52c856691ea49210VgnVCM100000e56411acRCRDapproved/thenational/Articles/Migration/2008-Q2Lethal cocktail lies over the counter42c856691ea49210VgnVCM100000e56411ac____Lethal cocktail lies over the counterMinistry to investigate after dangerous combination of drugs sold without warning by eight chemists in nine visited by <i>The National</i>.Ministry to investigate after dangerous combination of drugs sold without warning by eight chemists in nine visited by <i>The National</i>.<p>ABU DHABI // A potentially fatal combination of Viagra pills and angina patches is being sold without prescription in pharmacies, despite a Ministry of Health warning about the dangers.
An investigation by The National has identified ignorance among some chemists in the capital of the risks associated with mixing different treatments.
In eight out of nine Abu Dhabi pharmacies visited by The National, reporters were able to buy over the counter Nitroderm TTS 5, a nitroglycerine patch used in the treatment of angina patients, and Viagra, a remedy for impotence.</p>
<p>Both drugs require prescriptions.
A ninth chemist was willing to sell a box of patches, also without a prescription. Only one of the nine mentioned raised the dangers of using treatments together.
Combining the treatments, according to medical practitioners and pharmaceutical experts, can be fatal. Pfizer, which produces Viagra, said using its drug with the angina patch can cause irreversible hypotension - a severe drop in blood pressure that can lead to cardiac arrest. This year, the health ministry warned chemists that they should sell Viagra only to those who can provide a certificate proving they do not have a heart condition.</p>
<p>Under no circumstances, the ministry said, should the pills be sold with nitroglycerine patches.
When The National informed the ministry of its findings, it was told the matter would be investigated.
Dr Essa Ahmed bin Jakka al Mansoori, the director of the ministry's Drug Control Department, said: "Pharmacists who do this are risking not only losing their licence, but deportation and imprisonment for terms varying from six months to 10 years. If proof, such as a sales receipt, can be provided to the Abu Dhabi Health Authority's investigators, then the pharmacists will be prosecuted."</p>
<p>Dr Ahmad Abd-Ellatif, a fellow at the American College of Cardiology and professor of Cardiology at Cairo's Al-Azhar University, said Viagra enhanced the effect of the nitric oxide used to treat angina, creating "a major drop in blood pressure which can be fatal for a cardiac patient".
"That is why the two [Nitroderm TTS 5 and Viagra] should never be used together. If a patient wants to use Viagra he must stop nitrates in advance," he added.</p>
<p>Dr Abd-Ellatif said even a junior pharmacist should know of the need to warn patients against combining the two treatments.
When questioned, a pharmacist who sold both treatments without warning said: "When you came and asked for both drugs together, I simply assumed that you were a doctor.
"But from now on, I will make every effort to ensure that such a failure does not occur again. It's indeed the pharmacist's responsibility to warn patients."</p>
<p>Four other pharmacies also sold the two products together, as did two chemists attached to medical centres without warning about the dangers. Another chemist was willing to sell the angina patch but refused to sell the Viagra without a prescription.
The National has retained the records of all of these transactions and has made them available to the health ministry. At one pharmacy, the chemist said he had assumed the Viagra and the Nitroderm TTS 5 were for different people.</p>
<p>"I thought that you would know that using the two together would be dangerous," he explained.
When asked about selling Viagra without a prescription, he said: "Viagra does not require a prescription." According to Dr Mansoori, at the health ministry, that is incorrect. When this was explained, the chemist replied:
"Look, handing out medication without a prescription is wrong, but I only do it for humanitarian reasons. Many people don't have health insurance and can't afford to pay Dh200 to see a doctor just to get a prescription. I thought I was helping them out, but from now on I will be more careful."</p>
<p>At another pharmacy, a staff member did warn about the dangers but still sold both treatments. He asked: "Are these going to be used by the same person?" When told they were, he immediately advised that the two together could cause irreversible hypotension. Asked what could happen, the pharmacist replied:
"You could die."
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