Browsing by Author "Gordon-Graham, Eugenie"

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    Leaving the party - withdrawal of South African essential medicines
    (2005) Wilmshurst, Jo M; Blockman, Marc; Argent, Andrew; Gordon-Graham, Eugenie; Thomas, Jenny; Whitelaw, Andrew; McCulloch, Mignon; Ramiah, Malitha; Dyeshana, H; Ireland, Joe
    In August 2004 pharmacies and drug depots were advised that the sole supplier of parenteral phenobarbitone in South Africa, essential for the management of status epilepticus in children, was stopping production at the end of the same year. Alternative protocols for the management of status epilepticus resulted in more children requiring intensive care intervention (N = 9) at the Red Cross Children’s Hospital, over a 2-month period, than had occurred in any 12-month period since 2000 (2000 N = 3, 2001 N = 1, 2002 N = 1, 2003 N = 2, 2004 N = 7). Other agents that have suffered or are at risk of the same fate are sodium nitroprusside, labetalol and esmolol. Sodium nitroprusside is used extensively in the peri-operative period in cardiac patients requiring after-load reduction. There are no other nitrates with equivalent efficacy. Supply was stopped in 2005 and only reinstated after the pharmaceutical company was contacted directly. Supply of labetalol and esmolol was stopped without warning. Without access to these products it is necessary to resort to agents that are not appropriate for paediatric use. Acetylcysteine (Parvolex), used in the management of acetaminophen overdose, also became unavailable and the supply was re-established only after direct communication with the pharmaceutical company.
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    Surprises of off-label drug use - where had all the Prostin gone?
    (2009) De Decker, Rik; Gordon-Graham, Eugenie; Seller, Neil; Lawrenson, , John
    The off-label use of drugs is common, particularly in paediatrics, where many drugs have yet to undergo the rigorous scrutiny demanded by authorities such as the Medicines Control Council (MCC) and the US Food and Drug Administration (FDA) before registration.1,2 Yet some drugs (e.g. paracetamol, salbutamol) are so commonplace in paediatric practice that it may come as a surprise that their use is indeed off-label in many circumstances. Problems may arise when an important drug in everyday (off-label) use is unexpectedly in short supply. An example is dinoprostone, marketed in South Africa as Prostin E2 by Pfizer South Africa (but curiously not listed on their website). Its registered use in South Africa is for induction of labour (as an oral 0.5 mg tablet), yet it is commonly used in South Africa for the emergency maintenance of ductal patency in newborn babies.