|Al-Ahram Weekly On-line
5 - 11 April 2001
|Published in Cairo by AL-AHRAM established in 1875||Current issue | Previous issue | Site map|
A taste of their own medicineWith most drugs in Egypt sold over the counter, many of us prescribe our own medicines, or have friends prescribe them for us. Rana Allam peers inside some dangerous bottles
The United States: On 11 May 2000, the American Food and Drug Administration (FDA) received a study prepared by scientists at Yale University School of Medicine entitled Phenylpropanolamine and Risk of Haemorrhagic Stroke, which showed an increased risk of haemorrhagic stroke (bleeding in the brain) in people using Phenylpropanolamine (PPA). PPA is an ingredient used in prescription and over-the-counter medicines for the relief of nasal congestion or sinus and in weight and appetite control products.
In their study, the Yale scientists concluded that "an increased risk of haemorrhagic stroke was detected among women using the drugs containing PPA within three days of using the medication; men are also at risk." The Non-prescription Drugs Advisory Committee met on 19 October to discuss safety issues related to PPA use. The committee concluded that "although the risk is low, PPA cannot be considered safe for over-the-counter use." On 6 November, the FDA issued a public health advisory concerning the risks associated with PPA use and has requested that all drug companies discontinue marketing products containing PPA -- which the largest drug store chain in the US, CVS, did immediately.
Egypt: On any given day, walk into a drug store and ask for medication containing PPA (see box), and you will receive it without any warning or hint to the dangers you might be subjecting yourself to. Upon contacting the Ministry of Health (MOH), Al-Ahram Weekly was told that the MOH had no information on the matter. Further investigation however, revealed that a one-day workshop was held on 6 December to discuss this issue. Organised by two non-governmental organisations, Pharmex Consulting Group and Dawy Comprehensive Quality Consultants (DCQC), and attended by WHO representatives, pharmacology professors and representatives from drug-producing companies, the workshop concluded that "the validity of the Yale University study outcome arouses considerable doubt and unanswered questions, especially in relation to the usage and doses available on the Egyptian market."
It was also noted that although countries such as Brazil, Malaysia, Mexico, Singapore and Thailand have abided by the FDA report and banned the use of drugs containing PPA, other countries, such as France and Japan, have followed Britain's Medical Control Agency (MCA) report, which concluded that the safe ceiling of the daily dosage for PPA is 100mg, the dose commonly used in cold medicines. MCA found however, that in weight control medicines, the dose is 150mg, falling within the danger zone.
The workshop was in favour of the MCA findings, and hence concluded that Egypt would continue to use drugs containing a maximum of 100mg of PPA. Further, workshop members recommended the need to study the possibility of adding a boxed warning that would explain the hazards of PPA overdose. According to Mohamed Eldawi of DCQC and former dean of the pharmacology school at Tanta University, "Every drug has its side effects and this case is no different. We weighed the risk-benefit ratio before coming to our conclusion."
The recommendation taken however, does not meet unanimous approval within the medical establishment. "If PPA causes brain stroke, even to a small number of people, then it should be banned." Ali Ibrahim, secretary-General of the Arab Pharmacists Union told the Weekly. His opinion is endorsed by Ahmed Rami, member of the board of the Egyptian Pharmacists Union, who said that drugs with PPA should be banned. Rami went further to point out that even in the case that strict measures are taken against drugs containing PPA, implementation is a faulty process because there is no effective system of collecting drugs off of the market -- implementation of such measures is left to the producing companies.
There are 30 medicines available on the Egyptian market containing PPA, with collective annual sales revenue of up to LE60 million. Four of these drugs contain over 100mg of PPA and it would seem that economic interest is a factor behind which findings were approved. One of the recommendations adopted stated that "due to the possibility that some Arab and African countries may abide by the FDA report, then the companies producing and exporting drugs containing PPA should recompose these medicines using one of PPA's available alternatives."
But then PPA would not be the only medicine banned elsewhere and sold here freely, a couple of other examples being Novalgin and Introvioform. So think again before purchasing the neatly packed pills and capsules and ask carefully about what you are buying.
Information on the history of Phenypropanolamine, the Public Health Advisory, and the stroke study results can be found at: www.fda.gov/cder/drug/infopage/ppa/default.htm
Representative list of brand-names available on the Egyptian market containing PPA:
BC cold powder
Permathene Mega 16
Recommend this page
© Copyright Al-Ahram Weekly. All rights reserved
Letter from the Editor
|WEEKLY ONLINE: www.ahram.org.eg/weekly
Updated every Saturday at 11.00 GMT, 2pm local time