Eswatini Pharmacy Society

26/08/2025

Pharmacogenomic (PGx) information is essential for precision medicine, enabling drug prescriptions to be personalized according to an individual's genetic background. Almost all individuals will carry a genetic marker that affects their drug response, so the ideal drug prescription for these individuals will differ from the population-level guidelines. Currently, PGx information is often not available at first prescription, reducing its effectiveness.

24/08/2025

Many chronic and “incurable” illnesses—like type 2 diabetes, cardiovascular disease, hypertension, fatty liver disease, some cancers, and even certain autoimmune conditions—are strongly influenced by diet and lifestyle factors.
At EPS, we encourage the usage of herbal remedies–especially those suffering from chronic and autoimmune diseases—under the supervision of their healthcare practitioners.

13/08/2025

Many people, especially those selling herbal products on social media, often say these natural remedies don’t have any side effects. But that’s not quite true. Just like regular medicines, herbal products can affect how our bodies process drugs. Our liver uses special enzymes, called cytochrome P450, to break down many medicines and herbs. When certain herbs or foods change how these enzymes work, it can cause problems with how drugs behave in our bodies.

For example, St John’s wort, a common herbal supplement, can speed up an enzyme called CYP3A4. This means it can lower the amount of some medicines in your blood—like cyclosporine, a drug that prevents organ rejection after transplants—making it less effective.

Similarly, smoking to***co speeds up another enzyme, CYP1A2, which reduces levels of clozapine, a medicine used for obsessive-compulsive disorder. This can make the treatment less successful.

On the flip side, grapefruit juice works in the opposite way by blocking CYP3A4. This causes some medicines—like ritonavir, methadone, and certain heart drugs—to build up to higher levels in your body, which could be harmful if you consume them together.

So, while herbal remedies and natural foods can be helpful, they’re not always harmless. It’s important to be aware of how they might interact with your medications and talk to your healthcare provider before combining them.

12/08/2025

Pharmacogenetic polymorphisms can affect the extent of activity of organic anion transporting polypeptides (OATPs) in much the same way they affect the activity of Cytochrome P 450 isoenzymes.

08/06/2025

It's disheartening when our attempts to help as clinicians are misinterpreted as hostility. We are not your enemies — we are here to protect your health.

Some medications that are ordered or taken without a prescription can have serious side effects, including suicidal thoughts and other mental health risks (e.g. some antidepressants). These are not just pills — they’re powerful substances that require proper evaluation, medical history review, and counseling to ensure safe and effective use.

28/05/2025

Liver injury associated with Ketoconazole: review of the published evidence

Ketoconazole, an antifungal drug, has been in use since 1981 to treat fungal infections. In 2013, both the FDA and the European Medicines Agency issued warnings or restrictions on using oral ketoconazole due to its potential to cause liver damage, which can lead to liver failure or the need for a transplant. Although published data make it hard to assess how common liver damage from ketoconazole is, the risk is serious enough to raise concern.

Liver toxicity from ketoconazole is typically detected through abnormal liver function tests, even when patients show no symptoms. Nonetheless, cases of severe liver damage have been documented. Alternative drugs like itraconazole, fluconazole, voriconazole, and terbinafine may offer safer options, but there’s still limited evidence confirming their lower risk of liver toxicity.

There have been no substantial reports linking ketoconazole to liver damage in clinical trials where it was used as a CYP3A inhibitor in drug metabolism studies. For such research purposes, itraconazole, ritonavir, and possibly voriconazole are preferred alternatives to ketoconazole—but not clarithromycin.

Keywords: Azole antifungals, clarithromycin, fluconazole, hepatotoxicity, itraconazole, ketoconazole, liver injury, ritonavir, terbinafine, voriconazole

28/05/2025

Drug safety assessment of oral ketoconazole formulations

Ketoconazole was the first broad-spectrum oral antifungal approved by the FDA in 1981. Post-marketing reports of drug--related hepatotoxicity, endocrine dysregulation and drug interactions resulted in market withdrawal of the drug in some countries and strict product relabelling in others.

Although oral ketoconazole is effective in treating fungal infections, the potential for drug interactions, endocrine dysregulation, and hepatotoxicity may outweigh its benefits. Newer oral antifungals have similar or greater efficacy in treating dermatological conditions and are associated with less risk. Likewise, newer agents with specific targets and fewer drug interactions have been developed to treat systemic fungal infections. Therefore, by the time ketoconazole prescribing guidelines were amended, its use had largely been replaced with newer antifungals.

-PubMed

14/04/2025

Causes of chest pains

19/02/2025

Clinical pharmacists play a vital role in the healthcare system, utilizing their specialized training and expertise to optimize medication therapy and promote patient safety. With their extensive knowledge and skills, they are an invaluable asset to healthcare teams and help to enhance the overall quality of patient care. If you are considering a career in pharmacy, clinical pharmacist training can provide you with the necessary skills and knowledge to excel in this fulfilling and rewarding profession.

02/02/2025

🔴PHARMA NEWS

**Wisconsin Family Sues After Son Dies Due to Skyrocketing Asthma Medication Costs**

The family of Cole Schmidtknecht, 22, has filed a lawsuit after he died from an asthma attack when the price of his life-saving medication, Advair Diskus (fluticasone/salmeterol combinations), surged from $66 to $539. Schmidtknecht, who had chronic asthma since infancy, relied on the medication covered by his employer-provided United Health-OptumRx Plan. On January 10, 2024, he was informed at a Walgreens in Appleton, Wisconsin, that the drug was no longer covered, leaving him unable to afford the $539 out-of-pocket cost. The lawsuit, filed on January 21 in federal court, alleges that the lack of coverage led to his preventable death. The case highlights growing concerns over insurance practices and drug affordability.

Source: Pharmwar

13/01/2025

Drinking water should be relative to exercise. Excessive intake of water can overwhelm your kidneys and dilute the sodium content of your blood; where your kidneys excrete excess water together with significant amounts of electrolytes. Electrolytes imbalance can lead to sharp drop in serum albumin ( a vital transport protein help balances fluid pressure).

A clear colourless urine is a sign of excessive hydration. Make sure to take food and supplement rich in vital electrolyte such as, good salts, calcium, magnesium, potassium, liver.

11/07/2024

A four-year-old female is brought to a health clinic in the Democratic Republic of Congo by her mother.

The child has had a cough for four days and has been generally unwell. The mother said she knows of another child who had similar symptoms and got better after taking antibiotics purchased from a local seller. The mother gave her daughter some leftover antibiotics she had at home but they have run out and didn’t seem to help. The mother tried the local pharmacy but they advised that she needed to take the child to a local doctor before treating with antibiotics. She has come to the clinic asking for antibiotics.

Examination shows respiratory rate (RR) 25/min, heart rate (HR) 80 beats/minute, blood pressure (BP) 100/70 mmHg, temperature 37.6°C.

The child is eating and drinking normally.

Her chest is clear on examination.

She has a mildly red oropharynx and her left ear is mildly inflamed.

She has no rashes and otherwise appears well.

Widespread, inappropriate use of antibiotics contributes to the development of antimicrobial resistance (AMR) and is a global concern. Healthcare professionals have a duty to consider antimicrobial stewardship as we collectively try to tackle the global challenge of AMR.

Addressing the challenge of AMR requires a multidisciplinary approach, with support and engagement from all healthcare professionals working in different disciplines. All healthcare professionals are responsible for ensuring appropriate use of antibiotics, minimising over-prescribing, preventing resistance and improving overall patient care. In this case, the patient’s mother has sought advice from a pharmacist and is now seeking advice from a clinic. Following WHO as well as appropriate regional guidelines helps ensure a consistent approach and communication to patients. The WHO’s AWaRe (Access, Watch, Reserve) antibiotic book provides concise guidance on the use of antibiotics for some of the most common infections seen in children and adults. (1)

The mother of this patient is clearly concerned about the health of her child, which has prompted her visit to the clinic and is likely to be her most pressing concern.

The predominant symptom of cough accompanied suggests an upper respiratory tract infection (URTI). This is likely to have a viral aetiology(1) and in the absence of any concerning symptoms, antibiotics are not indicated. Despite this, URTI’s are associated with frequent and unnecessary use of antibiotics.(1) In a recent study, it was reported that 68.7% of children in the Congo who had a recent fever or cough were prescribed an antibiotic, with around half from unqualified sources.(2)

Many common childhood infections are self-limiting. The mother should be counselled about symptoms to look out for that could indicate progression to more severe disease. This includes shortness of breath, increased heart rate and increased respiratory rate that could be indicative of pneumonia. The cough itself may persist for one to three weeks. Yellow or green sputum does not indicate bacterial infection. Paracetamol or ibuprofen can be indicated if required to reduce fever.(1)

It is also important to explain and ensure the mother understands why antibiotics are not being recommended for her daughter. In this case, antibiotics are unlikely to be of benefit.(3) In addition, they have a risk of side effects such as diarrhoea or allergy. From a wider perspective, inappropriate prescribing increases the chance of drug resistance, making more serious infections harder to treat.

References

1. World Health Organization. The WHO AWaRe (Access, Watch Watch, Reserve) antibiotic book [Internet]. 2022 Dec [cited 2024 Jan 12]. Available from: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2022.02
2. Hossain MS, Islam MF, Arka PB, Rohman M, Ahmed TS, Ahammed T, et al. Antibiotic prescription from qualified sources for children with fever/cough: cross-sectional study from 59 low- and middle-income countries. EClinicalMedicine [Internet]. 2023 Jul 1 [cited 2024 Jan 15];61. Available from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00232-8/fulltext
3. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis [Internet]. Vol. 2017, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2017 [cited 2024 Jan 15]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000245.pub4/epdf/full

Web Annex. Infographics