Thursday, December 5, 2019

Diet in bowel preparation before colonoscopy

A couple of days ago, a provisional registered pharmacist highlighted to me that in bowel preparation for colonoscopy, based on product leaflets, if the patient is taking Fortrans, then he can take either low-fiber diet (e.g. plain porridge, white fish and skinless chicken) or clear liquids; but if the patient is taking oral Fleet solution, then he can only take clear liquids.
Image result for fortrans Image result for fleet phospho 

Well, I am surprised on how detailed the provisional registered pharmacist in reading the product leaflets.

To me, in bowel preparation, the patients should either consume a low-residue diet or clear liquids for at least one day prior to elective colonoscopy. A 2009 trial found that there was no significant difference in preparation quality between patients treated with 4L of polyethylene glycol who were assigned to receive either a low-residue diet or clear liquids the day prior to the examination.
  • A low-residue diet is low in fiber, and patients should be avoiding food such as fruits, vegetables and whole grains.
  • Clear liquids include water, clear broth, coffee or tea (without milk), ices, gelatins and fruits juices, such as apple, grapefruit and lemonade.
  • Liquids that are red can be mistaken for blood in the colon or can obscure mucosal details and hence, should be avoided.
  • Oral iron should be stopped at least five days before the colonoscopy since it makes the residual feces black, viscous and difficult to purge.
  • Some medications may need to be adjusted prior to colonoscopy, such as medications for diabetes, due to decreased oral intake prior to the procedure.
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Insulin stability

Just would like to have a random discussion on this issue...

If you have ever checked on Toujeo website, you will find out that the in-use stability of Toujeo is up to 56 weeks at room temperature (temperature below 30°C). This recommendation is in contradict with the product leaflet of Toujeo marketed in Malaysia (may be stored for a maximum of 4 weeks below 30°C.) and Medicines Compendium UK (it may be stored for a maximum of 6 weeks below 30°C).

Why could there be a difference, when it is the same product? Well, in this case, it could be because of different legal requirement when registering the product in different countries.

My next question would be, if there is any insulin marketed in Malaysia which has an in-use period longer than 28 days?

In the Forum for Injection Technique Malaysia (FIT-MY) page 32, it is written that once insulin is opened, it should not be used for more than 28 days, except for insulin determir which may be used for up to 42 days.

However, in reality, if you looked at product leaflet of Actrapid, Insulatard, Mixtard, Insugen-R, Insugen-N and Insugen 30/70, you will be surprised to find out that the in-use shelf life are all 6 weeks when stored below 30°C.

When I noticed this fact, it actually made me to reponder on the 28-day policy that I have been taught thus far. Is it because insulin not stable at room temperature or purely there is not enough study to prove that insulin has a longer in-use period than 28 days.

Similarly, for most commercial marketed eye products, the shelf life that we always tell our patients and customers is 28 days after opening, unless otherwise stated.

However, a NPS article dated in 2008 challenge that this 28-day policy is based on research from earlier times when drops were dispensed in glass bottles with glass pipettes, and many eye drops did not contain preservatives. However, to author knowledge, none of this research is current, using modern dropper-type bottles. Plus, the policy seems a terrible waste and causes increased expense to the patients and the health system. 

Friday, November 29, 2019

GeneBrandex APK

Cover art

By accident, I came across this application in Google Play Store. It contains drug information from Lexicomp and Martindale totally free without subscription. (Note: by experience, the database is not updated as frequent as Lexicomp mobile application.)

Screenshot Image

Note: Just before you can start to use this mobile application, you may need to watch few advertisement first before downloading the relevant databases.

Download link: