4 DISCUSSION
To the authors´ best knowledge, the current study is considered the first of its kind in Yemen on the availability of the two banned drugs in the CPs. Likewise, no official document from the High Authority for Medicines was found that prohibited their use in the Yemeni CPs. The PP is dispensed informally in the CPs under the name of Sharbat Alkhat . Although the name is different, the active ingredient is the same. Additionally, KZ is sold in most pharmacies without any restrictions on its use.
The data from one study revealed that the infrequent use of PP did not increase the risk of some types of cancers that were identified in animal studies (ovarian cancer, kidney cancer, leukemia, and lymphoma). However, this study could not verify the risks of using PP on average once a week for no less than two years. The study’s authors thought that level of use could increase the risk of developing some types of cancer [16]. The percentage of CPs dispensing PP is considerable lower than the percentage dispensing KZ.
The data from the present study revealed that the percentage of pharmacies keeping and selling KZ is high (n=31, 62% of CPs sold it) in comparison to PP. KZ was approved in 1981 as an oral antifungal drug and since that time it has been recognized to cause liver damage or impairment. Studies determined that the hepatic injury was the result of direct hepatocellular toxicity rather than immunologically intermediated effects. The active metabolite of KZ, N-desacetyl-ketoconazole, may be responsible for the hepatic damage and toxicity as shown in experimental models. However, that toxicity is related to its dosage, concentration and period of application [17]. Nevertheless, information that has been gathered to the present time and published in the biomedical studies shows that KZ is occasionally a quantitatively significant offending medicine that can trigger a process of drug-related liver damage and even liver failure.
The study would like to recommend the following:
  1. The health ministry should issue an official document to limit the import of these medicines into the country and prevent their dispensation in the CPs.
  2. The Ministry of Health needs to organize a periodic inspection committee to monitor the dispensing of these drugs.
  3. The community pharmacists should be made aware of the potential health hazards associated with the long-term use of banned medicines.
  4. The list of banned drugs should be periodically renewed and provided to the CPs.
  5. The students in the Faculty of Medicine and Health Sciences should be educated about the risk of using the banned medicines.