Tuesday, October 9, 2012

About Viral Exanthem

What is Viral Exanthem? ü Skin rash caused by viral infection Transmission ü Droplets (sneezing or coughing) ü May also spread during contact with infected saliva or nasal mucus Symptoms ü Body aches ü Cough ü Fever ü Headache ü Nasal congestion ü Nausea ü Runny nose ü Sore throat or vomiting Medical Treatment ü Oral anti-histamines for itching ü Non-steroidal anti-inflammatory medications for fever and pain Home Care ü Apply moisturizer for dry skin ü Avoid scratching for this can cause infection ü Avoid contact with irritating substances ü Wash skin gently with mild soap 2x a day ü Take lukewarm showers or baths ü Drink plenty of fluids ü Wear cotton clothing Prevention ü Avoid exposure to others who have a rash. ü Wash your hands frequently

Monday, October 8, 2012

New Reformulated Rexidol Forte

Brand Name, Dosage Format and Strength
Rexidol   600 mg Tablet

Therapeutic Category
Central Nervous System



A round, yellow-colored, flat, beveled-edge tablet, bisected on one side and plain on the other side.

Unilab announced the reformulated formula for Rexidol Forte at Parklane Hotel. One of their endorser is the popular radio commentator and tv reporter "Supper Bobby" Bobby Nalzazro himself. Where this he mentioned that this is the first time he actually endorsed a product with a grand reception.

Nalzaro encourages Cebuanos to try new Rexidol Forte to address headaches, fever, muscle pains, and bughat or other common pains. This new product brings the same effect that expensive branded products are known to give, or even better versus some single-ingredient formulations. “Rexidol Forte is affordable and gaan sa bulsa.” Nalzaro shares. “Kusog ang upat ka banat sa Rexidol Forte” as he mentioned in his actual TVC for Rexidol Forte.

New Rexidol Forte is now available in leading pharmacies in Visayas and Mindanao with SRP of P3.75.  

There is also an discussion by Dr. Rhodora Quano-Jayme about Safety of Pain Medications, which is very informational.


Impact of Pain on Quality of Life

Almost two-thirds (59%) reported an
impact on their overall enjoyment of life.

More than three quarters of patients (77%)
reported feeling depressed.

70% said they have trouble concentrating

74% said their energy level is impacted by
their pain.

86% reported an inability to sleep well.

2006 survey conducted for the American Pain Foundation

What are the more common over the counter
pain relievers that are being recommended?

A. Paracetamol
B. Ibuprofen
C. Mefenamic acid
D. Aspirin

Some Common
Over the Counter
Pain Relievers

Some Common Over the Counter Pain Relievers


NSAIDS (Aspirin)

NSAIDS Ibuprofen)

NSAIDS(Mefenamic acid)

Relieves mild to moderate pain from muscle aches, headaches,
colds, sore throats, backaches, arthritis, toothaches, and
menstrual periods.
Also helps reduce fever.

Used to treat mild to moderate pain
Also helps reduce fever

Relieves mild to moderate pain; relieves pain due to arthritis,
menstrual cramps, cold and fever, muscles aches, toothaches,
backaches, and headaches.
Also helps to reduce fever

Used for patients > 12 years old
Mild to moderate pain. People take them to treat pain due to
arthritis, menstrual cramps, cold and fever, muscles aches,
toothaches, backaches, and headaches.

Some Common Over the Counter Pain Relievers



(with paracetamol
and caffeine)

Relief of mild to severe headache, fever,
toothache, neuralgia, dysmenorrhea, fatigue
due to common colds & other viral


How safe are the available OTC
pain medications?

Fact 1

• Our goal is to “ Give the RIGHT medicine, at the RIGHT time, at the RIGHT price to the RIGHT people”

Fact 2

• There is massive misuse of medicines which causes ill rather than better health

Fact 3

• Safer alternatives to restricted/banned agents are widely available

How safe are the available OTC
pain medications?



NSAIDS (Aspirin)

( Ibuprofen)


• May cause stomach irritation and bleeding
• Those under 18 should not take aspirin because of the risk of developing Reye Syndrome

• Can irritate the stomach lining and increase the risk for stomach bleeding and ulcers.
• Some medications, smoking, and drinking alcohol can increase this risk.

• Increased risk of serious and sometimes fatal heart and blood vessel problems (eg, heart attack, stroke). Risk may be greater if you already have heart problems or if you take it for a long time
• May cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding

Ibuprofen safety data

• Meta-analysis of 12 case-control and cohort studies of the risk of admission for peptic ulcer complications associated with NSAIDs (Henry et al, 1996).

– Ibuprofen was associated with the least risk of serious upper gastrointestinal complications;

• Based on the comprehensive review and analyses of available data, although ibuprofen is the safest of the NSAIDs there appears to be a dose-related risk for GI and renal adverse events. However, at OTC doses of 1200 mg/day or less, the risks appear negligible

International Ibuprofen Foundation 2002


How safe are the available OTC
pain medications with Propyphenazone?



(with paracetamol
and caffeine)

• Pyrazolone derivatives which include aminophenazone, metanizole sodium, phenylbutazone and propyphenazone have been associated with serious
adverse effects. Since safer alternatives are available, some regulatory authorities have withdrawn or restricted their use.

•Increasing case reports on anaphylaxis; this leads to concern because it is available as OTC medication

Drug-associated Anaphylaxis

Drugs frequently associated with anaphylaxis wereglafenine, combination preparations with PROPYPHENAZONE, diclofenac, dextran, ibuprofen,floctafenine, allergen extracts, sulfamethoxazole with trimethoprim.

Drug associated anaphylaxis: 20 years of reporting in the Netherlands (1974-1994) and review of literature Clinical and Experimental Allergy

Reports of Anaphylaxis on Propyphenazone

Odds ratio for anaphylactoid reactions on the combination

Anaphylactic shock and anaphylactoid reaction

Propyphenazone 18.2 (10.6 -31.3)

Paracetamol 1.4 (1.2-1.6)

Caffeine 0.8 (0.1-5.7)

Lareb database
Netherlands Pharmacovigilance Center


• Regulatory actions :

– 9 countries took some sort of regulatory action
– 4 countries banned the product
– 5 countries have made some restrictions

• May affect the liver if dose used is inappropriate

Is paracetamol safe?

• On Paracetamol and liver injury:

– There are only slight increases in liver transaminases (0.4%-1%) after intake of therapeutic doses of Paracetamol
– Acute supratherapeutic paracetamol ingestion and hospitalization for acute toxicity and poisoning remain low
– Paracetamol-induced acute liver failure is mostly due to overdose ( unintentional - 48%; intentional - 44%) and not due to therapeutic doses

Pharmacotherapy. 2007 Sep; 27(9): 1219-30

Recognizing the
Paracetamol ADVANTAGE:

First used clinically by Von
Mering in 1893.

Called the non-aspirin pain

Marketed in US – 1950; in
UK- 1956

Paracetamol has no significant action on COX1, thus its freedom from Gastrointestinal side effects

Over the counter status (OTC) in the US since 1955

Recognizing the
Paracetamol ADVANTAGE:




Three randomized, multicenter, double-blind, single-dose, placebo-controlled studies have been conducted by McNeil , which evaluated the efficacy of acetaminophen in the tension headache model.

Post-Oral Surgery Pain, Episiotomy pain, Orthopedic Surgery Post-Immunization Muscle Aches and Pain Sore Throat

Adverse effects like hepatotoxicity may only be seen in:

Proven efficacy supported by evidence based studies

Acute Overdose; Receiving supratherapeutic doses & Appropriate Single dose given at less than 4 hour intervals

“The ease, range and availability of pain
medications has reached amazing levels in
the 21st century. BUT, more than a little old
fashioned CAUTION is called for in the
consumption and recommendation of these


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