NotOnly Dispensing

Diltiazem, Amlodipine and Verapamil (DAV) and their interactions with Simvastatin Good Evening, Today I would like to share a tiny bit of information on Diltiazem, Amlodipine and Verapamil (DAV)  and their interactions with Simvastatin . The use of statin may induce myopathy as one of its side effects. High dose of Simvastatin (>80mg) has been associated with increased risk of myopathy .  One may experience muscle-related symptoms such as fatigue, muscle pain or weakness, cramps and it may be aggravated by physical exertion. Simvastatin is metabolized by CYP3A4 enzyme in the body. The DAVs are all CYP3A4 enzyme inhibitors . Concomitant use of the drugs may lead to increased plasma concentration of Simvastatin, which in turn, increases the risk of myopathy. Findings from multiple studies has shown that the coadministration of Amlodipine 10mg and Simvastatin has the potential to increase the plasma concentration of Simvastatin by approximately 2-fold . On the other hand...

Good morning, Oral Iron Supplementation is essential in the management of anemic patient. Ferric Ammonium Citrate (FAC) 400mg/5ml mixture   can be commonly found in government hospital setting in Malaysia, to be used as one of the iron supplementations for pediatric patients. Dosing calculation for iron supplementation requires familiarization of iron content within each iron supplements. One can be quite confused at first when they are new to FAC syrup dose calculation. An important piece of information that should not be overlooked is that the strength of FAC syrup , 400mg/5ml, should NEVER be used in the calculation of amount of FAC required. In fact, 400mg/5ml of FAC contains 86mg of *Elemental Iron* in every 5ml of the mixture .  This is based on the approximation of molar mass ratio between iron and ferric ammonium citrate. Molar mass : Iron = 55.845 g/mol Ferric Ammonium Citrate Citrate = 261.98g/mol Approximation ratio calculation : 55.845/261.98 x 400 = 85.27 (...

Sharing a case today on Asthma inhalers Patient came into Emergency Department with shortness of breath and frequent coughing few weeks ago. After treatment was given, I approach the patient. Had some conversation with him, he complained that the Salbutamol pressurized metered-dose inhaler (pMDI),  which he had received past few weeks was not effective in managing nor relieving his asthma attacks. He had 4 attacks in these recent weeks. After using the MDI, the asthma attack did not relieved. Suspecting the patient might use the MDI wrongly, I asked the patient to demonstrate how he used it. I was right. He did not shake the MDI before using it, neither did he hold his breath after adminster the medication. He insisted that, shaking the MDI before use was an extra work which waste his energy and holding breath is pointless as the medication is already administered. After counselled him on the purpose of doing these actions, he went back home. Today, he came to see me, thanked...

Myth of Paracetamol Seen by a pediatric patient's mother today. Worried and anxious, she asked regarding the dose and myth of  Paracetamol before giving it to her child.    " Legends says that, when Paracetamol is taken, it will remain in the body until the day one dies. " *Staring at her in disbelief*   (  O_O) This is what was told by her, with a concern that her newborn child will have to bear the Paracetamol in its body until the day it passes away. Sounds funny and unbelievable, but this is what happens right now in reality due to misinformation. Paracetamol (PCM)  @ Panadol®, also known as Acetaminophen (AAP) @ Tylenol® in some regions, especially in the US, is a wonderful drug. It is can be found worldwide in different brands and strength. PCM can be used as either mild  analgesic or  antipyretic for treating fever. However, how it actually works is still a mystery itself.  Some debate that it works through prostaglandin ...