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The Pharmaceutical Journal
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From Mrs D. K. Roberts, FRPharmS
A small section of the otherwise excellent paper (PDF* 70K) from Pates et al (PJ, 9 February, p179) requires clarification.
In the discussion section the authors state that, in 1998, Pfizer withdrew Sleepia (a liquid-filled, soft gelatin capsule containing diphenhydramine) because of pressure originating from a letter to Addiction. This statement is incorrect. The letter to Addiction was wrongly referenced in the Pates et al paper. It should have been cited as "Roberts K, Gruer L, Gilhooly T. Misuse of diphenhydramine soft gel capsules (Sleepia): a cautionary tale from Glasgow (letter). Addiction 1999;94:1575?8". It actually describes the sequence of events that ultimately resulted in the withdrawal of Sleepia from the UK market in 1998. By the time the letter was published, the product had been unavailable for some time. It was the quick thinking and rapid reporting by community pharmacists in Glasgow that alerted the Greater Glasgow Health Board and the Medicines Control Agency to the abuse potential of the product.
Sleepia was launched in the UK in May 1997. Immediately following the broadcast of a television advertisement for the product, community pharmacists in Glasgow contacted me expressing concern that Sleepia was being requested by name by "methadone patients". At that point I alerted my colleagues Dr Laurence Gruer and Dr Tom Gilhooly. In addition. I wrote a letter to The Pharmaceutical Journal (PJ, 30 August 1997, p330) and Dr Gruer and I both wrote to the company. Our letter resulted in a firm rebuttal by the company that there was any problem. It was only when the local Glasgow press took up the story that representatives of the company visited Glasgow, spoke with my colleagues and officials of the health board, and reluctantly recognised that our concerns were genuine. They subsequently agreed to withdraw the product in Glasgow (PJ, 18 October 1997, p636) and later in the UK (PJ, 31 January 1998, p153).
Pates et al note in their paper that most pharmacists are aware of the misuse of OTC products and are working to curb the problem. However, individual efforts are likely to have limited impact.
Improved communication between community pharmacists, GPs, community addiction teams and the general public is essential in the implementation of urgently needed national policies. Indeed, as demonstrated by the Glasgow experience with Sleepia, local initiatives can sometimes result in a major impact at a national level.
Citation: The Pharmaceutical Journal URI: 20006083
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