In the past two years, overseas shopping has become another channel for more and more parents to buy children's drugs. It is not uncommon for various e-commerce, WeChat and other platform channels to sell online red drugs. But do parents really know about overseas shopping drugs? Is overseas shopping children's medicine really reliable? Wang Xiaoling, director of the pharmacy department of Beijing Children's Hospital, and Xu Xiaochen, pharmacist of the pharmacy department of Beijing Children's Hospital, visited Xinhua to explain the above issues in detail.
Wonderful opinions
What are the problems of overseas shopping children's medicine?
Wang Xiaoling: Overseas shopping for children's medicine hides many problems
Overseas shopping drugs may cause many problems due to their wide coverage. Common problems can be summarized as follows:
First, the instructions or labels on the drug packaging are difficult to understand. Generally, overseas shopping drugs are marked with packages and instructions in local languages, so parents who are not familiar with foreign languages, especially those who are not familiar with some small languages, may not be able to understand all the information and specific usage of the drugs purchased, and may also be difficult to get professional guidance from doctors and pharmacists.
Second, the quality of drugs may be difficult to guarantee. Some drugs have special requirements for environmental conditions such as temperature and humidity during storage and transportation, but the transportation conditions in the general overseas shopping process are difficult to meet these requirements, or because the self purchasers do not pay attention to these special requirements, which may lead to quality problems of drugs.
Third, there may be ethnic differences between the East and the West in some drugs, leading to different dosage. If the drugs are used according to the drug instructions, there may be excessive or insufficient administration, which may affect the treatment effect. Fourth, once adverse drug reactions lead to drug source damage, or drugs have quality problems, hospital treatment and patient rights protection are difficult.
Regarding the transportation of drugs under special conditions, what risk consequences may be caused if the transportation conditions are not met?
Xu Xiaochen: Overseas panning drugs will "deteriorate" if the transportation temperature is too high or too low
All drugs are strictly regulated in terms of temperature. The temperature higher or lower than the standard temperature of the drug itself will have a greater impact on the quality of the drug, which will lead to deterioration and damage of the drug and loss of efficacy. For example, although drugs transported in the cold chain need a low temperature environment, too low a temperature can also cause problems. Take insulin for example. Although it needs a low temperature environment, if the temperature is lower than zero, the insulin will freeze inside, and the structure of insulin protein will be destroyed, leading to the failure of the drug. Another example is ophthalmic drugs and some other solution preparations. Once the temperature is too low, it will lead to drug crystallization. For some oral liquids, it will lead to decreased efficacy. For ophthalmic drugs, it is difficult to re melt after crystallization, and it will stimulate the eyeball after being dropped into the eye.
In addition to temperature, the most important factor affecting the quality of drugs during transportation and storage is humidity, because too high humidity will affect the process of drug deterioration. Some solid drugs are easy to absorb moisture and agglomerate. For example, aspirin will decompose due to moisture, and will produce substances harmful to the stomach. Some other common dosage forms, such as various capsules, sugar coated tablets, granules, powders, effervescent tablets, are also easy to absorb moisture, leading to drug failure.
If there is a problem with the quality of the drug or it goes bad, is there a simple way to let everyone do some identification?
Xu Xiaochen: To fundamentally ensure the safety of drug use, we should also use legitimate drugs approved by the state
First, look at the external package of the drug to see if the package is complete, if there is serious extrusion or damage, if there is any leakage or mildew on the surface of the package, if there is, the drug may have deteriorated, so avoid using it.
Second, if it is a tablet or capsule, the color changes, the surface is rough or has cracks, and the smell changes, the drug may have deteriorated, so it should be avoided. For liquid preparations, if there is more turbidity or precipitation in the solution, and the precipitation will not disappear after shaking hard, we also think that there are some quality problems or deterioration of the drug. If the color of the powder preparation changes or lumps, the color of the ointment and cream changes, and there is oil floating, the supposed transparent ophthalmic liquid becomes turbid, so it is recommended to avoid using it.
What needs to be emphasized here is that these methods cannot completely guarantee the quality of drugs. To fundamentally ensure the safety of drug use, we should also use legitimate drugs approved by the state.
What are the drugs with different dosage due to national and ethnic environmental differences?
Xu Xiaochen: Taking medicine according to foreign instructions may cause misuse
Due to various circumstances, the instructions of the same drug in China and abroad have different usages or doses, and even the instructions of the same product from the same manufacturer have different usages or doses. But there are many reasons for these situations. Let me give some typical examples.
Pulmicort respules are used for children's aerosol inhalation treatment. The US instructions for children are marked with 0.25mg for once a day, while the Chinese instructions for the same drug from the same manufacturer are marked with 0.25-1mg for twice a day. In clinical practice, the drug dosage in China is larger than that in the United States because the particle size produced by the atomizing pump used in China is larger. Therefore, in order to achieve the same therapeutic effect, the drug dosage needs to be increased.
Methylphenidate can treat attention deficit hyperactivity disorder. In China, most oral dosage forms are tablets, with the initial dosage of 15mg and the maximum dosage of 54mg. But in the United States, most of them are capsules, and the dosage is 10-60 mg.
Carbamazepine, the manual clearly pointed out that the risk of adverse reactions in Asians increased by 10 times, and Chinese people should pay special attention to this, because of the genetic polymorphism of HLA-B * 1502 allele. If conditions permit, Chinese patients need to test the gene before they can use it with confidence.
For the treatment of hypertension, metoprolol is 100-450 mg in the American instruction, while the recommended dose in the Chinese instruction is 100-200 mg. This is because metoprolol is affected by CYP2D6 gene. Different races have different gene distribution frequencies and different drugs.
What risks will there be once you mistakenly take drugs for children from overseas shopping?
Wang Xiaoling: High dose of overseas shopping drugs or serious adverse reactions
Possible misuse and risks of overseas shopping drugs include:
First, medication errors in terms of drug dosage, that is, too large or too small a drug dosage may lead to adverse drug reactions, even drug poisoning or inadequate treatment;
Second, it may also cause serious adverse drug reactions due to the neglect of safety tips such as medication precautions, especially the administration of drugs to people with contraindications;
Third, the indication is wrong. For example, when non asthma drugs are given to children with asthma, the treatment may be affected and other damages may be caused.
What are the common adverse drug reactions in children?
Xu Xiaochen: Wrong drugs may affect the liver and kidney
Adverse drug reactions in children can affect various systems and organs of the whole body. The common adverse drug reactions are skin and its accessories damage (such as rash, flushing, edema, pruritus, blisters, etc.) and digestive system damage (such as nausea, vomiting, abdominal pain, abdominal distention, diarrhea, anorexia, etc.).
The liver is the main place where drugs are metabolized in the body, and drug induced liver injury may be caused by drug damage. Many marketed drugs have potential hepatotoxicity. The liver of children is immature, and the tolerance of drug hepatotoxicity is low; Drug induced liver injury is more likely to occur when there are more kinds of drugs and when combined with drugs. Drug induced liver injury in children occurred more frequently within 4 weeks of drug use, mainly manifested as poor appetite, jaundice, nausea and vomiting, fatigue and abdominal discomfort.
Some drugs may cause damage to the structure or function of the kidney in the course of medication, and cause corresponding clinical manifestations.
How to prevent adverse drug reactions in children? What should be done once it appears?
Xu Xiaochen: Once adverse reactions are suspected, the first principle of treatment is to seek medical attention in time
Under the current medical and pharmaceutical conditions, there is no way to eliminate the occurrence of adverse drug reactions in children, but the following aspects can be taken to reduce adverse drug reactions in children:
First, drugs suitable for children should be selected as far as possible. When there is no special drug for children to choose, the drug with detailed information about children's use and dosage in the drug manual should be selected as far as possible. These drugs have more data on children's drug use.
Second, what is proposed by WTO and often mentioned in China is that it can be taken orally without intramuscular injection, and it can be intramuscular without intravenous injection. The appropriate dosage form and route of administration should be selected according to the child's age and condition. Because during intravenous drip, the drug enters the blood directly without passing through the mucosal barrier and the first pass effect of the liver, and has a rapid effect. The drug concentration, endotoxin, insoluble particles, administration speed, time interval and other factors are more likely to lead to adverse drug reactions than other administration routes.
Third, try to avoid self medication and use it under the guidance of doctors, pharmacists and other professionals. If you have any questions about medication, you should consult professionals in a timely manner.
Once adverse reactions are suspected, the first principle of treatment is to seek medical attention in time.
