Ayman Allahham

Maintenance fluids for neonates, which are commonly composed of glucose 10%, sodium chloride (NaCl) 0.225% w/v with potassium chloride (KCl) 20 mmol/L (GSP), are administered as a continuous infusion, and prescribed medications are required to be co‐administered frequently through a Y‐site. There are limited studies on the compatibility of commonly used medicines with this maintenance fluid. Therefore, the objective of this study is to study the compatibility of commonly used medicines in the neonatal intensive care unit with maintenance fluid (GSP). An audit at the RCH Neonatal Intensive Care Unit (NICU) was performed to determine the average doses, durations of infusion, and volumes of maintenance fluid, benzylpenicillin, and calcium gluconate administered. The Y‐site chemical compatibility of calcium gluconate with the GSP was determined using a titration method. The Y‐site physical compatibility for both calcium gluconate and benzylpenicillin with the GSP was determined on the basis of visual appearance, turbidity, and pH. There was no clinically significant change in pH, turbidity, or concentration of the calcium gluconate at a 1:1, 1:2, 1:4, or 2:1 ratio with GSP with a contact time of up to 4 hours. Both physical and chemical analyses demonstrated the stability of calcium gluconate with GSP at a range of concentrations and time points, indicating Y‐site compatibility. Physical changes were detected in the samples containing benzylpenicillin and GSP following the longer interaction time, thus indicating potential Y‐site incompatibility. This has been confirmed by both the turbidity and the Z‐average tests.

Background/Objectives: Complementary medicines (CMs) are widely used in Australia, yet consumer beliefs about their safety and effectiveness often diverge from the scientific evidence. Contemporary statewide data from Victoria, particularly about these perceptions and underlying perception profiles, are limited. We therefore aimed to characterise CM use patterns and perceptions of it among Victorian adults and identify the demographic and use-related belief patterns. Methods: A cross-sectional survey was conducted in metropolitan and regional Victoria (November 2024–August 2025) among adults (≥18 years) who had used complementary medicines in the previous 12 months (N = 447). The questionnaire assessed CM use patterns, perceived effectiveness, safety, quality, perceived risk relative to prescription medicines, adverse events, and demographics. The analyses included descriptive statistics, χ² tests with multiple-comparison control, Spearman correlations, and a multivariable regression. An exploratory factor analysis (EFA) and latent class analysis (LCA) were used to identify the perception dimensions and distinct consumer profiles. Results: CM use was frequent (62.2% daily; 19.2% weekly) and often long term (>1 year, 55.0%). The most commonly used products were vitamin D (53.0%), multivitamins (39.8%), magnesium (34.5%), iron (33.8%), and vitamin C (30.0%). The perceptions were favourable: 77.3% rated CMs as effective, 90.4% as safe, and 60.3% as high quality; 78.5% perceived CMs to have lower side-effect risks than prescription medicines. Adverse events were reported by 12.3%. In the adjusted models, adults ≥ 65 years and monthly/occasional users were less likely to endorse “lower risk than prescription medicines” (aOR: 0.18; 95% CI: 0.06–0.51; aOR: 0.36, 0.18–0.72). East Asian respondents had lower odds of endorsing CM effectiveness than Caucasian/White respondents (aOR: 0.28, 0.11–0.72). Their perceived quality was higher among men (aOR: 1.73, 1.09–2.74) and adults aged 55–65 years (aOR: 3.81, 1.39–10.48). Conclusions: In this contemporary statewide Victorian sample, CM use was common and generally viewed positively, yet the comparative risk may be underestimated. Profiling perception patterns and identifying belief patterns by age, culture, and use intensity provides actionable targets for clinician/pharmacist counselling and culturally tailored education to support safer, evidence-aligned CM use.

Dysphagia is common among older adults and frequently necessitates the use of thickening agents to facilitate safe swallowing of medicines, which may in turn alter their bioavailability. This study investigated the impact of two commercially available lubricants—Gloup^® Forte and extremely thick water—on the in vitro dissolution behaviour of immediate-release gliclazide tablets. Dissolution studies were conducted using crushed and whole tablets in different media consisting of reverse osmosis water, phosphate buffer (pH 6.8), and 0.1 N HCl at 37 °C. Dissolution profiles were compared using similarity factor (f₂) analysis and modelled using established kinetic equations. Gliclazide dissolution was significantly delayed in the presence of Gloup^® Forte across all media for both crushed and whole tablets, with f₂ values below 50, indicating dissimilar profiles. Dissolution kinetics confirmed that mixing the formulated gliclazide with Gloup^® Forte delayed the release and reduced the dissolution rate constant for drug from both crushed and whole gliclazide tablets in media studied.

Feeding tubes are essential for patients unable to maintain adequate oral intake, serving multiple purposes including nutrition delivery and medication administration. The impact of administering medications through feeding tubes on their stability requires systematic investigation. This review aims to systematically evaluate factors affecting medication stability when administered via enteral feeding tubes versus oral administration in healthy populations, focusing on solid dosage forms converted to liquid formulations. A comprehensive search was conducted across PubMed/MEDLINE, Embase, and CINAHL databases from July to October 2024, using a combination of MeSH and non‐MeSH terms. Studies that assessed medication stability in enteral feeding tubes were included, while those that did not report on this outcome were excluded. The risk of bias was evaluated using ROBINS‐I, RoB‐ II, Cochrane tools, and the QUIN tool. From 2368 articles, 115 were retained for further assessment, and finally 24 met the inclusion criteria and were included, comprising 16 in vivo, 4 in vitro, and 4 combined studies. Approximately 20.8% of the studies found reduced stability/bioavailability for certain medications, such as warfarin and tolvaptan, while 8.3% of the studies found enhanced absorption, as observed with clopidogrel. Most medications maintained their stability. This systematic review suggests that enteral feeding tube administration can variably affect medication stability, influenced by factors such as tube material and preparation methods. Although most medications remain stable, concerns regarding instability and quality persist. The findings of this review provide a foundation for developing evidence‐based guidelines to optimize clinical practice and improve patient outcomes.

Complementary medicines (CMs), including herbal products, nutritional supplements, vitamins, minerals, probiotics and prebiotics, are increasingly integrated into standard medical treatments. Despite their growing popularity, concerns about safety, efficacy, and potential interactions with conventional medications persist. This systematic review evaluates the effectiveness of various educational interventions (EIs) designed to enhance the knowledge, informed decision-making capabilities, awareness of side effects, and consumer perceptions of safety and efficacy of CMs. This study aims to identify the most effective strategies for improving the awareness of potential risks and benefits, and overall health literacy among CMs users. A comprehensive literature search was conducted across multiple databases including PubMed/ MEDLINE, Embase, ISI Web of Science, and the Cochrane Library to identify relevant studies published from inception to May 2024. Medical Subject Headings (MeSH) and non-MeSH terms, along with various logic operators, were used to identify studies evaluating EIs aimed at improving CMs knowledge and decision-making. We included the studies if they evaluated EIs about CMs for consumers, patients, and caregivers, with eligible designs including randomized controlled trials (RCTs) and other types of interventional studies. Fifteen eligible studies were included. Interventions ranged from interactive multimedia programs and online platforms to personalized face-to-face counselling. The interventions demonstrated significant improvements in CMs knowledge, self-efficacy, and informed decision-making among participants. High levels of participant satisfaction were consistently reported, particularly with interactive and engaging tools. This systematic review underscores the critical role of education in promoting the safe and informed use of CMs. Effective educational interventions enhance knowledge, informed decision-making abilities, and awareness of side effects. However, challenges such as high attrition rates and variability in study designs indicate the need for further research to optimize these interventions. Future efforts should focus on standardizing educational strategies to improve CMs related health literacy and ensure the safe use of CMs.

Complementary medicines (CMs) are widely used worldwide, with usage rates ranging from 24% to 71.3%. Despite their popularity, many CMs lack robust scientific support and can potentially lead to adverse health effects. Limited research exists on CMs-related adverse events and the role of CMs’ labels in conveying crucial information to consumers. This cross-sectional study investigated the usage, consumer perspectives, and influence of labels specifically on product-based CMs, including nutritional supplements, vitamins, minerals, probiotics, prebiotics, and herbal medicines. Practitioner-led therapies and mind-body practices were outside the scope of this research. Data were collected through an online questionnaire and analyzed using descriptive statistics and correlation analysis. The study enrolled 125 participants who were current CMs users. Pharmacies and supermarkets were the primary sources for CMs procurement. Participants’ perceptions of CMs effectiveness and safety were positively correlated. Label warnings prompted participants to seek additional information, but consultation with healthcare professionals was infrequent. Adverse reactions were reported by 18.5% of participants, with self-management approaches being common. Label warnings play a significant role in prompting consumers to seek more information about CMs. However, the limited engagement of healthcare professionals, especially pharmacists, suggests an opportunity for improved consumer education and pharmacist involvement in CMs-related discussions. Addressing these aspects can lead to safer CMs practices and informed decision-making among consumers.

Background: Recent studies produced conflicting results on the suitability of repackaging dabigatran etexilate (Pradaxa) capsules in dose administration aids (DAAs).Aim: To determine the stability of Pradaxa capsules in climate zones II (25°C and 60% relative humidity [RH]) and IVa (30°C and 65% RH).Method: Pradaxa 110 mg capsules were subjected to two storage conditions (25°C/60% RH and 30°C/65% RH) in both the original packaging and after repackaging into Webster packs. Content assay, appearance, pH, and dissolution profile of capsules were determined at baseline, and 2 and 4 weeks after storage. Ethics approval was not required for this research article as it was a stability study and did not contain human participants or human data.Results: Dabigatran etexilate content (± standard deviation) decreased significantly after 4 weeks of storage in DAAs at 30°C/65% RH (87.7% ± 4.4%). In addition, the amount of dabigatran etexilate released from the capsules at 45 min was significantly lower for capsules repackaged in DAAs and stored at 30°C/65% RH at both time points. Considerable changes in the appearance of capsule content were also observed following storage at 30°C/65% RH for 4 weeks in DAAs. There were no significant changes to dissolution profile or drug content of capsules repackaged and stored at 25°C/60% RH. No significant changes in the pH of dabigatran etexilate solutions were observed.Conclusion: Repackaging impacts the chemical stability of dabigatran etexilate if the DAAs are exposed to climate zone IVa conditions. Although repackaged dabigatran etexilate stored at 25°C/60% RH appears to be stable, caution should be exercised if these DAAs are to be stored at ambient room conditions due to the inability to guarantee humidity levels.

Background: Complementary and alternative medicines (CAM) are widely used, with pharmacies accounting for a significant share of the distribution market. Despite their popularity, many CAMs lack scientific evidence for effectiveness, and some can cause adverse health effects. Limited research exists on CAM-related adverse events and the effectiveness of CAM labels in conveying crucial information. Methods: This cross-sectional study aimed to investigate CAM utilization, consumer perspectives, and the influence of labels on CAM usage in Melbourne, Australia. Data were collected through an online questionnaire and analysed using descriptive statistics, Pearson's correlation, MANOVA, and regression analyses. Results: The study enrolled 125 current CAM users, primarily recruited from pharmacy and supermarket customers (age: predominantly 31-50; gender: 20.8% male, 79.2% female). Participants' perceptions of effectiveness and safety were positively correlated. Label warnings prompted information-seeking, but consultation with healthcare professionals (HCPs), particularly pharmacists, was infrequent (24%). Adverse reactions were reported by 18.5% of participants, with 8.3% experiencing severe reactions. The analysis revealed relationships between CAM usage and demographics. Ordinal logistic regression showed a significant association between calcium consumption and higher age groups (coefficient = 1.658, p = 0.006), while binary logistic regression identified higher iron consumption among females (coefficient = 2.177, p = 0.007). Conclusions: Label warnings significantly prompted consumers to seek more information about CAMs. However, a limited engagement of HCPs, especially pharmacists, suggests an opportunity for improved consumer education and pharmacist involvement in CAMs-related discussions. The findings highlight demographic influences on CAM usage being essential for developing targeted health interventions and policies. Addressing these aspects may lead to safer CAM practices and informed consumer decision-making.

Background: Dose administration aids (DAAs) or multi-compartment compliance aids are commonly used to organise doses of medications in accordance with a patient’s dosing schedule. Despite their widespread use, there is a paucity of information on the stability of repackaged medications in DAAs. Objectives: The objectives of this work were to evaluate stability studies conducted on repackaged medicine in DAAs and to provide a summary of the latest stability data available. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed on studies associated with repackaged medications in DAAs and drug stability. PubMed, CINAHL, EMBASE and SCOPUS were searched from January 1998 to June 2021. Key findings: A total of 342 articles were retrieved and 29 articles met the inclusion criteria. Data regarding medications from the reviewed papers were reported according to stability testing and physicochemical properties. The extracted data were then compared with stability information on DAA provision available on the database in the UK. This review identified several discrepancies between this dataset and reported stability and reveals a significant shortage in the stability data of medications repackaged in DAAs. Conclusion: This review highlights the need for further studies to be conducted to better understand the impact of DAA repackaging on the stability, safety and efficacy of medications. It is recommended that a database of stability information of repackaged medications via systematic stability testing studies could be established, serving as a valuable resource for pharmacists when preparing DAAs without compromising patient safety.