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Ask the doctor: Fake pills and ‘in house’ pharmas

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The Phnom Penh Post has partnered with licensed doctors from the International SOS Clinic to answer readers’ medical questions every first Wednesday of the month. Send your medical questions to ppp.lifestyle@gmail.com

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I’ve been hearing horror stories about generic medications sold here in Cambodia. How reliable are they? What is the difference between generics and “brand” medications? How do I know which is which?

You raise two issues: the first one is fake medications, and the second is generic medications. Regarding fake medications, it is one of the major public health threats in Asia, and Cambodia is no exception.

Either incorrect dosages or presence of a different substance – be it active with unexpected and harmful effects or inactive – may occur. The only way to prevent getting sick when taking medications – apart from possible side effects or wrong prescriptions – is to get them from an authorised pharmacy of good reputation.

According to Cambodian law, a pharmacy must have a licensed “in house” pharmacist, but there are problems with the law’s implementation and interpretation. There are more outlets than pharmacists available and as a result a pharmacist may work in one outlet but sell his name and qualification to two or three other outlets without being physically present as required by law.

Regarding generic and “brand” medications (assuming we are talking about genuine ones): The problem is completely different.

A generic is similar to the original “brand” one, and manufactured according to the same process since the licence of the original molecule goes to the public domain after a while. The only differences with the original are the excipients (binders) and its presentation. In terms of efficacy, the generics and “brands” are basically identical, although some scientists have recently raised concerns with some antibiotics (minor differences anyway).

It can be difficult to know “which is which”, and doing so usually requires the expertise of a medical doctor or a qualified pharmacist.

But never forget: The only professionals trained to diagnose and prescribe a treatment are medical doctors, although qualified and graduated pharmacists can provide medical advice.

I’ve seen some reports of increased drug-resistant malaria in Cambodia. If these are true, how worried should I be? How effective, safe or recommendable are prophylactics for an expat living long-term in Cambodia?

Yes, we have strong evidence of a developing malaria resistance at the Cambodian-Thailand border well as at the western Thailand-Myanmar border. However, we have also evidence that the usual ACT – artemisine combined therapy – remains efficacious for the treatment of the most common and severe malaria disease – caused by the Plasmodium falciparum parasite – in this area.

The usual recommended prophylaxis for those exposed to malaria remains efficacious too. According to the US Centers for Disease Control and other international health organisations, the only areas free of malaria are: Angkor Wat complex, Phnom Penh and around Lake Tonle Sap.

For those staying in all other areas for a long stay, malaria prophylaxis is recommended with Atovaquone-Proguanil combination (Malarone) or Doxycycline. The duration of such a prophylactic treatment is controversial, but should never last less than six months. This duration of treatment covers the period at highest individual risk, when the immune system has not yet met the parasite.

Afterwards, the immune system gives some protection against the parasite, and the decision to continue treatment takes into account the benefits, such as protection against the Plasmodium, and the risks – side effects of a long-term preventive treatment and selection of resistant parasites.

Last but not least: Mosquito-bite prevention is of the utmost importance. Repellents, long sleeves and pants, bednets, are the main ones, which by the way will protect from all the other mosquito-borne diseases, so frequent in Cambodia (dengue fever, Japanese encephalitis, chikungunya amongst the most famous).

This week’s guest columnist is Dr Jean-Jacques Bernatas, Chief Medical Officer at the International SOS clinic in Phnom Penh.
This article contains general information about medical conditions and treatments. The information is not advice, and should not be treated as such. You must not rely on the information as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider.

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