Pharmacists' and communities knowledge on the safety and halal status of pediatric medications containing alcohol
Keywords:
Alcohol, Knowledge, Halal, Pharmacist, Pediatrics
Abstract
Knowledge of the halal characteristics of products is essential in evaluating product quality, especially within societies where this consideration holds substantial significance. In this context, the presence of alcohol in medicinal substances can significantly impact consumer preferences due to potential halal implications and safety concerns. Therefore, this study aims to assess the level of awareness and comprehension concerning these critical aspects among pharmacists and the broader community.
This study involved a convenience sampling method of 180 participants from the Special Region of Yogyakarta, Indonesia. The sample consisted of 100 community members with prior experience purchasing pediatric cough and flu syrups and 80 community pharmacists. Data collection utilized a self-administered, paper-based questionnaire distributed from April-June 2023. Descriptive statistics were used for data analysis.
The study revealed that 76.1% of the community exhibited good knowledge of the halal considerations regarding alcohol in pediatric cough and flu syrup medications. However, there appeared to be a lack of specific knowledge regarding the permissible alcohol content necessary for these medications to qualify as halal. Concerning community pharmacists, they demonstrated a nuanced understanding of both the health risks associated with alcohol in such syrups and the halal considerations, reflecting an average knowledge score of 73.88%. Notably, The community pharmacist did not have adequate knowledge regarding the legally permissible alcohol content limits in pediatric medications, as well as the resulting blood alcohol concentration in children following consumption. This study highlights the imperative for pharmacists to enhance their comprehension of alcohol content within pediatric formulations and actively disseminate this information within the community.
References
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Batista, L. R., & Antoniosi Filho, N. R. (2020). Ethanol content determination in medicine syrups using headspace and multidimensional heart-cut gas chromatography coupled to mass spectrometry. Journal of the Brazilian Chemical Society, 31(2), 394–401. https://doi.org/10.21577/0103-5053.20190193
Bekele, K. M., Abay, A. M., Mengistu, K. A., Berhanemeskel, Atsbeha, W., Demeke, C. A., Belay, W. S., & Yimenu, D. K. (2020). Knowledge, attitude, and practice on over-the-counter drugs among pharmacy and medical students: a facility-based cross-sectional study in Punjab, Pakistan. Latin American Journal of Pharmacy, 9, 135–146. https://doi.org/doi: 10.2147/IPRP.S266786
Biologiche, V., Net-, F. E., Map, E. R., Paediatric, E., Report, D., Analysis, C., Discovery, P. M., Pharma-cology, P., Studies, U. P., Contentregistered, E., Preparations, P., Excess, A. T. H. E., Ethanol, B., Agency, E. M., The, M., & Drug, I. (2017). Ethanol Content in Registered Paediatric Preparation: Address the Excess. Arch Dis Child, 102(10), 20–21. https://adc.bmj.com/content/archdischild/102/10/A20.full.pdf?casa_token=TWt2df95I18AAAAA:8gFgc7nvzMxMus-Uq5XU8T_b0abOgtc_JZzpCL1x_ai5WFZ31c6k9HZBsO7k1kEtmG-i1FYabxc
Christiansen, N. (2015). Ethanol exposure through medicines commonly used in paediatrics. Archives of Disease in Childhood: Education and Practice Edition, 100(2), 101–104. https://doi.org/10.1136/archdischild-2013-305671
European Medicines Agency. (2010). European Medicines Agency. Ethanol Content in Herbal Medicinal Products and Traditional Herbal Medicinal Products Used in Children. 44(January), 1–8. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000402.jsp
Fathoni, M. A. (2020). Potret Industri Halal Indonesia: Peluang dan Tantangan. Jurnal Ilmiah Ekonomi Islam, 6(3), 428. https://doi.org/10.29040/jiei.v6i3.1146
Haorah, J., Heilman, D., Knipe, B., Chrastil, J., Leibhart, J., Ghorpade, A., Miller, D. W., & Persidsky, Y. (2005). Ethanol-induced activation of myosin light chain kinase leads to dysfunction of tight junctions and blood-brain barrier compromise. Alcoholism: Clinical and Experimental Research, 29(6), 999–1009. https://doi.org/10.1097/01.ALC.0000166944.79914.0A
Haorah, J., Knipe, B., Gorantla, S., Zheng, J., & Persidsky, Y. (2007). Alcohol-induced blood – brain barrier dysfunction is mediated via inositol 1,4,5-tripjosphate receptor (IP3R)-gated intracellular calcium release. Journal of Neurochemistry, 100(2), 324–336. https://doi.org/:10.1111/j.1471-4159.2006.04245.x
Haorah, J., Schall, K., Ramirez, S. H., & persi. (2008). Activation of protein tyrosine kinases and matrix metalloproteinases causes blood-brain barrier injury: novel mechanism for neurodegeneration associated with alcohol abuse. Glia, 56(1), 78–88. https://doi.org/10.1002/glia
Ieraci, A., & Herrera, D. G. (2007). Single alcohol exposure in early life damages hippocampal stem/progenitor cells and reduces adult neurogenesis. Neurobiology of Disease, 26(3), 597–605. https://doi.org/10.1016/j.nbd.2007.02.011
Inkelis, S. M., Moore, E. M., Bischoff-Grethe, A., & Riley, E. P. (2020). Neurodevelopment in adolescents and adults with fetal alcohol spectrum disorders (FASD): A magnetic resonance region of interest analysis. Brain Research, 1732(January), 146654. https://doi.org/10.1016/j.brainres.2020.146654
Kelber, O., Steinhoff, B., Nauert, C., Biller, A., Adler, M., Abdel-Aziz, H., Okpanyi, S. N., Kraft, K., & Nieber, K. (2017). Ethanol in herbal medicinal products for children: Data from pediatric studies and pharmacovigilance programs. Wiener Medizinische Wochenschrift, 167(7–8), 183–188. https://doi.org/10.1007/s10354-016-0474-x
Laksitorini, M., & Purnomo, H. (2023). Application of Hildebrand Solubility Parameter to Identify Ethanol-Free Co-Solvent for Pediatric Formulation. Indonesian Journal of Pharmacy, 34(2). https://doi.org/10.22146/ijp.6627
Laksitorini, M., Yathindranath, V., Xiong, W., Parkinson, F. E., Thliveris, J. A., & Miller, D. W. (2021). Impact of Wnt/β-catenin signaling on ethanol-induced changes in brain endothelial cell permeability. Journal of Neurochemistry, 157(4), 1118–1137. https://doi.org/10.1111/jnc.15203
McCaig, D., Fitzgerald, N., & Stewart, D. (2011). Provision of advice on alcohol use in community pharmacy: A cross-sectional survey of pharmacists’ practice, knowledge, views and confidence. International Journal of Pharmacy Practice, 19(3), 171–178. https://doi.org/10.1111/j.2042-7174.2011.00111.x
Muneer, P. M. A., Alikunju, S., Szlachetka, A. M., & Haorah, J. (2012). The mechanisms of cerebral vascular dysfunction and neuroinflammation by MMP-mediated degradation of VEGFR-2 in alcohol ingestion. Arteriosclerosis, Thrombosis, and Vascular Biology, 32(5), 1167–1177. https://doi.org/10.1161/ATVBAHA.112.247668
Neo, M. S., Gupta, S. M., Khan, T. M., & Gupta, M. (2014). Quantification of ethanol content in traditional herbal cough syrups. Pharmacognosy Journal, 9(6), 821–827. https://doi.org/10.5530/pj.2017.6.128
Rahmah, M., & Barizah, N. (2020). Halal certification of patented medicines in Indonesia in digital age: A panacea for the pain? Systematic Reviews in Pharmacy, 11(12), 210–217. https://doi.org/10.31838/srp.2020.12.34
Rahmah, R. (2019). Alcohol and Khamr in Fiqh Based on Science Perspective. IJISH (International Journal of Islamic Studies and Humanities), 2(1), 1–10. https://doi.org/10.26555/ijish.v2i1.859
Sheridan, J., Wheeler, A., Chen, L. J. H., Huang, A. C. Y., Leung, I. N. Y., & Tien, K. Y. C. (2008). Screening and brief interventions for alcohol: Attitudes, knowledge and experience of community pharmacists in Auckland, New Zealand. Drug and Alcohol Review, 27(4), 380–387. https://doi.org/10.1080/09595230802093760
Singh, A. K., Jiang, Y., Gupta, S., & Benlhabib, E. (2007). Effects of chronic ethanol drinking on the blood-brain barrier and ensuing neuronal toxicity in alcohol-preferring rats subjected to intraperitoneal LPS injection. Alcohol and Alcoholism, 42(5), 385–399. https://doi.org/10.1093/alcalc/agl120
Soremekun, R., Ogbuefi, I., & Aderemi-Williams, R. (2019). Prevalence of ethanol and other potentially harmful excipients in pediatric oral medicines: Survey of community pharmacies in a Nigerian City. BMC Research Notes, 12(1), 1–5. https://doi.org/10.1186/s13104-019-4486-7
Svirskis, D., Toh, M., & Ram, S. (2013). The use of ethanol in paediatric formulations in New Zealand. European Journal of Pediatrics, 172(7), 919–926. https://doi.org/10.1007/s00431-013-1972-0
Taylor, J. G., Ayosanmi, S., & Sansgiry, S. S. (2023). Consumer Impressions of the Safety and Effectiveness of OTC Medicines. Pharmacy, 11(2), 51. https://doi.org/10.3390/pharmacy11020051
Wulandari, P. (2023). Blood alcohol prediction (BAC) prediction and pharmacist knowledge on ethanol-containing medication: Cold and Cough Syrup. In Universitas Gadjah Mada. https://doi.org/10.1201/9780849378812.ax2
Zahálka, L., Klovrzová, S., Matysová, L., Šklubalová, Z., & Solich, P. (2018). Furosemide ethanol-free oral solutions for paediatric use: formulation, HPLC method and stability study. European Journal of Hospital Pharmacy, 25(3), 144–149. https://doi.org/10.1136/ejhpharm-2017-001264
Zuccotti, G. V., & Fabiano, V. (2011). Safety issues with ethanol as an excipient in drugs intended for pediatric use. Expert Opinion on Drug Safety, 10(4), 499–502. https://doi.org/10.1517/14740338.2011.565328
Attebäck, M., Hedin, B., & Mattsson, S. (2022). Formulation Optimization of Extemporaneous Oral Liquids Containing Naloxone and Propranolol for Pediatric Use. Scientia Pharmaceutica, 90(1). https://doi.org/10.3390/scipharm90010015
Aziza, Y. (2023). Alcohol profile in medication and community perception on halalness of cold and cough pediatric syrup. In Universitas Gadjah Mada.
Barnes, G. E., & Chappell, N. L. (1981). Pharmacists’ knowledge in the area of alcohol, and alcohol and drug interactions. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 15(5), 649–657. https://doi.org/10.1016/0271-7123(81)90088-2
Batista, L. R., & Antoniosi Filho, N. R. (2020). Ethanol content determination in medicine syrups using headspace and multidimensional heart-cut gas chromatography coupled to mass spectrometry. Journal of the Brazilian Chemical Society, 31(2), 394–401. https://doi.org/10.21577/0103-5053.20190193
Bekele, K. M., Abay, A. M., Mengistu, K. A., Berhanemeskel, Atsbeha, W., Demeke, C. A., Belay, W. S., & Yimenu, D. K. (2020). Knowledge, attitude, and practice on over-the-counter drugs among pharmacy and medical students: a facility-based cross-sectional study in Punjab, Pakistan. Latin American Journal of Pharmacy, 9, 135–146. https://doi.org/doi: 10.2147/IPRP.S266786
Biologiche, V., Net-, F. E., Map, E. R., Paediatric, E., Report, D., Analysis, C., Discovery, P. M., Pharma-cology, P., Studies, U. P., Contentregistered, E., Preparations, P., Excess, A. T. H. E., Ethanol, B., Agency, E. M., The, M., & Drug, I. (2017). Ethanol Content in Registered Paediatric Preparation: Address the Excess. Arch Dis Child, 102(10), 20–21. https://adc.bmj.com/content/archdischild/102/10/A20.full.pdf?casa_token=TWt2df95I18AAAAA:8gFgc7nvzMxMus-Uq5XU8T_b0abOgtc_JZzpCL1x_ai5WFZ31c6k9HZBsO7k1kEtmG-i1FYabxc
Christiansen, N. (2015). Ethanol exposure through medicines commonly used in paediatrics. Archives of Disease in Childhood: Education and Practice Edition, 100(2), 101–104. https://doi.org/10.1136/archdischild-2013-305671
European Medicines Agency. (2010). European Medicines Agency. Ethanol Content in Herbal Medicinal Products and Traditional Herbal Medicinal Products Used in Children. 44(January), 1–8. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/general/general_content_000402.jsp
Fathoni, M. A. (2020). Potret Industri Halal Indonesia: Peluang dan Tantangan. Jurnal Ilmiah Ekonomi Islam, 6(3), 428. https://doi.org/10.29040/jiei.v6i3.1146
Haorah, J., Heilman, D., Knipe, B., Chrastil, J., Leibhart, J., Ghorpade, A., Miller, D. W., & Persidsky, Y. (2005). Ethanol-induced activation of myosin light chain kinase leads to dysfunction of tight junctions and blood-brain barrier compromise. Alcoholism: Clinical and Experimental Research, 29(6), 999–1009. https://doi.org/10.1097/01.ALC.0000166944.79914.0A
Haorah, J., Knipe, B., Gorantla, S., Zheng, J., & Persidsky, Y. (2007). Alcohol-induced blood – brain barrier dysfunction is mediated via inositol 1,4,5-tripjosphate receptor (IP3R)-gated intracellular calcium release. Journal of Neurochemistry, 100(2), 324–336. https://doi.org/:10.1111/j.1471-4159.2006.04245.x
Haorah, J., Schall, K., Ramirez, S. H., & persi. (2008). Activation of protein tyrosine kinases and matrix metalloproteinases causes blood-brain barrier injury: novel mechanism for neurodegeneration associated with alcohol abuse. Glia, 56(1), 78–88. https://doi.org/10.1002/glia
Ieraci, A., & Herrera, D. G. (2007). Single alcohol exposure in early life damages hippocampal stem/progenitor cells and reduces adult neurogenesis. Neurobiology of Disease, 26(3), 597–605. https://doi.org/10.1016/j.nbd.2007.02.011
Inkelis, S. M., Moore, E. M., Bischoff-Grethe, A., & Riley, E. P. (2020). Neurodevelopment in adolescents and adults with fetal alcohol spectrum disorders (FASD): A magnetic resonance region of interest analysis. Brain Research, 1732(January), 146654. https://doi.org/10.1016/j.brainres.2020.146654
Kelber, O., Steinhoff, B., Nauert, C., Biller, A., Adler, M., Abdel-Aziz, H., Okpanyi, S. N., Kraft, K., & Nieber, K. (2017). Ethanol in herbal medicinal products for children: Data from pediatric studies and pharmacovigilance programs. Wiener Medizinische Wochenschrift, 167(7–8), 183–188. https://doi.org/10.1007/s10354-016-0474-x
Laksitorini, M., & Purnomo, H. (2023). Application of Hildebrand Solubility Parameter to Identify Ethanol-Free Co-Solvent for Pediatric Formulation. Indonesian Journal of Pharmacy, 34(2). https://doi.org/10.22146/ijp.6627
Laksitorini, M., Yathindranath, V., Xiong, W., Parkinson, F. E., Thliveris, J. A., & Miller, D. W. (2021). Impact of Wnt/β-catenin signaling on ethanol-induced changes in brain endothelial cell permeability. Journal of Neurochemistry, 157(4), 1118–1137. https://doi.org/10.1111/jnc.15203
McCaig, D., Fitzgerald, N., & Stewart, D. (2011). Provision of advice on alcohol use in community pharmacy: A cross-sectional survey of pharmacists’ practice, knowledge, views and confidence. International Journal of Pharmacy Practice, 19(3), 171–178. https://doi.org/10.1111/j.2042-7174.2011.00111.x
Muneer, P. M. A., Alikunju, S., Szlachetka, A. M., & Haorah, J. (2012). The mechanisms of cerebral vascular dysfunction and neuroinflammation by MMP-mediated degradation of VEGFR-2 in alcohol ingestion. Arteriosclerosis, Thrombosis, and Vascular Biology, 32(5), 1167–1177. https://doi.org/10.1161/ATVBAHA.112.247668
Neo, M. S., Gupta, S. M., Khan, T. M., & Gupta, M. (2014). Quantification of ethanol content in traditional herbal cough syrups. Pharmacognosy Journal, 9(6), 821–827. https://doi.org/10.5530/pj.2017.6.128
Rahmah, M., & Barizah, N. (2020). Halal certification of patented medicines in Indonesia in digital age: A panacea for the pain? Systematic Reviews in Pharmacy, 11(12), 210–217. https://doi.org/10.31838/srp.2020.12.34
Rahmah, R. (2019). Alcohol and Khamr in Fiqh Based on Science Perspective. IJISH (International Journal of Islamic Studies and Humanities), 2(1), 1–10. https://doi.org/10.26555/ijish.v2i1.859
Sheridan, J., Wheeler, A., Chen, L. J. H., Huang, A. C. Y., Leung, I. N. Y., & Tien, K. Y. C. (2008). Screening and brief interventions for alcohol: Attitudes, knowledge and experience of community pharmacists in Auckland, New Zealand. Drug and Alcohol Review, 27(4), 380–387. https://doi.org/10.1080/09595230802093760
Singh, A. K., Jiang, Y., Gupta, S., & Benlhabib, E. (2007). Effects of chronic ethanol drinking on the blood-brain barrier and ensuing neuronal toxicity in alcohol-preferring rats subjected to intraperitoneal LPS injection. Alcohol and Alcoholism, 42(5), 385–399. https://doi.org/10.1093/alcalc/agl120
Soremekun, R., Ogbuefi, I., & Aderemi-Williams, R. (2019). Prevalence of ethanol and other potentially harmful excipients in pediatric oral medicines: Survey of community pharmacies in a Nigerian City. BMC Research Notes, 12(1), 1–5. https://doi.org/10.1186/s13104-019-4486-7
Svirskis, D., Toh, M., & Ram, S. (2013). The use of ethanol in paediatric formulations in New Zealand. European Journal of Pediatrics, 172(7), 919–926. https://doi.org/10.1007/s00431-013-1972-0
Taylor, J. G., Ayosanmi, S., & Sansgiry, S. S. (2023). Consumer Impressions of the Safety and Effectiveness of OTC Medicines. Pharmacy, 11(2), 51. https://doi.org/10.3390/pharmacy11020051
Wulandari, P. (2023). Blood alcohol prediction (BAC) prediction and pharmacist knowledge on ethanol-containing medication: Cold and Cough Syrup. In Universitas Gadjah Mada. https://doi.org/10.1201/9780849378812.ax2
Zahálka, L., Klovrzová, S., Matysová, L., Šklubalová, Z., & Solich, P. (2018). Furosemide ethanol-free oral solutions for paediatric use: formulation, HPLC method and stability study. European Journal of Hospital Pharmacy, 25(3), 144–149. https://doi.org/10.1136/ejhpharm-2017-001264
Zuccotti, G. V., & Fabiano, V. (2011). Safety issues with ethanol as an excipient in drugs intended for pediatric use. Expert Opinion on Drug Safety, 10(4), 499–502. https://doi.org/10.1517/14740338.2011.565328
Published
2024-11-05
How to Cite
Wulandari, P., Aziza, Y. N., Ghozali, M., Laksitorini, M., & Endarti, D. (2024). Pharmacists’ and communities knowledge on the safety and halal status of pediatric medications containing alcohol. Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.11656
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