4 DISCUSSION
To the authors´ best knowledge, the current study is considered the
first of its kind in Yemen on the availability of the two banned drugs
in the CPs. Likewise, no official document from the High Authority for
Medicines was found that prohibited their use in the Yemeni CPs. The PP
is dispensed informally in the CPs under the name of Sharbat
Alkhat . Although the name is different, the active ingredient is the
same. Additionally, KZ is sold in most pharmacies without any
restrictions on its use.
The data from one study revealed that the infrequent use of PP did not
increase the risk of some types of cancers that were identified in
animal studies (ovarian cancer, kidney cancer, leukemia, and lymphoma).
However, this study could not verify the risks of using PP on average
once a week for no less than two years. The study’s authors thought that
level of use could increase the risk of developing some types of cancer
[16]. The percentage of CPs dispensing PP is considerable lower than
the percentage dispensing KZ.
The data from the present study revealed that the percentage of
pharmacies keeping and selling KZ is high (n=31, 62% of CPs sold it) in
comparison to PP. KZ was approved in 1981 as an oral antifungal drug and
since that time it has been recognized to cause liver damage or
impairment. Studies determined that the hepatic injury was the result of
direct hepatocellular toxicity rather than immunologically intermediated
effects. The active metabolite of KZ, N-desacetyl-ketoconazole, may be
responsible for the hepatic damage and toxicity as shown in experimental
models. However, that toxicity is related to its dosage, concentration
and period of application [17]. Nevertheless, information that has
been gathered to the present time and published in the biomedical
studies shows that KZ is occasionally a quantitatively significant
offending medicine that can trigger a process of drug-related liver
damage and even liver failure.
The study would like to recommend the following:
- The health ministry should issue an official document to limit the
import of these medicines into the country and prevent their
dispensation in the CPs.
- The Ministry of Health needs to organize a periodic inspection
committee to monitor the dispensing of these drugs.
- The community pharmacists should be made aware of the potential health
hazards associated with the long-term use of banned medicines.
- The list of banned drugs should be periodically renewed and provided
to the CPs.
- The students in the Faculty of Medicine and Health Sciences should be
educated about the risk of using the banned medicines.