339–354. 5. IQVIA MIDASR data. January 2020. 6. Onishi Y, et al. Superior glycaemic control with once-daily insulin degludec/insulin aspart versus insulin glargine in Japanese adults with type 2 diabetes inadequately controlled with oral drugs: a randomized, controlled phase 3 trial. Diabetes, Obesity and Metabolism. 2013; 15:826-832. 7. Philis Tsimikas A, et al. Similar glycaemic control with less nocturnal hypoglycaemia in a 38 week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin- treated subjects with type 2 diabetes mellitus. Diabetes Research and clinical practice. 2018;147:157-165.
S3 Name of the medicine: Ryzodeg® Composition: Each ml contains insulin degludec/insulin aspart (70 % soluble insulin degludec and 30 % soluble insulin aspart) 100 units/ml Therapeutic Indications: Treatment of adult diabetes mellitus patients, as basal add on to co-medication in patients who are inadequately controlled: - In type 1 diabetes mellitus, Ryzodeg® should be used with short-acting soluble insulin for use at the mealtimes when Ryzodeg® is not used. - In type 2 diabetes mellitus, Ryzodeg® should be used as an add on to oral antidiabetic medicines. Treatment of diabetes mellitus in adults, adolescents and children from the age of 2 years. Contra-Indications: Hypersensitivity to the active substances or to any of the excipients. Pregnancy. Special warnings and precautions for use: Hypoglycaemia: Too high insulin dose, omission of a meal or unplanned strenuous physical exercise may lead to hypoglycaemia. Patients whose blood-glucose control is greatly improved may experience a change in their usual warning symptoms of hypoglycaemia and must be advised accordingly. Usual warning symptoms of hypoglycaemia may be altered in patients with long-standing diabetes. The patient’s ability to concentrate and react may be impaired as a result of hypoglycaemia. Patients must be advised to take precautions to avoid hypoglycaemia while driving or operating machinery. Hyperglycaemia: Ryzodeg® should not be used to treat severe hyperglycaemia. Inadequate dosing and/or discontinuation of treatment in patients requiring insulin may lead to hyperglycaemia and potentially to diabetic ketoacidosis, which is potentially lethal. Concomitant illness, especially infections, may lead to hyperglycaemia and thereby cause an increased insulin requirement. Transferring to a new type, brand, or manufacturer of insulin must be done under strict medical supervision. Interactions: When using Ryzodeg® in combination with thiazolidinediones, patients should be observed for signs and symptoms of congestive heart failure, weight gain and oedema. Thiazolidinediones should be discontinued if any deterioration in cardiac function occurs. The following substances may reduce the insulin requirement: Oral antidiabetic medicines, glucagon-like peptide-1 (GLP-1) receptor agonists, monoamine oxidase inhibitors (MAOI), beta-blockers, angiotensin converting enzyme (ACE) inhibitors, salicylates, anabolic steroids and sulphonamides. The following substances may increase the insulin requirement: oral contraceptive, thiazides, glucocorticoids, thyroid hormones, sympathomimetics, growth hormones and danazol. Beta-blocking medicines may mask the symptoms of hypoglycaemia and may reduce the body’s response to hypoglycaemia. Octreotide and lanreotide may either increase or decrease the insulin requirement. Alcohol may intensify or reduce the hypoglycaemic effect of insulin. Insulin antibodies: Ryzodeg® administration may cause insulin antibodies to form. In rare cases, the presence of such insulin antibodies may necessitate adjustment of the insulin dose to correct a tendency to hyper- or hypoglycaemia. Immediate-type allergic reactions to either insulin itself or the excipients may potentially be life threatening. Skin and subcutaneous tissue disorders: Injection site reactions may occur. Patients must be instructed to perform continuous rotation of the injection site to reduce the risk of developing lipodystrophy (including lipohypertrophy, lipoatrophy) and cutaneous amyloidosis. There is a potential risk of delayed insulin absorption and worsened glycaemic control following insulin injections at sites with these reactions. A sudden change in the injection site to an unaffected area has been reported to result in hypoglycaemia. Blood glucose monitoring is recommended after the change in the injection site from an affected to an unaffected area, and dose adjustment of antidiabetic medications may be considered. In children, extra care should be taken to match insulin doses with food intake and physical activities to minimise the risk of hypoglycaemia. Paediatric population: Ryzodeg® may be associated with higher occurrence of severe hypoglycaemia compared to a basal-bolus regimen in the paediatric population, particularly in children 2 to 5 years old. For this age group, Ryzodeg® should be considered on an individual basis. Insulin initiation and glucose control intensification: Intensification or rapid improvement in glucose control has been associated with transitory, reversible ophthalmologic refraction disorder, worsening of diabetic retinopathy, and acute painful peripheral neuropathy. However, long-term glycaemic control decreases the risk of diabetic retinopathy and neuropathy. Fertility, pregnancy and lactation: Safety has not been established in pregnancy and lactation and Ryzodeg® should not be recommended for use during pregnancy. Posology and administration: Ryzodeg® can be administered once- or twice-daily with the main meal(s). When needed, the patient can change the time of administration, if Ryzodeg® is dosed with a main meal. The potency of insulin analogues, including Ryzodeg®, is expressed in units (U). 1 unit (U) Ryzodeg® corresponds to 1 international unit (IU) of human insulin and one unit of all other insulin analogues. In patients with type 2 diabetes mellitus, Ryzodeg® can be combined with oral anti-diabetic products approved for use with insulin, with or without bolus insulin. When using Ryzodeg® once-daily, it is recommended to consider changing to twice-daily when reaching 60 units. Split the dose based on individual patient’s needs and administer with main meals. In type 1 diabetes mellitus, Ryzodeg® is combined with short-/rapid-acting insulin at the remaining meals. Ryzodeg® is to be dosed in accordance with individual patients’ needs. Dose-adjustments are recommended to be primarily based on pre-breakfast glucose measurements. An adjustment of dose may be necessary if patients undertake increased physical activity, change their usual diet or during concomitant illness. Initiation: For patients with type 2 diabetes mellitus, the recommended total daily starting dose of Ryzodeg® is 10 units once daily with meal(s) followed by individual dosage adjustments. For patients with type 1 diabetes mellitus, Ryzodeg® is to be used once-daily at a mealtime and a short-/rapid-acting insulin should be used at the remaining meals with individual dosage adjustments. The recommended starting dose of Ryzodeg® is 60 - 70 % of the total daily insulin requirements. Transfer from other insulin medicines: Close glucose monitoring is recommended during transfer and in the following weeks. Patients with type 2 diabetes: Patients switching from once-daily basal or premix insulin therapy can be converted unit-tounit to once- or twice-daily Ryzodeg® at the same total insulin dose as the patient’s previous total daily insulin dose. Patients switching from more than once-daily basal or premix insulin therapy can be converted unit-to-unit to once- or twice-daily Ryzodeg® at the same total insulin dose as the patient’s previous total daily insulin dose. Patients switching from basal/bolus insulin therapy to Ryzodeg® will need to convert their dose based on individual needs. In general, patients are initiated on the same number of basal units. Doses and timing of concomitant antidiabetic treatment may need to be adjusted. Patients with type 1 diabetes: For patients with type 1 diabetes mellitus, the recommended starting dose of Ryzodeg® is 60 - 70 % of the total daily insulin requirements in combination with short-/rapid-acting insulin at the remaining meals followed by individual dosage adjustments. Doses and timing of concurrent short-/rapid-acting insulin products may need to be adjusted. Flexibility: Ryzodeg® allows for flexibility in the timing of insulin administration if it is dosed with the main meal(s). If a dose of Ryzodeg® is missed, the patient can take the next dose with the next main meal of that day, and thereafter resume the usual dosing schedule. Patients should not take an extra dose to make up for a missed dose. Ryzodeg® should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Undesirable effects: Very common (≥1/10); common (≥1/100 to < 1/10); uncommon (≥1/1 000 to < 1/100); rare (≥ 1/10 000 to < 1/1 000); very rare (< 1/10 000); not known (cannot be estimated from the available data). Very common: Hypoglycaemia. Common: Injection site reactions. Uncommon: Peripheral oedema and rare: Hypersensitivity and urticaria. Adverse Reactions from post-marketing experience: cutaneous amyloidosis (frequency unknown). Pharmacological classification: A 21.1 Insulin Preparations ATC code: A10AD06 Reg. No.: 47/21.1/0165. For full prescribing details, please refer to the Professional Information approved by the SAHPRA (South African Health Products Regulatory Authority).
The power of probiotics in reducing bloating
Help your patients say goodbye to bloating and embrace digestive comfort with multi-strain probiotics
Bloating,1 that uncomfortable feeling of a full and tight abdomen often caused by gas, can be an unwelcome guest. While gas symptoms like belching, bloating, and flatulence can vary from person to person, 2 some discomfort is normal, especially after meals. However, bloating can lead to abdominal pain. 2
Multi-strain probiotics, composed of diverse bacterial species, are like a team of helpful microorganisms working together to support your digestive health.3 These friendly helpers break down food, fend off illness-causing cells, and produce essential vitamins.3 They mirror the microorganisms naturally found in your body, making them your digestive buddies.3
MULTI-STRAIN PROBIOTICS
CAN REDUCE BLOATING BY
F Balancing gut microbiota: Probiotics can alleviate bloating by rebalancing your gut bacteria. 4
F Reducing gas production: Some probiotic strains can decrease the amount of gas produced in your gut,5 helping control bloating.
F Supporting bowel regularity: Probiotics promote regular bowel movements and softer stools, reducing the likelihood of constipation, a common cause of bloating.6
For those dealing with irritable bowel syndrome (IBS), probiotics offer potential relief from symptoms like abdominal pain, bloating, diarrhoea, and constipation.7
*References available on request
endocrinology Education
The stress-glucose connection
Understanding
the relationship between stress and diabetes
Stress has a significant impact on blood sugar levels, particularly for individuals with diabetes. Recent studies have provided insights into how stress affects glucose metabolism and diabetes management.
STRESS AND GLUCOSE METABOLISM
Stress activates the hypothalamic-pituitaryadrenal (HPA) axis, leading to the release of cortisol, a glucocorticoid hormone. Elevated cortisol levels can increase blood glucose levels by promoting gluconeogenesis (the production of glucose from non-carbohydrate sources) and reducing insulin sensitivity.1
Chronic stress can lead to sustained high levels of cortisol, which may contribute to the development of insulin resistance and type 2 diabetes (T2D). 2
stress-blood sugar relationship.5
A link between PTSD symptoms, stress, and inflammation has been found in several studies, indicating that severe stress can exacerbate blood glucose dysregulation through inflammatory pathways.6,7
BEHAVIOURAL AND ENVIRONMENTAL FACTORS:
IMPACT OF STRESS ON DIABETES MANAGEMENT
Stress and glucocorticoids are linked to the risk of developing alcohol use disorders and relapse, which can complicate diabetes management due to poor lifestyle choices and inconsistent medication adherence.3
Sleep deprivation, a common consequence of stress, potentiates HPA axis stress reactivity, leading to higher cortisol levels and subsequently higher blood glucose levels. 4
PSYCHOSOCIAL STRESS AND BLOOD SUGAR LEVELS
Chronic stress, as measured by hair cortisol concentrations (HCC), is associated with elevated blood glucose levels. This method of measuring long-term cortisol exposure provides a more accurate picture of the chronic
Studies have shown that individuals experiencing weight stigma or discrimination have higher cortisol levels, which can lead to increased blood glucose levels. Jackson et al. found that obese individuals who experienced weight-related discrimination had higher HCC levels than those who did not, suggesting that social stressors can directly impact metabolic health.8, 9 Environmental factors such as poor sleep,10 high glycaemic index diets,11 and excessive alcohol use12 can exacerbate stress responses and lead to higher blood glucose levels.
GENETIC AND INDIVIDUAL DIFFERENCES
Interindividual differences in glucocorticoid sensitivity, which can be partly genetically determined, may lead to varying responses to stress. Some individuals may have a higher vulnerability to stress-induced hyperglycaemia due to genetic variations in glucocorticoid receptor sensitivity.13,14
CLINICAL IMPLICATIONS
Understanding the relationship between stress and blood sugar levels can lead to more effective and individualised treatment strategies for managing diabetes. Integrating stress management techniques, such as mindfulness, cognitive-behavioural therapy, and lifestyle modifications, can help improve blood glucose control in individuals with diabetes.
*References available on request
Chronic stress can lead to sustained high levels of cortisol, which may contribute to the development of insulin resistance and type 2 diabetes
Education men's health
Spotlight on cancer for Movember
Specialists
tackle prostate cancer, a difficult men’s health topic
Testicular cancer is the most common male cancer among younger men between the ages of 15 and 49
November is a very important month for raising awareness around the serious health issues specifically affecting the male half of our population. Movember, as it has become known, sees healthcare professionals, men and some women around the globe joining forces in multiple events and campaigns to highlight what are considered the three vulnerabilities particular to the male sex, namely: prostate cancer, testicular cancer, and clinical depression in men.
Dr Paul Porteous, a urologist at Netcare Olivedale Hospital explained that although SA men have a one in 17 risk for being diagnosed with prostate cancer in their lifetime, prostate cancer is far more common with one in 10 men being diagnosed in areas with widespread screening. “The good news is that many, if not most, prostate cancers are slow growing, meaning that early detection does enable better management and improves the chances of a cure.”
AGE AND PROSTATE CANCER
Urologist, Dr Jan Wilhelmus Aucamp who practises at Netcare Union Hospital, reported that prostate cancer represents the second most common cancer in men and the fifth most common cause of cancer death in men. “Age related demographics do clearly indicate an increase as men age, and it is most often diagnosed in men aged 65-74 years. However, worldwide incidence of prostate cancer has increased in men as young as 15-40 years old, with an average of about 2% per year since 1990. Although rare, these men present with more advanced cancer with a worse prognosis than older individuals.”
Due to the significant role that age plays in the development of prostate cancer, healthcare professionals urge men to take the importance of screening seriously. Dr Stephen Cornish, a urologist at Netcare Sunninghill Hospital suggested: “Any man over the age of forty should consider having himself assessed with regards to the current state of his prostate gland as
men's health Education
Movember is a month-long event in which people are encouraged to grow moustaches to raise awareness of and funding for research related to men’s health issues, such as prostate cancer, testicular cancer, and mental health
well as its potential to develop prostate cancer in the future.”
RACE, GENETICS, AND LIFESTYLE INDICATE RISK FACTORS
“Racial disparity in the incidence and mortality rate of prostate cancer is significant, with a two-fold higher mortality in black men than in white. Asian men, in their native countries, have the lowest incidence,” said Dr Aucamp.
“Family history and genetic predisposition are additional risk factors. In men, immediate relatives with breast cancer increase the diagnosis by 21% and mortality by 34%. Similarly, a family history of prostate cancer increases risk by 68%. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, in families also predisposes individuals to a two-fold higher risk.”
Dr Aucamp warns that unhealthy lifestyle factors such as tobacco smoking and increased BMI (body mass index) with other components of metabolic syndrome increase prostate cancer risk.
SYMPTOMS AND SCREENING
According to Dr Aucamp, prostate cancer can be detected with screening before patients experience any symptoms, however local symptoms can include the following. These symptoms, however, usually only present at a more advanced stage:
F Lower urinary tract issues such as frequent, weak, interrupted, or painful urine flow
F Presence of blood in the urine or
seminal fluid
F Erectile dysfunction
F Urinary retention
Dr Cornish noted that many of the above symptoms can also indicate benign prostate enlargement, and that a good place to start is often the GP, who should be able to perform a baseline screening for prostate cancer. If there are concerning findings, then a referral to a urologist would be necessary.
P No symptoms
P No family history of prostate cancer
P No family history of breast cancer
P Normal prostate exam
P Low PSA level
Dr Porteous added that a further point to consider is that while many prostate cancers are indolent and may not even need to be treated but should be monitored through ‘watchful waiting’, there are those which are aggressive and certainly do warrant treatment. He asserts that current screening methods cannot distinguish between these cancers and screening programmes run the risk of over diagnosing and over treating some cancers in addition to incurring avoidable risks and costs for the patient, physically, financially, and emotionally. Ultimately, the specialists note that a great deal of consideration should be given at each step of the process as to the management of the condition.
P Family history of prostate disease
P PSA abnormally elevated
P Abnormal prostate exam
H ow to reduce dark marks ?
The search is over
NT cream: new hope for melasma
In a groundbreaking 24-week doubleblind randomised controlled trial, a novel triple combination cream has shown promising efficacy and safety in treating melasma, potentially offering a superior alternative to the established Kligman's Trio.
STUDY OVERVIEW
The study titled "Efficacy and safety of a novel triple combination cream compared to Kligman's trio for melasma: A 24-week double-blind prospective randomised controlled trial" was conducted to evaluate a new treatment for melasma. This trial was carried out over 24 weeks in Nice, France, involving 40 patients diagnosed with melasma. The study design was double-blind, prospective, and randomised, ensuring robust and unbiased results. Participants were divided into two groups: one receiving the novel triple combination cream (NT) and the other receiving Kligman's Trio (KT). Baseline characteristics included patients with moderate to severe melasma, and inclusion criteria ensured participants had not used any other melasma treatments prior to the study.
P Treatment details
The NT cream comprised isobutylamidothiazolyl-resorcinol, retinoic acid, and corticosteroid, while KT consisted of hydroquinone, retinoic acid, and corticosteroid. Both treatments were applied once daily for the first 12 weeks, accompanied by a standardised sunscreen regimen. This application regimen was designed to maximise efficacy while minimising potential side effects. No adjunctive treatments were used during the trial, ensuring that the results were solely attributable to the creams being tested.
P Efficacy outcomes
The primary endpoints of the study included improvement in melasma severity, reduction in pigmentation, and overall skin tone. These were measured using the modified Melasma
Area Severity Index (mMASI) after 12 weeks. Results indicated significant improvements in mMASI scores for both groups. The NT group achieved a 63% reduction (mean score of 2.93), while the KT group saw a 39% reduction (mean score of 3.51). Although the NT group showed a greater reduction, the difference was not statistically significant (p = 0.14). Quality of life was assessed using the MelasQoL score, with the NT group reporting a more substantial improvement compared to the KT group, showing a significant difference (p = 0.0006).
SAFETY AND TOLERABILITY
Safety profiles were a crucial aspect of the study. Both treatments were generally well-tolerated, with mild and transient adverse events such as erythema and irritation reported in both groups. Notably, only one patient in the KT group discontinued treatment due to an adverse event. Both groups experienced some relapse of melasma during the follow-up period, but no rebound effect was observed after treatment cessation. The absence of hydroquinone in the NT cream potentially contributed to its favourable safety profile.
IMPLICATIONS FOR CLINICAL PRACTICE
The study's findings are highly relevant for pharmacists recommending treatments for melasma. The NT cream demonstrated promising results, offering an effective and well-tolerated alternative to Kligman's Trio. This novel treatment could be particularly beneficial for patients seeking options with a better safety profile, especially those concerned about the adverse effects associated with hydroquinone. Pharmacists can consider the NT cream as a viable option for managing melasma, providing patients with an effective treatment that also prioritises safety.
Source: Bertold, et al. (2023). Efficacy and safety of a novel triple combination cream compared to Kligman's trio for melasma: A 24-week double-blind prospective randomized controlled trial. J Eur Acad Dermatol Venereol. 2023 Dec;37(12):2601-2607.
The NT cream demonstrated promising results, offering an effective and well-tolerated alternative to Kligman's Trio, particularly for patients seeking treatments with a better safety profile
The effect of UV radiation on the skin & the science behind sunscreen
Pharmacy Magazine recently hosted a webinar in partnership with Beiersdorf. Dermatologist, Dr Alice Prevost gave a comprehensive talk on the effect of ultraviolet (UV) radiation on the skin and the science behind sunscreen.
Focusing on the critical impact of UV radiation on skin health and the importance of effective sun protection, Dr Prevost explained the different types of UV radiation: UVA, which penetrates deeply and is associated with photoaging and skin cancer, and UVB, which primarily causes sunburn and is involved in vitamin D synthesis. Both types reach the Earth's surface and can lead to significant skin damage, particularly with repeated exposure.
Dr Prevost illustrated the effects of UV exposure through real-life examples, such as a truck driver and a toll booth worker, whose sun-exposed skin showed visible signs of damage, including wrinkles and pigmentation changes. She emphasised that early sunburns, especially in children, significantly increase the risk of developing skin cancer later in life. The session highlighted various skin conditions linked to chronic sun exposure, including actinic keratosis, basal cell carcinoma (BCC), and squamous cell carcinoma (SCC), stressing the importance of early detection and treatment.
avoidance, protective clothing, and the daily use of broad-spectrum sunscreen with an SPF of 15 or higher. She noted that regular sunscreen use could reduce skin aging by 24%. The discussion included practical guidelines for sunscreen application, recommending a specific amount for different body areas and emphasising the need for reapplication after swimming or sweating.
The webinar also addressed misconceptions about sun protection, such as the belief that natural remedies can effectively shield against UV damage. Dr Prevost clarified that while some dietary supplements may offer limited benefits, they should not replace traditional sun protection methods. She also discussed the unique considerations for individuals with darker skin tones, noting that while they have some natural protection, sunscreen remains essential to prevent photoaging and skin disorders.
People who use sunscreen daily with an SPF of 15 or higher show 24% less skin aging than those who don’t use sunscreen daily 24%
Preventative measures were a central theme of the webinar with Dr Prevost advocating for sun
Additionally, the session covered the safety of sunscreens, dispelling myths linking them to cancer and reinforcing the need for public education on sun safety, particularly in children and sports settings. Dr Prevost concluded by urging attendees to prioritise sun protection and skin health, advocating for better adherence to sun safety guidelines in schools and outdoor activities. Overall, the webinar provided valuable insights into the mechanisms of UV radiation, its effects on skin health, and the critical need for effective sun protection strategies.
Be sure to watch the webinar replay to learn about the effect of ultraviolet (UV) radiation on the skin & the science behind sunscreen
Dr Alice Prevost
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
SCAN ME
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
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
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
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
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
SCAN ME
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
Uric Acid Cristais
Swollen Joint inflamination
SCAN ME
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 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
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. 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
SCAN ME
CROSSWORD #69
TO ENTER
Use the letters in the highlighted blocks to find the final answer for this month’s crossword puzzle. Email the answer with your name, surname, and cell phone number to PharmacyMagazine@newmedia.co.za. Competition closes 20 December 2024. Winners will be contacted directly. Visit www.pharmacymagazine.co.za for full terms and conditions.
ACROSS
3. Pharmacy Magazine recently hosted a webinar on the effect of ultraviolet (UV) radiation on the skin and the science behind . (PAGE 27)
5. cancer represents the second most common cancer in men. (PAGE 22 & 23)
7. You can consider recommending multivitamin to older adults, especially those with a history of CVD, as part of a strategy to maintain cognitive health. (PAGE 29)
8. masculinity influences how men express mental health struggles, leading to ‘restrictive emotionality,’ where men are socialised to suppress emotions and avoid discussing feelings. (PAGE 33)
10. Recent studies have highlighted a significant connection between gout and cardiovascular disease, underscoring the importance of management strategies that involve pharmacists. (PAGE 31)
12. Ferrous Forte Somal has no expected system side effects. (PAGE 2)
14. Presto Gel is a fast and effective natural product for . (PAGE 8)
15. Covid-19 has also been linked to diseases such as obesity. (PAGE 7)
16. Achieving universal health coverage in SA necessitates substantial improvements in healthcare . (PAGE 13)
DOWN
1. It is crucial to understand the and treatment of heartburn to better assist patients during the festive season. (PAGE 30)
2. Moringa is a natural approach to management. (PAGE 10)
4. In a groundbreaking 24-week double-blind controlled trial, a novel triple combination cream has shown promising efficacy and safety in treating melasma. (PAGE 25)
6. NSAIDs are approved for use as , anti-inflammatory, and analgesic agents. (PAGE 15)
9. Bloating is an feeling of a full and tight abdomen often caused by gas. (PAGE 19)
11. KuraFlo have launched our new anti-inflammatory, antibacterial, Skin Healing Cream to help for those skin irritations, rashes, mosquito bites, cuts, and sunburn. (PAGE 16)
13. InoLax Forte is a herbal promoting regularity and liver support. (PAGE 20)
