From SA to Spain: how pharmacists are revolutionising access to essential medicines
EDITOR: Nicky Belseck
Email: nicky.belseck@newmedia.co.za
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EDUCATION
NOTE 13 The vital role of nutrients in osteoporosis
15 5 tips before dispensing ACE inhibitors for hypertension
simplex virus (HSV) is a common, lifelong viral infection affecting millions worldwide.
Heartburn: dispelling myths for better patient care
A common ailment for many, heartburn is shrouded in misconceptions. It's crucial to understand the facts and educate patients effectively.
WEBINAR REPORTS
21 AR webinar dives deep on intra-nasal corticosteroids and oxymetazoline
25 Managing a congested patient
27 Enhancing pain management in pharmacy practice
DIRECTOR: David Kyslinger
COMMERCIAL DIRECTOR: Maria Tiganis
STRATEGY DIRECTOR: Andrew Nunneley
CHIEF FINANCIAL OFFICER: Venette Malone
INTERIM CEO: MEDIA24: Raj Lalbahadur
29 Decoding SPF: the science behind sun protection
31 Mupirocin: effective solution for secondary bacterial infections
33 Guide to topical fungal infections
Basic guidelines and the benefits of Emzaloid technology.
35 UTIs & diabetes: managing risks and complications
A common concern for patients with diabetes, pharmacists play a crucial role in managing UTIs and their risks to ensure optimal patient outcomes.
37 One pill, once a day: transforming epilepsy treatment with Levetiracetam XR
39 Insomnia: the importance of sleep & treatment options
By understanding the role of REM sleep, practicing good sleep hygiene, and seeking appropriate treatment, individuals can manage insomnia effectively.
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From SA to Spain: how pharmacists are revolutionising access to essential medicines
The role of pharmacists in improving access to safe and quality essential medicines and medical devices is the focus of a new reference document published by the International Pharmaceutical Federation at the beginning of October.
The publication contains case studies from SA, Australia, Egypt, Malaysia, the Netherlands, and Spain, presenting the current situation of access to essential medicines, including related regulations and impact of pharmacists in each country.
“Access to essential medicines and medical devices is vital for managing health conditions, preventing diseases, and improving well-being. Essential Medicines Lists serve as a foundation for promoting equitable access to healthcare and addressing the most pressing health needs within a population. This document highlights the importance of access to essential medicines. It also outlines the role of FIP in improving access and addressing the challenges and issues that exist around it,” said Mr Lars-Åke Söderlund, FIP vice president and co-chair of the FIP committee
that developed the reference document. The reference document also looks at capacity building for improved access to pharmaceutical expertise, including new roles for pharmacists in light of developments in public health and technology.
INTERESTING TOPICS IN THIS MONTH’S ISSUE INCLUDE:
• Key features to look for in a pharmacy practice management solution (page 7)
• Ocular allergies & eye drops (page 11)
• The vital role of nutrients in osteoporosis (page 13)
• 5 tips before dispensing ACE inhibitors for high blood pressure (page 15)
• UTIs & diabetes: managing risks and complications (page 35)
CROSSWORD CHALLENGE
Congratulations to the winner of Crossword #66 Saaema Noorbhai. For your chance to win a R500 Woolworths voucher don’t miss this month’s crossword puzzle on page 41.
WORDS TO LIVE BY
“Life isn't about waiting for the storm to pass, it's about learning how to dance in the rain.” – Vivian Greene
retail management Innovation
Key features of a pharmacy practice management solution
Arobust Pharmacy Practice Management Solution (PPMS) is essential for ensuring smooth operations in modern pharmacies, helping them run their businesses more efficiently and maximise productivity. By streamlining workflows and simplifying daily tasks, it significantly reduces time and effort, while enhancing overall service quality.
Pharmacy Magazine spoke to Vexall CEO, Christiaan Stavast to find out what to consider when selecting a system for a retail pharmacy.
INVENTORY MANAGEMENT
Effective inventory management is the backbone of a successful pharmacy operation. A good PPMS should offer real-time tracking of stock levels. “You need a system that can alert you when items are running low and automatically place them onto the shopping list, ensuring stockouts are avoided,” Stavast said.
“This not only optimises stock levels but also reduces the risk of overstocking, which can lead to expired products. By keeping inventory data up-to-date, pharmacies can maintain a balanced inventory and improve overall cash flow.”
as transaction processing at a Point of Sale (POS) is pivotal in any PPMS, helping you to keep track of your revenues and expenses,” Stavast said. “The new PPMS system we’re launching in 2025 offers seamless integration with medical aid switches, allowing for Realtime claim processing in the dispensary.”
CUSTOMER RELATIONSHIP MANAGEMENT AND ENGAGEMENT CRM
Pharmacies thrive on strong customer engagement, and a PPMS with CRM features play a key role in building customer loyalty. “You want CRM functionality built in with integration capabilities allowing pharmacies to track customer interactions, store medication histories, and provide personalised services, such as tailored reminders for prescription refills. In addition, integration to loyalty programmes encouraging repeat business and offering rewards to frequent customers is important.
A CRM integration tool should allow pharmacies to send targeted promotions, health tips, or wellness program invitations, further enhancing the patient experience.”
INTEGRATION CAPABILITIES
PATIENT AND RESCRIPTION MANAGEMENT
“The most critical function in retail pharmacies is patient and prescription management. An effective PPMS should optimise this process, ensuring both efficiency and compliance with regulatory requirements. You want a dispensing system that simplifies prescription processing and recording of a comprehensive patient-specific medication profile.”
FINANCIAL MANAGEMENT
“Claim processing, invoicing, and billing as well
“In today’s digital landscape, it is crucial that a PPMS can integrate seamlessly with other systems,” Stavast advised. “The PPMS system we’re launching integrates with various thirdparty software platforms that simplifies tracking and reporting, ensuring amongst other things accurate billing and financial records. Connecting with e-commerce platforms allows customers to order online, while integration with medical aids ensures speedy claim processing and payments. Robust integration capabilities foster greater operational efficiency and reduces the duplication of work across systems.”
An
effective PPMS should optimise this process, ensuring both efficiency and compliance with regulatory requirements
*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.
Novo 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.
AUTHOR: Industrial psychologist Taegan Devar.
The cost of playing the rescuer & how to transition to a coach
People in helping professions often assume the role of ‘rescuer,’ where they take on responsibilities of solving, fixing, saving, or healing. This mindset often spills over into other areas of life, making them the ‘go-to’ person in their family or social circle; the decision-maker, carer or even funder. But what personal toll does consistently playing this role take? writes industrial psychologist
Taegan Devar – MD
of organisational development company PeopleSmart.
According to David Emerald's Empowerment Dynamic, the rescuer role is played by someone who steps in to solve other’s problems and derives a sense of validation from this behaviour. When people play the rescuer, they are often doing so in service of themselves and not to empower and enable others.
A common example in the workplace is when a new leader, eager to integrate into the team, volunteers to take on other’s tasks. Over time, the leader becomes overwhelmed with excessive responsibilities. Team members notice the pattern and begin to step back and delegate their work upwards. Many leaders I've worked with express frustration about working long hours, feeling overwhelmed by the sheer volume of tasks that they have taken on from others. This ‘rescuer’ behaviour reinforces the team's powerlessness and creates a destructive cycle, where both leader and team suffer. In work cultures that glorify this behaviour and long hours, this cycle worsens, often leading to stress, burnout, and poor health.
SHIFTING FROM RESCUER TO COACH:
While the rescuer role fosters dependency, it’s constructive flipside – the role of coach – views others as naturally creative and capable. This
empowering role encourages people to take agency and accountability. A coach supports individuals by asking insightful questions that help clarify goals, assess current realities, and explore possible next steps. Rather than swooping in to ‘fix’ things, the coach empowers others to leverage their own talents and strengths to achieve their objectives.
Leaders in helping professions can adopt coaching behaviours by:
P Creating safe spaces and facilitating collaborative problem-solving. Leaders don't need to provide all the answers. Their role is to create environments where others can come together and generate solutions.
P Recognising others as capable, creative, and independent. Empower individuals to take ownership of what’s within their control, and trust in their ability to manage it.
P Asking questions that inspire self-direction. By asking thoughtful questions, leaders help others define their own goals and develop their own steps toward achieving them, fostering a sense of responsibility and ownership over the process.
Where rescuing leads to dependency for the rescued and exhaustion for the rescuer, coaching produces energy and resourcefulness within both parties.
“Many leaders I've worked with express frustration about working long hours, feeling overwhelmed by the sheer volume of tasks that they have taken on from others”
Ocular allergies & eye drops
Eye allergies, also known as allergic conjunctivitis, are a common condition, especially at this time of year, that can significantly impact a patient's quality of life. Understanding the symptoms, treatment options, and the importance of comprehensive management are crucial to providing optimal care for patients.
SYMPTOMS OF ALLERGIC CONJUNCTIVITIS
Allergic conjunctivitis generally presents with four primary symptoms:
1. Redness: Caused by the dilation of blood vessels in the conjunctiva.1,2,4,5
2. Tearing: Increased tear production as a response to allergens.1,2,4,5
3. Itching: A hallmark symptom due to the release of histamines.1,2,4,5
4. Swelling: Inflammation of the conjunctiva and surrounding tissues.1,4,5
Effective treatment requires addressing all these symptoms to provide comprehensive relief and improve patient outcomes.
TOPICAL TREATMENT OPTIONS
1. Antihistamine eye drops: Antihistamine eye drops work by blocking histamine receptors, thereby reducing itching, redness, and swelling. They provide quick relief.1,2,3,4,5 Newer generation antihistamines like olopatadine have the benefit of mast cell stabiliser properties too.6
2. Mast cell stabiliser eye drops: Mast cell stabilisers prevent the release of histamine and other inflammatory mediators from mast cells. They are effective for long-term management and prevention of symptoms but need to be used before an allergic response has occured.1,2,3,4,5
3. Combination eye drops: Combination drops that include both antihistamines and decongestants offer the benefits of immediate relief and long-term prevention.1,2,3,5
4. Corticosteroid eye drops: Opthalmic steroids can be used for severe cases
of allergic conjunctivitis to reduce inflammation. However, they should be used under medical supervision for short-term treatment due to potential side effects such as increased intraocular pressure and cataracts.1,4
5. Decongestant eye drops: While decongestant eye drops work by constricting blood vessels to reduce redness, they do not address itching, tearing, or swelling and are not suitable for long-term use. Prolonged use (beyond five days) can lead to rebound hyperaemia, where redness worsens once the drops are discontinued. Therefore, decongestants should be used with caution and only for short-term relief of redness.3,5
IMPORTANCE OF COMPREHENSIVE TREATMENT
Dual-activity agents are considered the appropriate first-line therapy.1 Pharmacists should emphasise the importance of using antihistamines and mast cell stabilisers over decongestants for the following reasons:
F Comprehensive symptom relief: Antihistamines and mast cell stabilisers address all four symptoms of allergic conjunctivitis, providing more effective and holistic relief. 1,5
F Prevention: Mast cell stabilisers help prevent the release of histamines, reducing the likelihood of future allergic reactions.1,5
F Safety: Decongestants can cause side effects such as rebound hyperaemia and increased intraocular pressure, making them less suitable for long-term management.3,5
Effective management of allergic conjunctivitis requires a comprehensive approach that addresses all symptoms –redness, tearing, itching, and swelling. Pharmacists play a crucial role in educating patients about the benefits of antihistamines and mast cell stabilisers for both treatment and prevention. By guiding patients towards appropriate and safe treatment options, you can help improve patient outcomes and quality of life.
*References available on request
Eyelid Cornea Pupil Iris
Eye allergies affect up to 40% of the population6
Conjuctiva
Conjuctiva
Eyelid
SOUTH AFRICA’S BESTSELLING CALCIUMRANGE
BONE HEALTH SIMPLIFIED
Calcium For strong bones and teeth
Vitamin D3
Helps promote calcium absorption
Magnesium
Helps regulate calcium levels and helps prevent muscle cramps3,4
Vitamin K2
Directs calcium to bones and helps prevent arterial calcification5 Vitamin C
Helps promote collagen formation
nutrition & supplements Education
The vital role of nutrients in osteoporosis
Vastly underdiagnosed and undertreated, osteoporosis is a significant public health concern. It is characterised by weakened bones, increasing the risk of fractures, particularly in the hip, spine, and wrist.1 As pharmacists, understanding the intricacies of osteoporosis and the importance of essential bone nutrients is crucial in guiding patients towards better bone health.
CRITICAL IMPORTANCE OF CALCIUM
Calcium is a vital mineral for bone health, but it is important to note that because the human body cannot produce calcium on its own, the only way to obtain it is through dietary intake. This underscores the importance of ensuring adequate calcium consumption through diet or supplements. Foods rich in calcium include dairy products, leafy green vegetables, and fortified foods. However, many individuals may not consume enough calcium daily, making bone health supplements essential.1
3. Magnesium: Magnesium supports calcium levels and plays a role in the activation of vitamin D, which is necessary for calcium homeostasis. It is found in foods such as nuts, seeds, whole grains, and green leafy vegetables.3
4. Vitamin K2: This vitamin ensures that calcium is deposited in the bones and not in soft tissues, reducing the risk of cardiovascular issues. Vitamin K2 is found in fermented foods and animal products. 4
5. Vitamin C: Essential for collagen formation, vitamin C supports joint health and the structural integrity of bones. Citrus fruits, berries, and vegetables like bell peppers are rich in vitamin C.5
5 ESSENTIAL BONE NUTRIENTS
1. Calcium: The cornerstone of bone health, calcium is necessary for maintaining strong bones and teeth. It is crucial for the prevention and management of osteoporosis. Dairy products, almonds, broccoli, kale, canned salmon with bones, sardines, and soy products like tofu are good sources of calcium. 2
2. Vitamin D: Essential for the absorption of calcium in the gut, without adequate vitamin D, the body cannot absorb calcium effectively, regardless of dietary intake. Sun exposure and foods like fatty fish and fortified dairy products are good sources of vitamin D. 2
RISK FACTORS AND PREVENTION
Osteoporosis is influenced by several non-modifiable risk factors, including age, gender, and family history. Women are more susceptible to bone loss than men, with one in three women over the age of 50 likely to experience osteoporotic fractures. Menopause and certain medical conditions, such as diabetes and rheumatoid arthritis, also increase the risk. 1,2
PREVENTIVE MEASURES
• Healthy diet: Ensure a balanced diet with adequate intake of calcium, protein, vitamin D, vitamin K, and other essential nutrients. 1
• Regular exercise: Weight-bearing and resistance exercises strengthen bones. 1
• Avoiding harmful habits: Smoking and excessive alcohol consumption are risk factors for osteoporosis. 1
• Medical assessment: Regular check-ups and bone density tests, especially for those with risk factors. 1
*References available on request
Any fracture after the age of 40 resulting from a minor bump or fall needs to be assessed for osteoporosis
Posology and method of administration: The starting dose is 0,6 mg once daily. The dose should be increased to 3,0 mg once daily in increments of 0,6 mg with at least one week intervals to improve gastro-intestinal tolerability. If escalation to the next dose step is not tolerated for two consecutive weeks, consider discontinuing treatment. Daily doses higher than 3,0 mg are not recommended. Saxenda® is for subcutaneous use only. It must not be administered intravenously or intramuscularly. Saxenda® is administered once daily at any time, independent of meals. However, it is preferable that Saxenda® is injected around the same time of the day. It should be injected in the abdomen, thigh or upper arm. Patients must be instructed to perform continuous rotation of the injection site to reduce the risk of developing cutaneous amyloidosis. There may be a potential risk of change in Saxenda® absorption or effect following Saxenda® injections at sites with cutaneous amyloidosis. Saxenda® should not be used in combination with another GLP-1 receptor agonist. When initiating Saxenda®, consider reducing the dose of concomitantly administered insulin or insulin secretagogues (such as sulfonylureas) to reduce the risk of hypoglycaemia. Saxenda® is not recommended for use in children below 12 years of age or in adolescents with a body weight below or equal to 60 kg due to lack of data. Contraindication: • Hypersensitivity to liraglutide or to any of the excipients listed under Composition. • Pregnancy and lactation. Special warnings and precautions for use: Saxenda® must not be used as a substitute for insulin. There is no clinical experience in patients with congestive heart failure New York Heart Association (NYHA) class IV and Saxenda® is therefore not recommended for use in these patients. The safety and efficacy of Saxenda® have not been established in the following patients, viz: • Treated with other products for weight management, • With obesity secondary to endocrinological or eating disorders or to treatment with medicinal products that may cause weight gain, • With severe renal impairment, • With severe hepatic impairment, • With inflammatory bowel disease and diabetic gastroparesis. Use in these patients is not recommended. Acute pancreatitis has been observed with the use of GLP-1 receptor agonists. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, Saxenda® should be discontinued; if acute pancreatitis is confirmed, Saxenda® should not be restarted. In the absence of other signs and symptoms of acute pancreatitis, elevations in pancreatic enzymes alone are not predictive of acute pancreatitis. In clinical trials, a higher rate of cholelithiasis and cholecystitis was observed in patients treated with Saxenda® than in patients on placebo. Patients should be informed of the characteristic symptoms of cholelithiasis and cholecystitis. In clinical trials in type 2 diabetes, thyroid adverse events, such as goitre have been reported in patients with pre-existing thyroid disease. Saxenda® should therefore be used with caution in patients with thyroid disease. An increase in heart rate was observed in clinical trials. Heart rate should be monitored at regular intervals consistent with usual clinical practice. Patients should be informed of the symptoms of increased heart rate (palpitations or feelings of a racing heartbeat while at rest). For patients who experience a clinically relevant sustained increase in resting heart rate, treatment with Saxenda® should be discontinued. Patients treated with Saxenda® should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Patients with type 2 diabetes receiving Saxenda® in combination with insulin and/or sulphonylurea have an increased risk of hypoglycaemia. Fertility, pregnancy and lactation: Saxenda® should not be used during pregnancy and lactation. Undesirable effects: Gastrointestinal reactions were the most frequently reported adverse reactions during treatment with Saxenda®. Very common side effects are nausea, vomiting diarrhoea, constipation, headache. Common side effects include: Hypoglycaemia, insomnia, dizziness, dysgeusia, dry mouth, dyspepsia, gastritis, gastro-oesophageal reflux disease, abdominal pain upper, flatulence, eructation, abdominal distension, cholelithiasis, injection site reactions, cutaneous amyloidosis, asthenia & fatigue, increased lipase/increased amylase. Uncommon side effects include: dehydration, tachycardia, pancreatitis, cholecystitis, urticaria & malaise. Rare side effects include: anaphylactic reaction, acute renal failure & renal impairment. Overdose: With overdose, the patients reported severe nausea, vomiting and diarrhoea, but recovered without complications. Severe hypoglycaemia has also been observed. In the event of overdosage, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. The patient should be observed for clinical signs of dehydration and blood glucose should be monitored. Reg. No.: 50/21.13/1091. For full prescribing information, refer to the Professional Information approved by the Regulatory Authority. Ver. 12/09/2022.
5 tips before dispensing ACEI for hypertension
Hypertension remains a significant public health issue in SA, of particular concern is the high prevalence but lack of awareness, particularly among men and young adults.1
ACE inhibitors (angiotensinconverting enzyme inhibitors) are commonly used for the treatment and management of hypertension. They work by inhibiting the angiotensinconverting enzyme, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that increases blood pressure. By inhibiting this enzyme, ACE inhibitors reduce the levels of angiotensin II, leading to vasodilation and, consequently, lower blood pressure.2,3
Pharmacy Magazine spoke to pharmacist and ICPA CEO, Jackie Maimin, who shared five counselling tips that pharmacists should provide to patients prescribed an ACE inhibitor for hypertension.
1. TAKE MEDICATION AT THE SAME TIME DAILY
Advise patients to take their angiotensinconverting enzyme inhibitors (ACEI) consistently, ideally at the same time each day. This helps maintain stable blood pressure and ensures the medication's effectiveness. If they miss a dose, they should take it as soon as possible unless it's near the time of their next dose.
2. PREGNANCY WARNING
Advise women of child-bearing age who have been prescribed an ACEI to use an effective contraceptive as ACEIs are known to be teratogenic and are contraindicated in the second and third trimesters of pregnancy.
3. MONITOR FOR COMMON SIDE EFFECTS ESPECIALLY A DRY COUGH
Pharmacists should be aware that a
dry cough is the most common adverse effect of ACEI, and that this symptom may occur not necessarily shortly after institution of therapy but months or even a year later. Replacement by another ACEI should not be tried, since the cough will almost always recur on rechallenge with the same or another ACEI. After withdrawal of the ACE inhibitor, which is the treatment of choice, cough will resolve usually within a few days.
4. STAY HYDRATED AND AVOID EXCESS POTASSIUM
ACEIs are potassium sparing. Warn patients about the risk of high potassium levels (hyperkalaemia), especially if they are taking potassium supplements or salt substitutes. Encourage them to stay hydrated and avoid OTC potassium supplements unless prescribed.
5. REPORT ANY SWELLING OR BREATHING DIFFICULTIES
Advise patients to seek immediate medical attention if they experience swelling of the face, lips, or throat, or difficulty breathing, as these could be signs of a rare but serious allergic reaction called angioneurotic oedema. In a patient having experienced ACE inhibitor-related angioedema, ACEI medicines as a class are a contraindication going forward and angiotensin receptor blockers should be used cautiously if at all.
These tips help ensure patients are informed and can manage their hypertension effectively while minimising risks.
*References available on request
Recommended as one of the firstline treatments for hypertension, ACE inhibitors are effective in lowering both systolic and diastolic blood pressure2,3
Jackie Maimin, ICPA CEO
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 s 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).
infectious diseases Education
Understanding the herpes simplex virus
Herpes
simplex virus (HSV) is a common pathogen that
causes recurrent infections in humans
Herpes simplex virus (HSV) is a common, lifelong viral infection affecting millions worldwide.1,2 Pharmacists play a crucial role in counselling patients, understanding the different strains, triggers, and treatment options.
HSV TYPES AND TRANSMISSION
There are two main types of HSV:
P HSV-1: Primarily associated with oral herpes, causing cold sores or fever blisters. It can also cause genital herpes.1,2,3
P HSV-2: Primarily associated with genital herpes but can also cause oral herpes through oral-genital contact.1,2,3
Both types spread through direct contact with infected skin or mucous membranes. Transmission can occur:
P During sexual contact, even without visible lesions1,2
P Through oral-to-oral contact, particularly during kissing 1,2
P Sharing personal items like razors, lip balm, or food utensils (more common with HSV-1)4
P From mother to child during childbirth.1,4
TRIGGERS AND OUTBREAKS
While individuals with HSV can be asymptomatic, outbreaks can be triggered by various factors:
P Stress, emotional upheaval
P Illness, fever
P Sun exposure (especially for HSV-1)
P Hormonal changes (in some women with genital herpes)
P Injury or surgery to the affected area (including friction during sexual intercourse).1,4
SIGNS AND SYMPTOMS
The clinical manifestations of an outbreak can vary, but may include:
P Tingling, burning, or itching at the infection site
P Blister formation that may weep or crust over
P Pain, burning, or discomfort during urination (genital herpes)
P In severe cases, flu-like symptoms like swollen lymph nodes and body aches.1,2
DIAGNOSIS AND TREATMENT
Diagnosis is typically based on clinical presentation and medical history. In some cases, viral swabs or blood tests may be used. Unfortunately, there is no cure for HSV. Treatment focuses on managing outbreaks and reducing viral shedding:
P Antiviral medications (acyclovir, valacyclovir, famciclovir): These can shorten outbreaks, reduce severity, and decrease transmission risk.3
P Pain relievers: Over-the-counter pain relievers can help manage discomfort. 4
P Topical treatments: Creams or ointments can be applied to lesions to reduce pain and promote healing. 4
P Suppressive therapy: For frequent outbreaks, daily antiviral medication can be prescribed to reduce their frequency and severity.3
P Lifestyle modifications: Encouraging patients to manage stress, use sun protection, and avoid known triggers can help reduce the frequency of outbreaks.
PHARMACIST ROLE
Pharmacists are well-positioned to provide education, support, and medication management for patients with HSV. Key areas include:
F Counselling: Providing accurate information about transmission, triggers, and management strategies.3
F Dispensing medication: Ensuring patients understand proper use of antivirals and potential side effects.
F Addressing concerns: Offering support and addressing anxieties associated with the diagnosis.
F Referral: Recommending patients to healthcare providers for further evaluation or management of complications.
Through proper education and counselling, pharmacists can help patients lead healthier lives and reduce the impact of HSV on their daily activities.
*References available on request
SA has one of the highest rates of HSV2 infection worldwide –50% prevalence among 15- to 44-year-olds5 50%
Kit Kat Group, Engen) 12 months ending November 2023.
0 CALPOL Paediatric Suspension. Reg no: B/2.7/767. Each 5 ml suspension contains 120 mg Paracetamol. Preservatives: Methyl Hydroxybenzoate 0,1 % m/v, Propyl Hydroxybenzoate 0,02 % m/v. Contains sugar (glucose and sorbitol). Alcohol Free. Haleon South Africa (Pty) Ltd. 11 Hawkins Avenue, Epping Industria 1, Cape Town, 7460. Reg. No: 2014/173930/07. For full prescribing information refer to the professional information approved by the medicines regulatory authority. Always read the label prior/before to use. For any further information, including safety, please contact the Haleon Hotline on +27 11 745 6001 or 0800118274. Trademarks are owned by or licensed to Haleon group of companies. Promotion Number: PM-ZA-CALP-24-00008
gastroenterology Education
Heartburn: dispelling myths for better patient care
A common ailment for many, heartburn is shrouded in misconceptions
It's crucial to understand the facts and educate patients effectively. Here's a breakdown of some prevalent myths and the corresponding truths:
Myth 1: Heartburn always means heart trouble
Fact: Heartburn, medically known as acid reflux, occurs when stomach acid backs up into the oesophagus. This burning sensation in the chest is unrelated to the heart. While severe heartburn can mimic a heart attack, it is usually benign and does not signify cardiac issues.
Myth 2: Milk soothes the burn
Fact: While milk may provide temporary relief, the lactose content can actually worsen symptoms in some individuals. Longterm, milk may increase stomach acid production.
and severity. Additionally, pharmacological options like H2-receptor antagonists and proton pump inhibitors (PPIs) can offer sustained relief by decreasing acid production.
Myth 6: Chronic heartburn is harmless and can be ignored
Fact: Frequent or severe heartburn may indicate gastroesophageal reflux disease (GORD), a condition that can lead to complications like oesophagitis, Barrett's oesophagus, and even oesophageal cancer if left untreated. Advise patients experiencing persistent heartburn to seek medical evaluation for proper diagnosis and management.
Myth 3: Spicy food is the main culprit
Fact: Spicy food can indeed trigger heartburn, but it's not the only culprit. Fatty or acidic foods, alcohol, caffeine, and even chocolate can be triggers.
Myth 4: Heartburn is no big deal
Fact: Occasional heartburn is normal, however, frequent episodes (twice a week or more) can indicate GORD (gastroesophageal reflux disease) and require medical attention.
Myth 5: Antacids are the only treatment for heartburn
Fact: While antacids provide quick relief by neutralising stomach acid, they are not a longterm solution. Educate patients about lifestyle modifications, such as dietary changes, weight management, and elevation of the head during sleep, to reduce heartburn frequency
EMPOWERING PHARMACISTS FOR BETTER PATIENT CARE
By understanding these myths, pharmacists can effectively:
P Counsel patients on identifying triggers and appropriate lifestyle changes (weight management, smaller meals, avoiding tight clothing).
P Recommend OTC medications while explaining their limitations and potential side effects.
P Advise patients to seek medical attention for frequent or severe heartburn, which could indicate GORD or other underlying conditions.
By debunking misconceptions and providing evidence-based guidance, you can empower patients to manage heartburn effectively through lifestyle modifications, appropriate medication use, and timely medical intervention when needed. Effective counselling can improve patient outcomes and quality of life for those suffering from heartburn.
Heartburn occurs when stomach acid backs up into the oesophagus
RESISTANCE IN BACTERIAL SKIN INFECTION
Scan QR code to register
Join Pharmacy Magazine in partnership with Glenmark for a one-hour webinar on
Unmasking resistance: effective approaches for bacterial skin infections
DATE: Thursday, 14 November 2024
TIME: 19h00
SPEAKER: Dr Hetesh Pitamber
REGISTRATION:
https://bit.ly/GlenmarkWebinar14Nov24
A key opinion leader in the South African dermatological industry, Dr Hetesh Pitamber MBBCh (WITS) FCDERM (SA) is a dermatologist in private practice in Johannesburg who has published several academic papers and is a regular guest speaker on both television and radio discussing dermatological issues.
Speaker: Dr Hetesh Pitamber
AR webinar dives deep on intra-nasal corticosteroids and oxymetazoline
Medical Chronicle recently hosted a webinar on Uncontrolled AR and combination use of INCS and oxymetazoline and multi-symptom relief presented by Drs Marinda McDonald and Phumzile Skosana.
Dr Marinda McDonald outlined a comprehensive approach to diagnosing and treating allergic rhinitis, emphasising the importance of understanding symptoms, duration, and severity. She stated: "The diagnosis is basically divided up in three things. It's symptoms, duration, severity."
Treatment involves educating, advising, and referring patients, encapsulated in the dictum: "educate, advise, refer." Allergic rhinitis affects 20% to 40% of the population, Dr McDonald noted. This condition is part of the "atopic march" and has significant healthcare costs and quality of life impacts, such as presenteeism.
especially when it involves pets, but identifying the allergen is crucial. Medical management includes antihistamines, intranasal corticosteroids, and rescue medications like oxymetazolines.
Immunotherapy, which alters the patient's immune response, is the only disease-altering treatment available. Dr McDonald stressed the importance of distinguishing between a cold and allergic rhinitis based on symptoms, duration, and severity. Allergic rhinitis symptoms include watery rhinorrhoea, sneezing, congestion, and itchiness of the nose and eyes, often recurring and worse during pollen seasons.
Severe cases may involve nasal polyps, with up to 40% of these patients having aspirinexacerbated respiratory disease, requiring aggressive treatment. Dr McDonald also highlighted primary immune deficiency, where patients experience recurrent infections and need referral for immune system workups.
MANAGEMENT OF AR
The management of allergic rhinitis includes avoidance, medical management, and immunotherapy. Avoidance can be challenging,
In contrast, cold symptoms last 5 to 10 days, are more common in winter, and lack the persistent and recurrent nature of allergic rhinitis. Treatment guidelines, such as the ARIA and South African guidelines, recommend continuous use of intranasal corticosteroids, with stepup therapy involving oral antihistamines or combination drugs for more severe cases.
Dr Skosana, in turn, explained that the common cold is an acute illness of the upper respiratory tract, primarily caused by the rhinovirus, though other viruses like coronavirus and adenovirus can also be responsible. She noted, "Coronavirus almost wiped out a lot of our people," but our immune systems have since adapted. The cold's symptoms, such as cough and congestion, are due to the immune response rather than tissue damage.
EMAIL john.woodford@newmedia.co.za to request an attendance certificate
To watch a recording of this webinar, please visit bit.ly/3Aa5t2e.
Drs Marinda McDonald
Phumzile Skosana
References:
1. Quatarone & Hasler-Nguyen. Comparison between two diclofenac diethylamine gel formulations, 1.16 % Vs 2.32
it only increasing the strength of the active ingredient enough? Arthritis & Rheumatology 2014;66:2243. *vs. 1.16%
1
Voltaren Emulgel
0 20 g, 50 g
100 g. Voltaren Emulgel. Each 100 g of gel contains 1,16 g diclofenac diethylamine corresponding to 1 g diclofenac sodium. Reg.No.: U/3.1/77. Indicated for use in adults and adolescents older than 12 years. Safety in pregnancy and lactation has not been established. Consult your pharmacist/ healthcare professional if needed.
1 Voltaren Emulgel 12 Hour. Each 100 g of Voltaren Emulgel 12 Hour contains, 2,32 mg of the active substance diclofenac diethylamine, which corresponds to 2,0 mg diclofenac sodium. Reg.No.: 46/3.1/0649. Indicated for use in adults and adolescents older than 14 years. Safety in pregnancy
Haleon South Africa (Pty) Ltd. 11 Hawkins Avenue, Epping Industria 1, Cape Town,
Managing a congested patient allergies
Pharmacy Magazine recently hosted a webinar in partnership with Bayer in which Dr Tshegofatso Mabelane delved into the complexities of managing congested patients, providing valuable insights and practical advice. The session was comprehensive, covering various aspects from diagnosis to treatment options, emphasising the critical role pharmacists play in patient care.
F UNDERSTANDING CONGESTION
In an overview of congestion, Dr Mabelane highlighted its common causes such as allergies, infections, and chronic conditions like asthma and COPD, stressing the importance of accurate diagnosis, and cautioned that congestion can often be a symptom of underlying issues that require different treatment approaches.
F DIAGNOSTIC TOOLS AND TECHNIQUES
Pharmacists were encouraged to utilise a range of diagnostic tools to assess congestion. The use of patient history, physical examinations, and, when necessary, referral to other healthcare professionals for further testing were discussed. The importance of distinguishing between viral and bacterial infections was particularly emphasised, as this determines the appropriate course of treatment.
F OPTIONS
The webinar provided a detailed review of treatment options available for managing congestion. OTC medications, such as decongestants and antihistamines, were discussed, along with their mechanisms of action, benefits, and potential side effects. Dr Mabelane also covered prescription medications, including corticosteroids and antibiotics, and the scenarios in which they are most effective.
F NON-PHARMACOLOGICAL INTERVENTIONS
In addition to medications, Dr Mabelane highlighted several non-pharmacological interventions that can help alleviate congestion. These included the use of saline nasal sprays, steam inhalation, and lifestyle modifications such as staying hydrated and avoiding known allergens. The role of complementary therapies, such as acupuncture and herbal remedies, was also briefly touched upon.
F PATIENT EDUCATION AND COUNSELLING
Dr Mabelane dedicated a significant portion of the webinar to the role of pharmacists in patient education and counselling. Pharmacists were urged to take the time to educate patients about their condition, the proper use of medications, and the importance of adherence to prescribed treatments. Dr Mabelane provided practical tips on how to effectively communicate with patients, including the use of simple language and visual aids.
CASE STUDIES
The session concluded with a series of case studies that illustrated the practical application of the discussed concepts. These real-world examples helped to reinforce the learning points and provided attendees with a clearer understanding of how to manage different types of congested patients.
A valuable resource for pharmacists, the webinar equipped attendees with the knowledge and tools needed to effectively manage congested patients. By combining pharmacological and nonpharmacological treatments, and emphasising patient education, pharmacists can play a crucial role in improving patient outcomes.
Be sure to watch the webinar replay for a full breakdown of nasal decongestion and selecting safe, effective OTC treatments
Real-world examples helped to reinforce the learning points and provided attendees with a clearer understanding of how to manage different types of congested patients
Dr Tshegofatso Mabelane
RELIEVE PAIN
MINUTES
JUST
References : 1. Wilson CG, Clarke CP, Starkey YY, Clarke GD. Comparison of a novel fast-dissolving acetaminophen tablet formulation (FDAPAP) and standard acetaminophen tablets using gammascintigraphy and pharmacokinetic studies. Drug development and industrial pharmacy. 2011;37(7):747-53. 2. Yue Y, Collaku A, Brown J, et al. Efficacy and Speed of Onset of Pain Relief of Fast-Dissolving Paracetamol on Postsurgical Dental Pain: Two Randomized, Single-Dose, Double-Blind, Placebo-Controlled Clinical Studies. Clinical Therapeutics. 2013;35(9):1306-1320. * At 1000 mg dose. Than standard paracetamol tablets.
Enhancing pain management in pharmacy practice
Pharmacy Magazine recently hosted a comprehensive webinar in partnership with Haleon to address the evolving role of pharmacists in pain management. The session featured presentations by Prof Romy Parker and pharmacist, Nishern Govender, alongside a detailed discussion on the pharmacology of pain and patient expectations.
F UNDERSTANDING PAIN AND ITS MANAGEMENT
Prof Romy Parker delved into the complex nature of pain, distinguishing between nociception (the physiological detection of harmful stimuli) and pain as an emotional response. Pain was categorised into acute and chronic types, with chronic pain further classified into nociceptive, neuropathic, and nociplastic pain. Chronic pain conditions such as low back pain, fibromyalgia, and complex regional pain syndrome were highlighted, emphasising the significant prevalence and impact of pain on individuals' lives.
F PHARMACISTS' ROLE IN PAIN MANAGEMENT
Nishern Govender's presentation focused on the critical role pharmacists play in pain management. A survey revealed that 91% of pharmacists seek more support in encouraging patients to adopt healthier behaviours. Underscoring the importance of personalised conversations between pharmacists and patients regarding pain management, Govender advocated for a new approach in pain relief.
F PHARMACOLOGY OF PAIN
The pharmacology of pain was addressed,
detailing the use of OTC analgesics like paracetamol and NSAIDs. The modified WHO analgesic ladder was discussed for managing pain of varying severity, and the need for pharmacists to take patients' pain seriously and understand its impact on quality of life was emphasised.
F PATIENT EXPECTATIONS AND EXPERIENCES
Patient expectations were a significant focus, with 72% of patients wishing for better training for pharmacists on individual pain experiences. Negative experiences during treatment were noted, with many patients feeling dismissed or poorly treated by healthcare professionals when discussing their pain. Govender called for pharmacists to be better equipped with resources to address these issues effectively.
F EMPATHETIC VALIDATION AND NON-MEDICATION TREATMENTS
The emotional and social impacts of pain were highlighted, noting that individuals suffering from pain often feel withdrawn, judged, and isolated. Prof Parker and Govender suggested providing empathetic validation, identifying patients' fears related to pain, and empowering them with knowledge about various nonmedication treatment options, such as exercise, mindfulness, and sleep hygiene.
The webinar concluded with a call to action for pharmacists to enhance their expertise in pain management and to adopt a more empathetic and personalised approach in their practice. By doing so, pharmacists can significantly improve the quality of life for patients experiencing pain.
Be sure to watch the webinar replay to learn about the patient behind the pain and what patients want healthcare professionals to know about their pain experiences
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
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
The ONLY mupirocin cream in a 30 g tube size.3
ONE 30 g tube is 25 % more affordable than TWO originator 15 g tubes!3
1609, 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
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 40%
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
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.
neurology CPD activity
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
“To
Sleep... Perchance to Dream”
William Shakespeare
NEW ZILSUN MR
ZILSUN MR
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
Do your eyes feel Dry? Tired? Irritated?
Soreness
Grittiness
CROSSWORD #68
WIN:R500 WOOLWORTHS VOUCHER
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 November 2024. Winners will be contacted directly. Visit www.pharmacymagazine.co.za for full terms and conditions.
2. Pharmacy Magazine recently hosted a comprehensive webinar in partnership with to address the evolving role of pharmacists in pain management. (PAGE 27)
10. Eye can significantly impact a patient's quality of life. (PAGE 11)
12. tract infections (UTIs) are a common concern for patients with diabetes. (PAGE 35)
13. ACE inhibitors are commonly used for the treatment and management of . (PAGE 15)
14. Pharmacy Magazine is hosting a webinar on Resistance in skin infection on 14 November 2024. (PAGE 20)
15. Insomnia is a common sleep disorder that affects of people worldwide. (PAGE 39)
1. Herpes simplex is a common, lifelong viral infection
affecting millions worldwide. (PAGE 17)
3. technology represents a significant advancement in the treatment of fungal infections. (PAGE 33)
4. SPF stands for Sun Factor. (PAGE 29)
5. A robust Pharmacy Practice Solution (PPMS) is essential for ensuring smooth operations in modern pharmacies. (PAGE 7)
6. Rohto Eye Drops provide intensive dry eye relief with technology. (PAGE 40)
7. occurs when stomach acid backs up into the oesophagus. (PAGE 19)
8. is a topical antibiotic widely recognised for its effectiveness in treating secondary bacterial infections. (PAGE 31)
