E-drug: Association Diclofenac/Misoprostol
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Dear Colleagues:
I'm Edith Delvechio. I'm from Argentina and I work at the Pharmaceutical
Drug Information Centre of the College of Pharmacists of the College of
Buenos Aires.
In our country we are starting to have problems related to the bad use of
the association Diclofenac/Misoprostol. This association is indicated to
reduce the gastrointestinal effects of NSAIDs, in this case Diclofenac,
which inhibits non selectively both isoforms of the enzime cyclooxigenase -1
and -2. By this mechanism it inhibits the synthesis of the gastroprotective
prostaglandins (PG-E1), and in this case misoprostol comes to replace this
antacid. Misoprostol increases the amplitude and frequency of the uterine
contractions, and stimulates uterine bleeding and total or partial expulsion
of the uterine contents in pregnant women.
It would be indicated in cases of Reumathoid Arthritis with 1 or more risk
factors for Gastric Ulcer.
The problem appears when it's used in an illegal way to produce abortion in
cases of non desired pregnancies. Though it is a combination that must be
sold only with medical prescription, sometimes it's easy to convince the
physician or pharmacist with no scruples about prescribing it.
I hope you are understanding what I'm meaning.
Now, my questions are, and I should like you to help me with this:
a) Is there an association like this in your countries?
b) If the previous answer is positive: Which are the legal restrictions?
c) Is there a really necessity for this combination, or there is other
solution to minimize gastrointestinal AE of NSAIDs?
d)Do you know about the illegal use of this drug in your counties, i.e. as
an abortifacient?
Thanks you all for your attention.
Hoping for your answers, yours,
Edith Elizabeth Delvechio
Pharmaceutical Drug Information Centre
College of Pharmacists of the Province of Buenos Aires
ARGENTINA
"C.I.M.F" <cimf@colfarma.org.ar>
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