The controversial diabetic drug Avandia, alleged to cause heart attacks and strokes, is still available in the Kenyan consumer market, despite a three-year old report condemning its use in the Western world.

In interviews with The EastAfrican,The controversial diabetic drug Avandia, alleged to cause heart attacks and strokes, is still available in the Kenyan consumer market, despite a three-year old report condemning its use in the Western world. pharmacists, medical representatives and doctors confirmed that prescriptions for Avandia are still being offered to older patients.

The practice highlights loopholes in Kenya’s drug market as patient seek cheaper products and companies look to push sales.

In Uganda, though Avandia is registered by the National Drug Authority (NDA), it is not on the market.

GlaxoSmithKline country manager Nathan Wasolo said they registered the drug with NDA but did not import it for the Ugandan market.

Officials at NDA told The EastAfrican that they have both Avandia and Avandum a combination drug for diabetic patients. According to DA head of drug inspection David Nahamya, the drug has not been totally recalled but there was an alert in July 2010.

“We do not commonly prescribe it, we use the most common drugs that are affordable,” said Dr Charles Kiggundu of Nsambya hospital.

For almost a decade, Avandia was one of the most expensive drugs in the Kenyan market. It was introduced in the Kenyan market in 2000. Its initial cost was Ksh3,015.60 ($37.5) for a pack of 28 tablets. But between 2006 and this year, the price has dropped to Ksh788 ($9.85).

This has not stopped Public Health Minister Beth Mugo from urging healthcare providers to consider lowering costs and subsidising treatment.

Major pharmacies in Nairobi like Pentapharm, Lyntons, KAM, Pharmart, Transchem and Lemuma admit to keeping a limited stock of the drug for their elderly patients who they claim come to collect it mostly every month.

Avandia (Rosiglitazone) is a Type-2 drug. Type 2 diabetes occur mainly in people aged over 40 when their body either do not produce enough insulin (a hormone that regulates the blood sugar level) or ignores the insulin produced.

Avandia, like any other type 2 diabetic drug, works by making the cells more sensitive to insulin. This lowers the blood sugar level by allowing the insulin to enter into the cells.

A technician at KAM Pharmacy said he is aware of the controversy surrounding the use of the drug and advises patients who go to buy it from their stores to consult their doctor to prescribe an alternative drug.

Others like Troy Chemists, Inkamed, Pharmtrade and Sunus Chemists do not stock Avandia.

Not prescribed

A physician at Kenyatta National Hospital doctors plaza mentioned that she no longer prescribes the drug to her diabetic patients and doubts if any of the other physicians she relates to prescribe it too.

She said those still buying the drug are the ones for whom it was prescribed before but do not follow up with their doctors’ clinical appointments to be enlightened on what is happening and maybe change their medication.
According to a medical representative with Glaxo SmithKline Kenya, the drug has not been marketed for the past three years. In addition, just a few orders have been received for the Kenyan market.

In 2007, the first study and scientific analysis on Avandia conducted at the Cleveland Clinic in the US concluded that the drug causes increased risk of cardiovascular disease and heart attacks by 43 per cent.

This research finding was published in the New England Journal of Medicine which led many doctors and patients to discontinue use of the drug.

In the intensely competitive drug industry, half truths and deception are sometimes allowed to trump the facts.

Glaxo SmithKline, the manufacturers and marketers of the drug, said an extensive survey on more than 52,000 patients was conducted that showed no statistical association between Avandia and heart attacks.

Independent sources showed that GSK knew about the dangers of the drug but attempted to cover up to protect its image.

To its credit, GSK agreed to add a “black box” warning to the drug pack that the drug can cause aggravated congestive heart failure in patients.

Black box warnings are the strongest type of warnings on drugs that have significant risk, serious or life threatening negative side effects.

A recent report released by a US Senate Committee indicates that GSK concealed the information that Avandia has caused tens of thousands of heart attacks to patients who took it.

In the report, the United States Food and Drug Administration (FDA) is indicted for failing to properly regulate the drug and ignoring the truth about its dangers.

FDA officials had conducted confidential studies on Avandia and made recommendations that the drug be pulled from the market because it is unsafe.

However, the FDA advisory committee of scientists and doctors voted overwhelmingly to keep the drug in the market while acknowledging the increased risks of heart attack.

As studies continued on whether Avandia causes heart attacks, stroke and deaths, sales of the drug continued to drop over the years.

A once top-selling drug that for example sold $3.2 billion in 2006 dropped to $1.2 billion by 2009 and continues to fall to date.

As the debate on Avandia continues to rage, patients using it to control Type-2 diabetes should not quit but schedule an appointment to meet and talk to their doctors or certified diabetes educator on other possible ways of controlling blood sugar with much less risks.

Additional reporting by Esther Nakkazi