Objective: To examine public opinion in Saudi Arabia regarding the technical drug package insert (PI) as a source of information and to assess the need for potential changes to the existing format in favor of a more patient-oriented package insert (PPI).
Design:A cross-sectional survey was conducted from March through May 1998 by means of a selfadministered questionnaire.Setting: Eighty-four community pharmacies in Riyadh.Participants: Two thousand twenty-nine customers entering community pharmacies in Riyadh were enrolled in this survey.
Results:Results of the survey showed that 88% of the respondents read the PI. The motives for reading the PI included the desire to know more about the medication (48.7%), to adhere to the prescription (21.7%), and to decide whether to take the medication (13.1%). From the list of information contained therein, respondents listed indications (47.1%) and adverse drug effects (46.6%) as the principal sections of interest. Respondents overwhelmingly endorsed the PI as a complementary source of drug information to the verbal instructions of the physician and the pharmacist. However, readers did criticize its detail, legibility, and poor graphic illustration. Respondents indicated their desire to see a concise PPI introduced, one that highlights only the most common adverse effects of a drug. It should be written in simple Arabic and include, whenever possible, illustrations to enhance comprehension.
Conclusions:The PI does not have the power to overrule the physician's or pharmacist's instructions. Since some patients may cease taking their medicines if they feel threatened by the adverse effects mentioned in the PI, precautionary statements should be prominently placed in the PI to explain the purpose of mentioning such information and what proper action should be taken by the patient.
The comparative pharmacological activity of Cordia fruit mucilage at daerent stages of maturity was investigated to determine the stage at which active substances were present in high proportions. The fruit mucilage of ripe and unripe Cordia myxa (RCm and URCm) decreased rabbit arterial blood pressure in a dose dependent manner without affecting the respiratory rate. Mucilage Erom both ripe and unripe Codiu obliqua (RCo and URCo) decreased rabbit blood pressure and stimulated the respiratory rate. RCm is 12.37-fold more potent as a hypotensive agent than RCo. However the respiratory stimulant effect of RCo is 7-fold more than its own hypotensive effect. Investigation of the mode of action revealed that the hypotensive effect was more likely due to activation of parasympathetic ganglia and dilatation of peripheral blood vessels, whereas the respiratory stimulant effect may partly be due to activation of chemoreceptors in the aortic arch and carotid body. In addition, a subeffective dose of the ripe fruit mucilage specifically antagonized nicotine-induced hypotensive effect on rabbit and nicotine ganglionic stimulant effect on the isolated guineapig ileum.
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