The Pharmacy was particularly busy that evening but the two elderly clients (Mr. Tieku and Mr. Alamu) were patiently waiting their turns. Mr. Alamu was telling Mr. Tieku that even if he had to wait for hours, he would still wait because he was certain his pharmacist would give him the regular medications. Mr. Alamu is hypertensive, diabetic and also being managed for benign prostatic hyperplasia (BPH). BPH is a disease of men usually occurring after 50 yrs.
There is an enlargement of the prostate with its attendant untoward effect on normal voiding of urine. He had been hypertensive for 15 years and diabetic for 10 years.
The benign prostatic hyperplasia (BPH) was fairly recent, that is about 2 years ago. He was due for retirement in two years’ time. He had settled for Mr. Mensah’s Pharmacy. Mr. Mensah, the pharmacist forges close relationships with his clients particularly those with chronic diseases.
Mr. Mensah would go the extra mile to get the same medicines for his chronic disease clients. As a result the clients have grown to know their medications. For diabetes, Mr. Alamo takes tab. Gliclazide MR 60mg one tablet every day, tab. Metformin 1g twice daily and tab. Pioglitazone 15mg one tablet daily. For the hypertension (high Blood pressure) he takes Ramipril 5mg one tablet every day and Tab. Amlodipine 10mg one tablet every day.
His medication for BPH was cap. Tamsulosin 400mcg one capsule every day. Mr. Alamu said he travelled out of town for a while and forgot to carry along his regular medications. He was compelled to settle for other types with a few issues throughout the trip notwithstanding the assurances of his health care provider there.
Mr. Tieku mentioned that he also had a similar experience. Mr. Tieku is hypertensive (5 years) and takes tab. Nifedipine Retard 20mg twice daily, tab. Lisinopril 10mg daily and tab. Bendrofluazide 2.5mg every morning. I usually go along with my empty packs to the Pharmacy together with my prescription for re-fill.
I was particularly worried about the Nifedipine Retard 20mg because I noticed that some types give me headaches. I learnt it was a side effect of Nifedipine. Interestingly this type (showing the empty pack) does not give me headaches. I was asked to try another type but the headache came back after two days so I went back to the first pharmacy but it did not have the type I wanted. I, therefore, came to this pharmacy and got what I wanted and have since remained stuck here.
The first pharmacy thought I was being demanding but I have had this disease for years so I think I can best describe what I feel on the medication.
The narrations from the clients are issues very familiar to many health care providers. There are several possibilities. It may be due to the grade of the active pharmaceutical ingredient (API) or the pharmaceutical excipient (PE) used to formulate the product.
As regards pharmaceutical excipient. I did a piece on this aspect of formulation of pharmaceuticals some time ago after having sited a paper titled “Excipient-related adverse drug reaction-A clinical approach” by Strauss J., Department of Pharmacology, University of Pretoria published in Current Allergy & Clinical Immunology, March 2015, Vol. 28. The most important part of a medicine as far as its weight is concerned, is constituted by its excipients, which have the important functions of guaranteeing the dosage, stability and bioavailability of the active principle (Pifferi et al , The safety of pharmaceutical excipients, Il Farmaco 58 (2003) 541-550). In effect no matter how good a molecule is it needs the appropriate PE to make it useful.
It is obvious that these are clients who understand the implications of non-adherence to therapy on their chronic diseases –hypertension, diabetes, etc. they made it a point to go back to their health care providers. There are some who will simply stop taking the medications on their own and end up with complications such as stroke. Cardiovascular complications resulting from hypertension, hyperlipidemia, and diabetes lead to substantial disability, morbidity, and mortality. For example, for every increase of 20 mm Hg in systolic BP and every increase of 10 mm Hg in diastolic BP, the risk of stroke and ischemic heart disease doubles (Lewington et al.
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002).
Personally I have known some clients (hypertensive, diabetics, etc) for several years. They regularly take their medications and make it a point to work together with the health care provider for their optimum health care. There are quite a number too who for various reasons renege on their own commitments towards their health care. The experiences of these clients should serve as a guide to all in the safe use of medicines.
The writer is a Chief Pharmacist, Cocoa Clinic
By Edward O. Amporful