Acetylcysteine: Bolehkah digerus? 

Formularium Nasional (ForNas) yang memuat daftar obat-obat, yang nampaknya ditujukan untuk menjadi standar terapi pasien BPJS, hanya memuat codeine dan acetylcysteine sebagai obat-obatan untuk berbagai jenis batuk. Hal ini sering menyulitkan, utamanya untuk fasilitas kesehatan yang memang mau patuh 100% dengan ForNas. Dokter-dokter Indonesia sangat suka memberikan obat-obat racikan untuk penyakit-penyakit seperti batuk ini, meskipun sediaan obat batuk sangat banyak yang telah diproduksi pabrik-pabrik farmasi. 

Masalah yang timbul dengan penggantian acetylcysteine dalam racikan obat batuk adalah, menurut beberapa apoteker, acetcysteine tidak boleh diracik. Kestabilan sediaan menjadi alasan utama untuk hal ini. Alasan ini kemungkinan berdasarkan satu keterangan dalam buku Martindale yang seperti ini: 


Di Martindale edisi 36 disebutkan bahwa acetylcysteine tidak tercampurkan dengan oksigen. Sepertinya, pasal ini yang jadi acuan apoteker yang berpendapat acetylcysteine tidak boleh digerus dalam racikan. 

Namun pabrikan farmasi ternyata tidak membuat sediaan acetylcysteine dalam bentuk khusus, seperti tablet salut selaput misalnya, yang akan melindungi zat aktif dari oksigen. Sediaan Fluimucil misalnya tersedia dalam bentuk granul. Bentuk sediaan granul tentunya tidak melindungi acetylcysteine dari paparan oksigen. 

Data lain dari Inggris menjelaskan masalah utama dari acetylcysteine adalah rasanya yang pahit dan tidak enak. Namun ternyata acetylcysteine juga sudah dibuat dalam bentuk tablet effervescent yang dilarutkan dalam air supaya keluar gelembung-gelembung CO2nya sebelum diminum. 

Pendapat saya pribadi untuk saat ini adalah acetylcysteine boleh digerus dalam obat racikan. Mengingat rasanya yang pahit, perlu ditambahkan adjuvant untuk memperbaiki rasanya. 

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Are You an Owner?

When you are sure enough something is yours, are you brave enough to let other people took it from you? 

When you already poured out everything on something that you believe it is yours, are you feel free enough to give it to someone else?

Today I watched a movie. For me, it is a scariest movie I ever watched. It is about a husband, a father of one boy who blind since his chilhood. He worked as a phone caller on a property company. One morning he experienced miracle. He can see. Something like tumor in his brain have gone, and its effect is his sight is restored. He grateful for that. However, soon after he got his sight, everything that he has becomes not right. He left his home, he abandoned his wife and his son. Since he performed very well in his company, he got promotion. He became rich person that owns almost everything. He found new girl and starting his new life in his new apartment. 

Soon after that, all people from her former life gone, his family first and then his friends. He changed it with a new life, a new family, new friends. 

He felt alright at that time until his sight gradually decrease again. No good explanatiom from medical doctor about that. He was afraid and he started to cry to god. But, it seems that his time is over. He was blind again. His new girl friend abandoned him. He tried to comeback to his old family and his old friends, but they changed. They can’t accept him as before. Finally, he lost again. He lost his sight, his families and friends. 

That kind of losses haunts me everyday. When I open up my messenger and find that I will loose something that very meaningful to me soon, I’m just crying inside my heart. I know my time is nearly over. I don’t want it happens soon, but I can’t hold it. I will loose it. 

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