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Background: There is limited long term data of generic atorvastatin in terms of clinical efficacy and safety. This study aimed to evaluate the efficacy of generic atorvastatin in a 12-month period. Methods: This study was a retrospective cohort study. The inclusion criteria were adult patients who received the original atorvastatin for at least three months and then switched to the generic atorvastatin for 12 months. Lipid profiles and safety profiles were evaluated after 12 months of switching therapy. Results: During the study period, there were 297 patients met the study criteria. The mean (SD) age of the patients was 61.05 (11.51) years. Male sex accounted for 46.80% (139 patients). For lipid outcomes, only HDL-c was significantly increased by 2.05 mg/dL (p 0.001). Serum creatinine was increasing by 0.07 mg/dL, while eGFR was decreasing by 2.55 ml/min/1.73m2. Other laboratory outcomes were not significantly changed after one year including ALT, AST, and CK. Conclusions: Generic atorvastatin had comparable effect on LDL-c reduction compared with the original atorvastatin. Renal deterioration were found with increasing HDL-c level in this study population with generic atorvastation. Physicians should be aware of declining of renal function in long term use of generic atorvastatin.

Panisa Manasirisuk,1 Nanthaphan Chainirun,1,2 Somsak Tiamkao,2,3 Sunee Lertsinudom,4 Kutcharin Phunikhom,5 Bundit Sawunyavisuth,6 Kittisak Sawanyawisuth3 1Department of Pharmacy Service, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand; 3Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4Division of Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; 5Department of Pharmacology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 6Department of Marketing, Faculty of Business Administration and Accountancy, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Nanthaphan ChainirunDepartment of Pharmacy Service, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, ThailandEmail kanokwanchainirun@yahoo.comKittisak SawanyawisuthDepartment of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, ThailandTel +66-43-363664Fax +66-43-348399Email kittisak@kku.ac.thBackground: The ability of statins to reduce LDL-c plays an important role in both primary and secondary prevention of atherosclerotic cardiovascular diseases. Such treatment can often be costly, but using generic atorvastatin may reduce cost by up to US$2635. In addition, a previous 8-week study found that it exhibited comparable efficacy to the brand-name medication. This study aimed to evaluate the efficacy of generic atorvastatin over a longer period of six months in a real-world setting.Methods: This was a retrospective cohort study in adult patients who had received brand-name atorvastatin for at least three months and then had switched to generic atorvastatin for at least six months. Lipid and safety profiles were evaluated at six months after switching. Adjusted analyses for age, sex, co-morbid disease, dosage, and indications for statin therapy were also performed.Results: During the study period, there were 488 patients who met the study criteria. The mean (SD) age of the patients was 60.97 (12.26) years, and 48.36% were male (236 patients). At six months, average total cholesterol, HDL-c, and LDL-c were all lower, from 174.43 to 166.15 mg/dL, from 51.64 to 49.51 mg/dL, and from 110.08 to 100.78 mg/dL (p < 0.001), respectively. There were no significant differences in terms of any other laboratory test results. LDL-c exhibited the highest significant reduction at 9.30 mg/dL. Stratified analyses by age, sex, co-morbid disease, dose, and indications for statin therapy revealed similar decreases in HDL-c and LDL-c as in the study population as a whole.Conclusion: Generic atorvastatin resulted in significantly lower LDL-c than name-brand atorvastatin but less of an increase in HDL-c.Keywords: low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, HMG CoA reductase inhibitors

Background: Several randomized controlled trials have examined the benefits of multidisciplinary CKD care on estimated glomerular filtration rate (eGFR). But, the results are inconclusive. Purpose: This study aimed to evaluate whether or not multidisciplinary CKD care was beneficial in terms of CKD progression. Methods: This is a randomized controlled trial and conducted at community hospital, Thailand. The inclusion criteria were patients with age of 18 years or older and diagnosed with up to stage 3b CKD based on the KDIGO guidelines. Eligible patients divided into two groups: intervention and control group. The intervention group received a type of multidisciplinary treatment, while patients in the control group received the standard treatment administered at the outpatient clinic. The primary outcome was eGFR outcomes at three months after enrollment. Results: During the study period, there were 334 patients who met the study criteria. Eligible patients were divided into two groups: intervention (166 patients; 49.70%) and control (168 patients; 50.30%). There were three outcomes that differed significantly between the two groups at 3 months: mean difference of eGFR from baseline, proportion of patients with eGFR decline greater than 4 mL/min/1.73 m2, and difference in CKD stage from baseline. A significantly higher percentage of patients in the intervention group experienced CKD improvement by one stage (24.10% vs 5.95%), and a significantly lower percentage experienced decline by one stage (8.43% vs 35.12%) than in the control group. Conclusion: Slower renal progression in patients with up to stage 3b CKD was shown in patients who were treated by a multidisciplinary approach.

This study aimed to determine the efficacy of a smartphone application named Quit with US among young adult smokers. An open-label, parallel, 2-group, randomized controlled trial with a 12-week follow-up was conducted between March and November 2020 among undergraduate students (18 to 24 years) in Chiang Mai Province, Thailand. A total of 273 participants were assigned by simple randomization procedure to the Quit with US intervention group (n = 137) or the control group (n = 136). All participants received pharmacists’ smoking cessation counseling at baseline and follow-ups. In addition, the intervention group’s participants were advised to use Quit with US. The baseline and 12-week follow-up assessments were conducted at a study unit, whereas other follow-ups were completed over the telephone. The primary abstinence outcome was the exhaled CO concentration level (≤6 ppm) verified 7-day point prevalence abstinence. At baseline, the participants’ mean (standard deviation) age was 21.06 (1.62) years. Most identified as daily smokers (57.9%, n = 158), consumed ≤10 cigarettes daily (89.4%, n = 244), and expressed low level of nicotine dependence as measured by Heaviness of Smoking Index score (86.1%, n = 235). Regarding intention-to-treat analyses, participants in the Quit with US intervention group achieved significantly greater smoking abstinence rate than those in the control group (58.4% (80/137) vs. 30.9% (42/136), risk ratio = 1.89, 95% confidence intervals = 1.42 to 2.52, p < 0.001). In conclusion, Quit with US integrated with pharmacists’ smoking cessation counseling significantly enhanced smoking abstinence rates among young adult light smokers consuming ≤ 10 cigarettes daily.

This study aimed to report the effectiveness of community pharmacy smoking cessation services in 13 health regions in Thailand using a retrospective data-collecting method from the Foundation of Community Pharmacy database. The participants were smokers aged at least 18 years. The outcomes were the abstinence of smoking at least 30 consecutive days by self-report only and self-report with exhaled CO level &lt, 7 ppm (if available), the number of cigarettes smoked daily, exhaled carbon monoxide (exhaled CO), and % peak expiratory flow rate (%PEFR), smokers measured these outcomes before and after receiving the smoking cessation services. Of 58 community pharmacies, 532 smokers (93% male, mean age of 42.4 ± 14.9 years) received smoking cessation services from community pharmacists. Of 235 smokers with complete data, 153 (28.8%, 153/532) smokers reported smoking abstinence by self-report. The mean number of cigarettes smoked daily reduced from 15.3 ± 8.7 to 1.9 ± 3.8 cigarettes, p-value &lt, 0.001. The exhaled CO levels of smokers significantly reduced from 11.7 ± 5.9 ppm to 7.2 ± 4.4 ppm, p-value &lt, 0.001. The %PEFR also significantly increased from 84.2 ± 19.4 to 89.5 ± 19.5, p-value &lt, 0.001. In conclusion, Thai community pharmacy smoking cessation services could aid smokers to quit smoking. This study is the outcome of the real-world community pharmacy smoking cessation service, policymakers should consider this service to be included in the national healthcare policy.

Background and aim Vernonia cinerea (VC) is a herb that can alleviate nicotine addiction, potentially aiding in smoking cessation. Previous studies have examined four-to eight-week treatments using VC, but have found it to be ineffective. This study aimed to evaluate the smoking cessation effects of VC in addicted smokers over a longer treatment duration with pastilles. Experimental procedure This was a randomized double-blinded controlled trial conducted at a community pharmacy. The inclusion criteria were age between 18 and 60 years, intention to quit smoking, and low to moderate level of nicotine addiction. All eligible participants were stratified according to nicotine addiction level and then randomly assigned either VC treatment or placebo. The VC group received two pastilles three times daily, while the control group received a placebo for 12 weeks. The outcomes were continuous abstinence rate (CAR) and point abstinence rate (PAR) at four and 12 weeks. Results There were 121 eligible participants; 10 participants were not willing to participate. In total, there were 111 eligible participants, 54 of whom were treated with VC (48.65%) and 57 of whom were given a placebo (51.35%). Baseline characteristics were comparable between the two groups. The VC group had a significantly higher chance of smoking cessation at 2.01 (95% CI of 1.03, 3.92) compared with the placebo group at the end of the study. There were no significant side effects in either group. Conclusion The VC pastille group had significantly higher CAR than the placebo group at week 12., Graphical abstract Image 1, Highlights • Vernonia cinerea (VC) is a potential herb for smoking cessation. • Several studies show non-significant results on smoking cessation by VC. • This is the first study showed that VC is effective for smoking cessation.

Background: Cytisine is a prospective pharmacological alternative for community pharmacy smoking cessation services. However, it has not yet been licensed because of a lack of efficacy and safety information in Thailand. Objective: The aim of this study was to evaluate the efficacy of cytisine in combination with community pharmacists’ counselling on smoking cessation in a community pharmacy in ThailandDesign. Setting, participants, and interventions: A double-blinded randomized placebo-controlled trials was carried out. Participants aged >18 years old who smoked >10 tobaccos/day were randomly assigned to receive cytisine or placebo and five sessions of counselling by a community pharmacist. The primary outcome was a continuous abstinence rate (CAR) at week 48. The CAR was also measured at weeks 2, 4, 12, and 24. Adverse events were monitored. Results: A total of 132 participants were included, with 67 receiving cytisine and 65 receiving a placebo. Approximately 95% of participants were male. The CARs were determined to be 14.93% and 6.15% for cytisine and placebo, respectively, at week 48. The relative risk (RR) was 2.41 (95% confidence interval (CI); 0.80–7.35, p = 0.102). The RRs for CAR at weeks 2, 4, 12, and 24 were 2.43, 2.91, 2.50, and 1.78, respectively. Only the RRs for weeks 2, 4, and 12 were statistically significant. Common and non-serious gastrointestinal and neurological adverse events were observed. Conclusion: Cytisine, when combined with community pharmacists’ counselling, did not statistically improve the CAR at week 48, although it did improve the CAR at weeks 2, 4, and 12. Adverse events of cytisine were common and non-serious (registration number: TCTR20180312001).

Intravenous levetiracetam has been approved for use as an antiepileptic drug, as well as in cases of status epilepticus. There are few reports that detail the clinical data and outcomes associated with this antiepileptic drug, particularly in patients with renal impairment. This was a retrospective analytical study conducted at Khon Kaen University’s Srinagarind Hospital in Thailand. The study period was between January 1, 2010 and December 31, 2014. The inclusion criteria were that patents were over 15 years old, had renal impairment, and had received intravenous levetiracetam treatment. The main clinical outcomes were seizure control and mortality. Clinical outcomes were compared between those with and without status epilepticus. Mortality of patients with status epilepticus were compared in terms of seizure control and order of intravenous levetiracetam treatment. During the study period, there were 247 patients who met the study criteria. The average age of the patients was 58 years with nearly equal sex distribution. Of those, 90 patients (36.4%) had GRFs of less than 15 mL/min/1.73 m2 and 60 patients (24.3%) received intravenous LEVE due to status epilepticus. The seizure control rates in the status epilepticus and non-status epilepticus groups were 36.7% and 88.7%, respectively (P

Background Quality indicators determine the quality of actual practice in reference to standard criteria. The Community Pharmacy Association (Thailand), with technical support from the International Pharmaceutical Federation, developed a tool for quality assessment and quality improvement at community pharmacies. This tool has passed validity and reliability tests, but has not yet had feasibility testing. Objective (1) To test whether this quality tool could be used in routine settings. (2) To compare quality scores between accredited independent and accredited chain pharmacies. Setting Accredited independent pharmacies and accredited chain pharmacies in the north eastern region of Thailand. Methods A cross sectional study was conducted in 34 accredited independent pharmacies and accredited chain pharmacies. Quality scores were assessed by observation and by interviewing the responsible pharmacists. Data were collected and analyzed by independent t-test and Mann–Whitney U test as appropriate. Results were plotted by histogram and spider chart. Main outcome measure Domain’s assessable scores, possible maximum scores, mean and median of measured scores. Results Domain’s assessable scores were close to domain’s possible maximum scores. This meant that most indicators could be assessed in most pharmacies. The spider chart revealed that measured scores in the personnel, drug inventory and stocking, and patient satisfaction and health promotion domains of chain pharmacies were significantly higher than those of independent pharmacies (p

Introduction: Incorrect use of inhaler devices is common problem in clinical practice. Providing pharmaceutical care services remains a core activity to improve medication safety and adherence. Objective: To determine the duration that the pharmacists used in the pharmaceutical care services for asthma and COPD patients using various types of inhaler devices that were MDI, DPI, and MDI with DPI. The comparison among the time use was employed. Method: We performed a descriptive study during October to December 2013. The data collection was done by using video tape to record the time spend on pharmaceutical care service for asthma and COPD patients every Friday. The patients were classified according to the inhaler devices used. They were MDI group (n=56), DPI group (n=18) and MDI with DPI (n=71). The differences between the three designs were analyzed by the Kruskal-Wallis test. The Mann-Whitney U-test (MWU test) was used for pairwise comparisons. The level of significance was set at p

Introduction: Pharmacist has many roles in an asthma and COPD clinic such as providing drug information and solving patient9s problems. A pharmacist spends much time but little is known about a pattern of time spending in the clinic. Objective: This study aimed to describe a pattern of pharmacist9s time spending to manage patients with asthma or COPD. Methods: A prospective descriptive study was conducted in an outpatient clinic in Thailand. Patients visited the clinic from August to December 2013 were included. Videotaping was recorded the pharmacist9s intervention and time spending. The records were reviewed to evaluate time spending for assessing patient, providing drug information, solving patient9s problems, and providing other services. Descriptive statistics were used. Time spending was presented as median ± inter-quartile range. Results: A total of 145 patients were included. An overall median time spending was 8.3±4.2 minutes/patient. Of the time, a pharmacist spent 1.68±1.88 minutes for assessing patient, 1.73±2.6 minutes for providing drug information, 1.85±1.9 minutes for solving patients9 problem, and 1.92±1.7 minutes for providing other services. A pharmacist spent 9.1±3.4 minutes for a patient with drug-related problem (DRP), while 6.4±3.3 minutes for a patient without DRP (p Conclusion: Pharmacist9s time spending should be on case-by-case basis. Patients with DRP or asthma patients who cannot control their disease stage need more time to provide pharmaceutical care services than others.

Background: Smoking cessation is crucial to minimize cardiovascular risks of patients with chronic diseases, but the outcomes of the pharmacist-run program in hospitals have not been fully assessed. Objectives: This study aimed to evaluate the pharmacist-led program impacts on patients9 smoking cessation and cardiovascular disease (CVD) risks with a one-year follow-up. Methods: A one-group intervention study was conducted in current smoking outpatients with hypertension and/or diabetes. They were initially assessed for cigarette smoking, stages of change and Framingham 10-year CVD risks, and then were counseled on its quitting and appropriate medicines. They were followed up for interim quit rates and relevant outcomes via telephone in weeks 1 and 2 and via attendance in weeks 4, 8, 24 and 52. Data were analyzed using a Chi-squared test and ANOVA with the significance level of 0.05. Results: A total of 176 patients, i.e., those with hypertension (59.7%), diabetes (33.5%) or both (6.8%), could significantly reduce the number of cigarettes per day from 12.4 (SD=7.9) at baseline to 2.7 (SD=3.5) in week 52 (p=0.001). The continuous abstinence rate reported in week 52 was overall 30.7%. The stages of change significantly moved from “pre-contemplation” to “maintenance”, albeit few relapses (5.1%), at the end (p=0.001). Patients with high-to-very-high risks reduced from 32.6% to 24.4% in week 52. The average reduction in CVD risk scores was identified from 18.4% to 13.5% (p=0.001). Conclusions: The pharmacist-led smoking cessation program has positive impacts on patients with chronic diseases in terms of significant quit rates and decreased 10-year CVD risks.

Objectives: To evaluate clinical outcomes and quality of life in asthma patients in the asthma clinic. Methods: Retrospective quasi-experiment in newly diagnosed with asthma patients and were visited to the asthma clinic from October 2010 to January 2012,followed-up for at least six months and received pharmaceutical care by pharmacists. The clinical outcomes were evaluated from lung function, and asthma control. Patients' quality of life was determined at the baseline and at 6 month after the treatment using the Thai Mini Asthma quality of life questionnaire. Results: The average of peak expiratory flow rate (PEFR) was greater than the baseline (304.76±102.91 and 331.71±114.15, respectively, p=0.019). The percentage of the patients with %PEFR above 80% were higher than what observed before the study (41.46% and 60.98%, respectively, p=0.003). The level of asthma control in patients were improved significantly (p=0.008). At baseline, the number of the patients with controlled, and partly controlled/uncontrolled asthma were 34.15% and 65.85% respectively. At the end of study, patients with controlled asthma increasing to 65.85% and patients with partly controlled/uncontrolled asthma decreasing to 34.15%. The overall patients' quality of life (mean±SD) were significantly improved from the baseline (4.0893±0.89 and 5.2349±1.02, respectively, p

2, 11, Isan Journal ofPharmaceutical Sciences

Background and Objective. Provocative factors are one causative factor of seizure attacks in persons with epilepsy (PWE). There are limited data of prevalence and major provocative factors in Asian populations.Methods. This study was performed at the Epilepsy Clinic, Khon Kaen University Hospital. The patients who aged 15 years or over, who had been treated at least 3 months with at least one antiepileptic drug, and who were followed up for at least one year were included. Data of seizure control and triggers were collected retrospectively from medical records. Data analysis was performed to identify independent provocative factors.Results. A total of 382 PWE met the study criteria. The mean age was40.4±0.8years. Approximately 44% of the patients had at least one provocative factor. By multivariate analysis, the independent provocative factors with the first three highest adjusted odds ratios were sleep deprivation (adjustedOR=8.64, 95% CI 3.73–19.99), alcohol consumption (adjustedOR=6.76, 95% CI 1.44–31.78), and feeling stressful (adjustedOR=2.97, 95% CI 1.29–6.86).Conclusion. Almost half of seizure attacks may be caused by provocative factors in Thai PWEs and some factors may be preventable. Avoidance of these factors should be emphasized to epilepsy patients for improving clinical outcomes and quality of life.

Isan Journal ofPharmaceutical Sciences, 7, 3, 55-60

The present study assessed the validity and reliability of the Thai Mini AQLQ in the Easy Asthma Clinic, Srinagarind Hospital.The present study used a cross sectional design, using an interview method by two trained-interviewers. The Thai Mini AQLQ consists of 15 items categorized into Symptoms, Activities, Emotions, Environment and Overall Scores. Scores range from 0 to 7 with higher scores meaning better quality of life. Cronbach's alpha was used to test for internal consistency reliability. Known group validation regarding asthma control was analyzed by the t-test and multiple regression, adjusting for age, gender and education.Of 168 patients recruited, 113 were controlled and, of these 55 were uncontrolled asthma patients, with an average age 53 +/- 13 years. Patients with controlled asthma reported significantly better scores in all domains compared with uncontrolled asthma: symptoms 6.6 +/- 0.54 vs. 4.7 +/- 1.14, p0.001; Activity 6.7 +/- 0.57 vs. 5.0 +/- 1.36, p0.001; emotion 6.4 +/- 0.91 vs. 4.6 +/- 1.67, p0.001; environment 5.3 +/- 1.10 vs. 4.1 +/- 1.24, p0.001 and overall scores 6.3 +/- 0.51 vs. 4.6 +/- 0.96, p0.001. Adjusting for age, gender and education using multiple regression, there was also a significant difference in all domains of Thai Mini AQLQ between the controlled and uncontrolled asthma patients. Internal consistency reliability was within the acceptable range (0.7) for all domains, except environment (overall 0.910; symptoms 0.855; activities 0.886; emotions 0.765 and environment 0.616).Thai Mini AQLQ has known to be reliable and valid. Further study on test-retest reliability and responsiveness to change are warranted.

Cancer pain remains an invisible problem in cancer care and our study aimed to document its prevalence, characteristics, and patterns of management at a tertiary care teaching hospital.Descriptive, prospective, cohort study.We recruited 335 consecutive adult patients diagnosed with cancers, admitted to Srinagarind Hospital, between February and April 2004. All of the participants were interviewed, and their pain evaluated by direct assessment using a numeric rating scale.The overall prevalence of cancer pain prior to admission was 56.5%, and within the first 24 hours of admission 41.5%. Three-quarters (74%) of patients with pain reported improvement; however one-third of those with pain never received any pain control intervention. Moreover; about half of those with persistent pain only received treatment by requesting it and then only received simple analgesics.Cancer pain remains under-detected and under-treated in many patients. Pain monitoring on a regular basis as well as a training program on pain management should be considered as first-line tools for improving pain control among cancer patients.

Isan Journal ofPharmaceutical Sciences, 4, 2, 13-23

previously validated and consists of open and closed ended questions. Following the implementation of various recruitment strategies, consumers were recruited and provided written informed consent. Results: 205 consumers were recruited. The average completion time for the questionnaire was 15 minutes (SD1⁄46.5). Only 11 (5%) consumers required assistance for completion. The three most commonly reported side effects were sedation (77%), difficulty waking up (59%) and anxiety (55%). In contrast the three side effects ranked as most bothersome were weight gain (23%) followed by feeling tired during the day (22%) and difficulty falling asleep (14%). The M3Q provided consumers with the opportunity to write about the impact these side effects had on their lives. Over half (53%) of the consumers reported thinking of stopping their medication; of these 64% had actually stopped taking their medication at some point. Side effects were the most common reason given for non-adherence. Conclusions: The M3Q was completed within a reasonable time frame with little need for clarification, allowing consumers to easily express their subjective experiences with side effects and contrasted the most common side effects with the most bothersome. Further research involving clinicians reviewing completed questionnaires will examine the clinical application of the M3Q.