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Australian Journal of Pharmacy : March 2005
pharmacy pro pharmacy professional updates ESULTS from an independent review of all evidence regarding the incidence, prevalence and treatment of constipation dispel many long-held beliefs about chronic constipation, in particular that too little liquid, roughage and a lack of exercise are three of the prime causes of constipation. ‘Myths and misconceptions about chronic constipation’, published recently in the American Journal of Gastroenterology, (www.amjgastro.com) found that many of the strongly held beliefs surrounding con- stipation are not evidence-based, includ- ing the fact that increased fluid and fibre intake do not necessarily alleviate the symptoms of constipation. Results from this review suggest that a diet poor in fibre should not be assumed to be the cause of constipation in general. Although for some people a diet rich in fibre may be helpful, the authors conclude that in many people with more severe con- stipation, fibre intake can make symptoms even worse and increased fluid intake will not provide significant relief, except in peo- ple where there is evidence of dehydration. In terms of treatments, laxative use has become one of the principal areas of con- troversy. Over the years, many claims related to laxative use have been circu- New light on constipation R lated, causing pharmacists and physicians to hesitate in recommending their use as a first-line treatment for constipation. The authors of the review found the following: • claims that contact laxatives cause damage to the colon have been made on poorly documented experiments and are not supported; • there is no supporting evidence that laxatives are an independent risk factor for colorectal cancer; • laxatives can cause electrolyte distur- bances or abdominal complaints but these can be minimised with appropri- ate drug and dose selection; and • developing a level of tolerance to laxa- tives is uncommon in the majority of users. Professor Müller-Lissner, from Hum- boldt University, Berlin, and lead author of the paper, commented: ‘Constipation is a widespread and sensitive disorder which is often ignored or considered to be of little importance by healthcare profes- sionals. Many sufferers are made to feel guilty and responsible for their symptoms, believing that their lifestyle is to blame. This review provides both sufferers and healthcare professionals with strong and legitimate foundations to remove these accusations and feelings of guilt.’ ¦ Review confirms low level of drug interactions with paracetamol A new review published in the current issue of the American Journal of Thera- peutics has confirmed the low level of drug interactions with paracetamol. Paracetamol is one of the most com- monly used analgesic antipyretic drugs worldwide and fortunately few clinically significant drug interactions have been documented. Toxicologist Dr Alison Jones, director of National Poisons Information Service in the UK, and her colleagues reviewed the evidence on potential interactions with warfarin and concluded that the dis- crepancies between observational studies and those in healthy volunteers made it difficult to confirm any clinically signifi- cant interactions occur. ‘Paracetamol really is remarkably clear of interactions with other com- pounds,’ said Dr Jones. ‘Animal experiments show how some compounds modify paracetamol hepa- toxity but these compounds are unlikely to be important at therapeutic doses.’ ¦ 156 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL 86 MARCH 2005 Help with mental illness medical care new resource from SANE Australia will help to reduce the confusion surrounding medical care for people suf- fering from mental illness. A The SANE guide to medication and other treatments is the result of an overwhelming number of callers to the SANE helpline in 2004 who sought better understanding of treatment for mental illness. ‘Fifty-seven per cent of callers to our helpline ask about the best treatments for mental illness,’ said SANE Australia’s executive director Barbara Hocking. ‘We know there is a lot of misunder- standing about how medication works and its role in recovery. Similarly, people want clear information about psycholog- ical treatments. For many people, the ideal treatment would include a combi- nation of medication and psychological therapy, along with access to community support programs, and education and support for families.’ The Guide is available for $9 plus postage from SANE Australia. Visit www.sane.org.au or phone 1800 688 382. ¦ Sleep disorders resource for pharmacists new Essential CPE booklet focusing on sleeping disorders has been released by the Pharmaceutical Society of Australia (PSA). A The 50-page booklet covers a range of areas including insomnia, hypersomnia, sleep apnoea, restless legs syndrome and nocturnal leg cramps. It includes infor- mation on the management of sleeping disorders using non-pharmacological methods as well as prescription, non-pre- scription and complementary medicines. PSA members who successfully com- plete the assessment questions will be awarded six credit points under PSA’s CPD&PI program. Members now also have the option of completing the assess- ment in the members-only area of PSA’s website. ¦