Helena Lutescia Luna Coelho

Perfil da automedicação no Brasil

INTRODUCTION The data presented are part of a World Health Organization (WHO) multicenter study of self-medication in Latin America. Brazilian sites included: Belo Horizonte, Fortaleza, the city of S. Paulo and outlying locations. The objective was to characterize self-medication practices by analyzing drugs sought by consumers in pharmacies without a physicians prescription. MATERIAL AND METHOD Drugs were classified according to the Anatomic Therapeutic Classification codes, and analyzed with respect to 1) intrinsic value; 2) recognition as an essential drug (by either WHO or Brazil); 3) number of active ingredients; and 4) requirement for prescription. RESULTS Five thousand, three hundred and thirty-two (5,332) different drugs, with 785 distinct active ingredients were sought. Of these, 49.5% were fixed dose combinations, 53.0% were of little intrinsic value, 44.1% required a physicians prescription, 71.0% were not essential drugs, and 40.0% of requests were based on prior prescriptions from the physician. The drugs most requested were analgesics (17.3%), nasal descongestants (7.0%), antirheumatic anti-inflammatory drugs (5.6%), and systemic anti-infective drugs (5.6%). CONCLUSIONS Self-medication in Brazil reflects the needs and habits of the population. It is strongly influenced by physicians-prescribing habits and by the inadequate selectivity of the Brazilian pharmaceutical market.

Misoprostol and illegal abortion in Fortaleza, Brazil

Misoprostol, a prostaglandin E1 analogue indicated for ulcer treatment, has been widely used as an abortifacient by women in Brazil, where abortion is legal only in cases of rape or incest, or to save the womans life. Because misoprostol is an inefficient abortifacient, many women who use it have incomplete abortions and need uterine evacuation. We reviewed the records of women admitted to the main obstetric hospital of Fortaleza, capital of Ceará state, Brazil, between January, 1990, and July, 1992, for uterine evacuation after induced abortion. The number of incomplete abortions induced by misoprostol increased substantially during the first half of 1990, and declined thereafter. Of the 593 cases in 1991, 75% were related to misoprostol, 10% to the use of other specified drugs, and 6% to unspecified drugs. For the remaining 9% the procedure used was not recorded; these included 3% in whom abortion had been induced by a clandestine abortionist. The number of uterine evacuations per month fell from 89 in August, 1990, to 62 in July, 1991, when sales of misoprostol in Ceará state were suspended. The fall continued after the sale of misoprostol ceased, to about 20 cases in December, 1991; numbers remained around this level until June, 1992, sustained by clandestine sales. The lack of access to contraception is the main reason for the large numbers of unplanned pregnancies and is a major public health issue for Brazilian women. The prohibition of abortion creates a void in which misuse of medicines is one extra complication, mainly because of the poor control of drug marketing.

Multicenter study on self‐medication and self‐prescription in six Latin American countries

To evaluate the patterns of self‐medication in Latin‐American countries.

Aspectos dos processos de prescrição e dispensação de medicamentos na percepção do paciente: estudo de base populacional em Fortaleza, Ceará, Brasil

O estudo visa avaliar aspectos da relacao medico-paciente e dispensador-paciente, durante a conduta prescritiva e no ato da dispensacao de medicamentos, a partir do ponto de vista dos pacientes. Trata-se de um estudo transversal de base populacional realizado em Fortaleza, Ceara, Brasil, no qual foram utilizadas informacoes de 957 pessoas, sendo que 904 responderam sobre a ultima consulta medica; e 831, sobre a ultima dispensacao. As informacoes coletadas dizem respeito as praticas desses profissionais e do comportamento do paciente, no que diz respeito as perguntas e informacoes formuladas para melhor direcionar a escolha e o consumo dos medicamentos. Na escolha da terapeutica, o medico falha ao nao perguntar sobre alergias medicamentosas anteriores (65%) e uso de outros medicamentos (64,1%), e menospreza, na maioria das vezes, os cuidados com as possiveis reacoes adversas (73,3%) e interacoes medicamentosas (58,2%). Na dispensacao do medicamento, a situacao e ainda mais grave, pois ela e realizada, principalmente, pelos balconistas (57,1%). O estudo sugere a baixa qualidade no atendimento medico e farmaceutico e a apatia do paciente no processo que envolve a prescricao e dispensacao de medicamentos e seu uso racional.

Misoprostol: The experience of women in Fortaleza, Brazil

Misoprostol is used by women in Brazil in case of unwanted pregnancy to attempt abortion. This paper reports the characteristics, pattern of misoprostol use and opinions of a group of 102 women (median age 25 years, range 16-49 years), from Fortaleza, capital of Ceará state, who had used misoprostol to attempt abortion. Seventy-five percent were women of lower social class, 58% had less than 8 years of education and 46% were never married. Misoprostol was used for the first induced abortion by 65 women. Modal dose was 4 tablets--200 micrograms of misoprostol each--most frequently 2 tablets by oral route and 2 tablets by intravaginal route. This pattern of use was associated with the highest rate of abortion, mainly at 9-12 weeks of amenorrhea. Fifty-five percent of women had no pregnancy test; 41% had 8 weeks or less of amenorrhea. Curettage was performed in 49 of 84 women who reported abortion and in 41 of 43 women who entered the hospital. Infection and uterine perforation were the complications described. Seventy-two percent of women were in favor of legalization of abortion, but 52% were also in favor of the prohibition of misoprostol sales; 66% would not repeat misoprostol use and 53% would not suggest it to a friend. The poorest women were less favorable to misoprostol ban. Despite the current lack of safer alternatives, misoprostol does not seem a satisfactory solution to illegal abortion in Brazil.

Reações alérgicas a medicamentos

OBJETIVO: Rever as publicacoes recentes mais relevantes sobre alergia medicamentosa e oferecer ao clinico subsidios para uma maior compreensao dessa problematica de grande relevância para a saude publica. FONTES DOS DADOS: Busca de artigos originais e revisoes indexados nas bases MEDLINE, Pubmed e Lilacs, publicados na ultima decada, relacionando o tema de alergia a medicamentos com mecanismos imunologicos, epidemiologia, diagnostico laboratorial, lesoes cutâneas, manejo clinico e reexposicao ao farmaco. SINTESE DOS DADOS: As reacoes alergicas representam um terco das reacoes adversas a medicamentos. Sao consideradas eventos raros, mas com elevada morbimortalidade. Apesar da descricao de Gell & Coombs, util para classificar reacoes alergicas a farmacos, algumas permanecem sem classificacao devido ao desconhecimento dos mecanismos imunologicos envolvidos. A existencia de subpopulacoes de celulas T com caracteristicas diversas daquelas comumente descritas revela a complexidade do tema e, ao mesmo tempo, elucida inumeras questoes inerentes ao mesmo. Recentemente, um novo conceito de apresentacao de farmaco a linfocitos T surgiu, diante de evidencias crescentes do seu envolvimento nas lesoes cutâneas decorrentes de reacoes alergicas a medicamentos. Na pratica clinica, e muito dificil a correlacao de sinais e sintomas das reacoes alergicas a medicamentos com o mecanismo imunologico envolvido sem o auxilio de testes laboratoriais. Testes cutâneos in vivo e testes in vitro tem sido empregados nas suspeitas de reacoes alergicas a medicamentos. No entanto, ha poucos produtos comerciais adequados para sua execucao. CONCLUSOES: As reacoes alergicas a farmacos constituem uma fracao importante dos eventos adversos a medicamentos. E importante enfatizar a necessidade de notificacao dessas reacoes pelos profissionais envolvidos no tratamento do paciente de forma sistematizada, por meio de acoes de farmacovigilância, bem como a identificacao dos possiveis mecanismos imunologicos envolvidos atraves de testes laboratoriais, historia e avaliacao clinica detalhadas.

Carência de preparações medicamentosas para uso em crianças no Brasil

OBJECTIVE: To identify drugs which are not suited for pediatric use in Brazil. METHODS: A descriptive study involving the development of a national list of unlicensed and off-label medications for pediatric use (problem drugs in pediatrics, PDP) through a literature review, a comparison among sources of the Brazilian pharmaceutical industry, and a survey with pediatricians. Drugs coded at the Anatomic Therapeutic Chemical (ATC) classification system were analyzed regarding licensing status in Brazil and recommendations/indications in pediatrics, based on the following reference sources: the list of licensed drugs of the Brazilian National Health Surveillance Agency (2005), the Brazilian Dictionary of Pharmaceutical Specialties (2005-2007) and the website www.bulas.med.br. RESULTS: Our literature search returned 126 PDP, but 24 drugs were excluded due to absence of national reference. To compose the final list, 24 other drugs referred by pediatricians were added. Of the 126 PDP, 23 drugs were not licensed in the country for use in children; and of the 103 licensed drugs, 24 presented age-related restrictions for pediatric use. The pharmaceutical list included 42 therapeutic groups and 68 subgroups. The groups containing larger numbers of PDP were: antibiotics for systemic use (15), antiepileptics (8), antiasthmatics (7), and analgesics (7). The most frequent problems were: inappropriate dosage (35), unlicensed for pediatric use (28), age-related restrictions (23). CONCLUSIONS: The lack of pediatric drug formulations in Brazil shows a profile similar to that observed in other countries, which involves a wide range of clinically important products. This study brings a contribution to the evaluation of the needs and priorities that support the development of suitable medicines for the pediatric patient.

Farmacovigilância: um instrumento necessário

This paper discusses the potential benefits of pharmacovigilance in promoting rational drug use and the implementation of drug policies, especially drug regulation, based on the WHO International Drug Monitoring Program. The initial development of pharmacovigilance in Brazil is presented and the need for a national pharmacovigilance system is stressed.

Reações adversas em pacientes com doença de Chagas tratados com benzonidazol, no Estado do Ceará

INTRODUCTION Chagas disease is caused by Trypanosoma cruzi and treated with benznidazole (BNZ). This drug has the troublesome features of presenting partial effectiveness and high toxicity ranging from hypersensitivity reactions to medullary aplasia. The objective here was to describe and evaluate the occurrence of adverse reactions in Chagas disease patients treated with benznidazole in Fortaleza, Ceará. METHODS This was a prospective descriptive study involving 32 chronic Chagas patients treated with benznidazole between January 2005 and April 2006. Sociodemographic and clinical data were collected through questionnaires, interviews and laboratory tests. Blood samples were collected before treatment and after 30 and 60 days of treatment. RESULTS Adverse reactions were reported in 28 patients (87.5%) patients and the most frequent of these were pruritus (50%), prickling (43.8%), muscle weakness (37.5%) and skin rash (31.3%). Out of the 28 patients with adverse reactions, eight (28.57%) discontinued their treatment. The adverse reactions that culminated with discontinuation of the treatment were prickling (7; 87.5%) or skin eruptions (5; 62.5%). There was a slight increase in aminotransferase levels during the treatment in 9.4% of the patients. CONCLUSIONS Following up the drug therapy administered to Chagas patients is of great importance for prevention and early detection of adverse reactions to drugs.

Prescrição e preparo de medicamentos sem formulação adequada para crianças: um estudo de base hospitalar

This work aimed to identify medicines whose form or pharmaceutical formula presents a problem to pediatrics (Problem Medication - PM), the strategies employed by doctors to use them in children, and the potential risks involved. Descriptive study: based on a survey with pediatricians from a SUS (Public Health System) reference hospital in Fortaleza-CE (Northeastern Brazil), in order to identify PMs, from July to August 2004; an analysis of prescriptions containing modification of medicines in the solid forms; and a follow-up of medicinal preparations, developed in December 2004 and January 2005, respectively. The medications were grouped by an anatomic, therapeutic and chemical classification and by means of a calculation of variables frequency. The pediatricians (N=48, 98% of the total) identified as PMs: 16 products without an injectable form; 32 in an injectable form that should be presented in lesser concentrations; and 30 without a liquid formula for oral use. Eighty two (82) prescriptions containing modifications of solid forms, involving 111 medicinal items were analyzed, all of which contained inadequacies; the main one being the partition of pills. In 33.6% of the cases, the prescribed doses were in accordance with that generally recommended. The modifications were carried out in inadequate places, by nonqualified professionals and without the use of best practices. The lack of appropriate formulae for pediatric use has an impact on medical practices. It is aggravated by the lack of appropriate conditions for medicines manipulation by pharmacists, in Brazilian hospitals, and this impact involves risks to patients.