Is Drug Packaging Distinctive Enough?
I take quiet a few medicinal drugs. Every day, I test my INR and then put the drugs for the next twenty-four hours in an old black 35 mm. film canister, which fits neatly into the bag I generally carry or a pocket of my coat.
When I go away for a few days, I put the required drugs plus a few for luck, in a white film container, which I then transfer to the black one every morning.
Look at these two pictures of two strips of drugs.
One is Spirolactone and the other is 1 mg. Warfarin. When I went to Glasgow because I was in a hurry, I took two Warfarin instead of two Spirolactone. It didn’t matter in this case, but for others similar mistakes could be more serious. A contributory factor in this mistake, was that Boots have started to give me a differently packaged brand of the Warfarin.
The top side of the drug packaging should be distinctive. I think too, that the old brand of Warfarin had the writing on the back in the same colour as the drug. i.e. brown in this case. The new one is just an anonymous black.
Interaction Between Warfarin And Terbinafine
A few weeks ago I was prescribed a course of oral Terbinafine to clear up a fungal infection. It seemed to work well, except that there is still some of the tinea in my toe-nails.
But over the time, I was taking the drug, I have felt that my INR was constantly wanting to slip downwards towards and below two.
Luckily I test my INR daily, and use a simple control algorithm to calculate my Warfarin dose. Normally, it is 4 mg, but if it goes below 2.3, I increase it to 5 mg, and if it goes above 2.8, I reduce it to 3 mg. So the algorithm got me taking a lot of 5 mg doses as opposed to the usual4 mg.
Only since I finished the course of Terbinafine has the INR stabilised around 2.5, which is my target value.
I didn’t at first see any link until everything settled after the course finished. But I decided today to type “Warfarin Terbinafine interaction” into Google. I found this paper from the BMJ entitled Drug points: Serious interaction between warfarin and oral terbinafine.
I think this minor incident shows the value of regular INR testing! Because I was testing daily, as the INR started to drop, my algorithm told me to increase the dose to 5 mg. In fact my average dose has gone up from 4 to 4.5 mg. in the period that I was taking the Terbinafine.
So there was no harm done at all!
A Worrying Report On CFCs And HCFCs
It is being reported that mysterious CFC and HCFC gases have been found in the atmosphere. Here’s the first part of the report.
Scientists have identified four new man-made gases that are contributing to the depletion of the ozone layer.
Two of the gases are accumulating at a rate that is causing concern among researchers.
Worries over the growing ozone hole have seen the production of chlorofluorocarbon (CFC) gases restricted since the mid 1980s.
I have no theory about how these gases got there, as I’m no chemist or environmental scientist.
But I do feel that there are an awful lot of unnecessary drug inhalers powered by HCFCs used in the world.
I don’t mean unnecessary from the medical point of view, although in the 1990s, there were some amazing anomalies in the prescribing of these devices.
Some years ago, I backed a company that went on to produce an inhaler, that used no compressed gases, no batteries or any other noxious or environmentally-unfriendly substance.
It was so impressive that we were brought up at the Montreal Protocol talks, where some delegates tried to get the banning of HCFCs as well. They failed as some countries and Big Pharma didn’t want a ban.
So what happened to our device?
We sold it to Bohringer Ingelheim for a lot of money and it is described on this website.
Do We Sometimes Push Technology Too Far?
I like proven technology, as often some of the things done fifty years or so ago, may not have been very good at the time, but somehow over time they have proved themselves to be reliable and economic.
The classioc is the Inter City 125 train, introduced as a stop-gap in 1976. But it is only one of a number of classic designs, that just never get replaced.
A personal old idea that affects me is Warfarin, which I take every day to thin my blood and stop myself having another stroke. There are more modern drugs, but I’ve heard cardilogists say that now is not the time to change, as we don’t know enough about the side effects of new drugs yet.
And that is the crux of the matter! When anything has been used for years, we have a vast knowledge base to make sure, that it doesn’t bite us or even worse.
So I was rather pleased to see this report that says the new Airbus A350 will use more traditional batteries than the Boeing 787. Before you use new technology in something as critical as an airliner, you must prove it as thoroughly as possible.
The problem with proving aircraft parts as compared to that of says cars, buses or trains, is that the aircraft leaves the ground and does other things land-based machines don’t.
I remember, my next door neighbour in London, when I was a child, a Mr. Gibbon, saying that if Ford wanted to test a new truck axle, they’d fit a few in trucks and give them to a contractor, who was known to break anything. If he couldn’t break any,then it was probably a better axle. But you can’t give aircraft to bad airlines and let them do the testing!
What worries me about these plane batteries, is how many other new ideas are incorporated, that haven’t been completely tested? Aviation is littered with mistakes, where new designs have failed.
On the other hand, look at this wing of the baby Airbus 319/320/321, on which I flew to Stockholm.
Airbus A320 Wing
Go back twenty years or so and the design of a wing would be similar, but you can see developments like the wing-tips, that make the wings more efficient, have now become commonplace.
More Spanish Practices
This story from the Daily Mail, asks if it is the biggest scandal in doping history. Even Andy Murray is laying into the row, as the first paragraphs say.
Andy Murray last night hit out at a Spanish judge who ordered evidence relating to one of the biggest doping rings in history to be destroyed.
Britain’s No 1 tennis player called the decision to dump more than 200 blood bags from stars in a number of sports as ‘the biggest cover-up in sports history’ and said it was a ‘joke’.
Sometimes you think that there is one law for Spain and one law for everybody else.
Is This The Next Antibiotic?
Read any paper or web site this morning and the doom-sayers are saying that growing resistance to antibiotics is a big risk to us all. Read about it here on the BBC web site.
The BBC News tonight did talk about a company called Phico. I looked at their web site and although I know little of pharmaceuticals, I do feel that this company may have the look of another success out of Cambridge.
Let’s hope that for everyone’s sake, they’ve got it right!
Note that, because of the backing of the Wellcome Trust, they shouldn’t be lacking in resources.
Paracetamol Deaths Fall
According to this article on the BBC, smaller pack sizes for paracetamol has led to fewer deaths, many of which are suicides.. However the number of suicides on the railways continues to grow to such a level, that special measures had to be taken.
And yesterday, it would appear that someone jumped off the roof of Eastfield. Accident? I doubt it!
The trouble with suicides, is that we try to stop them, by limiting the methods, when it would be better to stop the reasons people feel they might take their own life.
As to pain-killers, I rarely take them! A couple of years ago, I did have some severe pain after the stroke and had to resort to paracetamol, codeine and later amitriptyline. But I haven’t had a pain-killer since late 2010, although I may have had a small glass of the Scottish all-purpose remedy.
The Telegraph Attacks Two Targets In One Article
Toby Young in Her Majesty’s Daily Telegraph has attacked both Lance Armstrong and Alistair Campbell in this article.
It is getting that Lance Armstrong is becoming a non-laurel wreath to hang around anybody you don’t like’s neck.
Manly Library Classifies Armstrong’s Books As Fiction
This story is a classic Australian put-down for sports worst cheat.
So it’s only a hoax, but everybody got the joke.
Hugh McIlvanney Calls Lance Armstrong A Conman
In a well-reasoned piece in The Sunday Times, Hugh McIlvanney states his view on Armstrong. Conman came from the title.
I wonder if Armstrong will be suing McIlvanney!
I think he won’t, as The Sunday Times already has a lot of legal issues, it needs to discuss with Armstrong. Probably in a Court of Law!
The Anonymous Widower 