This unfortunate incident in Punjab highlights the scarcity of pharmacists who can implement proper drug safety.
KUALA LUMPUR: According to Punjab government officials, about 40,000 patients with heart problems might have received poor quality medicines since December 15, 2011. More than 150 patients have been admitted at different hospitals in Lahore following adverse drug reactions (ADRs) associated with the prescribed medicines from Punjab Institute of Cardiology, which was supplied free of cost.
It has already been reported that the patients affected by the substandard drugs experienced a rapid depletion of white cells and blood platelets leading to an impression that they were suffering a form of dengue fever. Other reported symptoms include marks on the body and bleeding from various parts. Whatever might be the reasons behind this tragic event, it clearly indicates the inability of healthcare professionals, physicians in particular, to recognise these ADRs early in the course of treatment — had they done so, many lives could have been saved.
After an initial probe by the provincial government, six medicines are suspected to have caused these symptoms: Cardiovestin (Simvastatin, 20 mg: a lipid-lowering agent), Alfagril (Clopidogrel, 75 mg: a blood-thinning agent), Concont (Amlodipine besylate, five mg: a blood pressure-reducing agent), Solprin (soluble Aspirin, 300 mg: a blood-thinning agent), Atenolol (Atenolol, 100 mg: a blood pressure-reducing agent) and Isotab (Isosorbide-5-mononitrate, 20 mg: a blood pressure-reducing agent). Unfortunately, facilities for detailed drug analysis at laboratories operated by the Sindh and Punjab governments do not exist.
With no option in hand, the Punjab government has sent samples of the drugs to France, Belgium and Singapore for detailed drug analysis. The first question that comes to mind is that if the Drugs Regulatory Authority does not have the capacity to analyse drug samples, how can it examine a particular drug, for content, side-effects and so on, prior to issuing a licence for it?
Our elected legislators tend to focus on issues that could only benefit them politically and not the public, such as the memo scandal and the Bhutto reference case, or those that coalition partners demand to be heard, such as changing the name of the province. Many other important issues, especially if they are potentially controversial, are often quickly and quietly set aside. This unfortunate incident in Punjab highlights the scarcity of pharmacists who can implement proper drug safety surveillance programmes in healthcare institutions in Pakistan.
The current role of pharmacists here is confined mainly to the pharmaceutical industry and to a lesser extent in private hospitals. In light of the recent tragedy in Lahore, their role should be widened to dealing with drug-related problems, and overseeing the introduction of generic or therapeutically-equivalent medicines, and reviewing older medicines as well as traditional ones, complementary and alternative medicines, non-prescription medicines, blood products, biologicals, medical devices and vaccines.
Pharmacists hold a clinical responsibility to detect the ADRs and other drug-related problems as well as to monitor their effectiveness. A pharmacist, being a part of the healthcare team, is a source of both information and critical evaluation of drugs used in clinical practice. The government and healthcare institution also need to acknowledge and promote the role of the pharmacist in the detection and reporting of suspected ADRs and other drug-related problems.
Shahzad Hasan and Imran Ahmed
Lecturers/clinical pharmacists
School of Pharmacy & Health Sciences
International Medical University
Published in The Express Tribune, January 29th, 2012.
