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A woman who bought drugs on the internet and took them for four years went blind as a result, doctors say.

The case highlights the dangers of the multimillion-pound international market in prescription medicines available from online pharmacies across the globe.The easy availability of drugs has allowed many people to bypass their doctors and self-prescribe medicines which they hope will boost their energy, improve their sex life or help them lose weight.

The 64-year-old woman from Sunderland diagnosed herself with chronic fatigue syndrome and, on the advice of a neighbour, bought oral steroids from an online pharmacy in Thailand. She later complained of loss of vision and doctors at Sunderland Eye Infirmary found cataracts in both eyes and signs of glaucoma (high pressure), both side effects of steroid use.

Dr Philip Severn and Dr Scott Fraser, consultant ophthalmologists, writing in The Lancet, warn colleagues to watch for patients who may have bought drugs online. “Some of the drug therapies can be counterfeit and contain a concoction of compounds that bear little resemblance to the drug named on the bottle,” they say.

“Even if the patient receives the actual drug, there are many problems with this unchecked availability, including interactions with coexisting treatment, side effects and the lack of careful medical monitoring.”

Popular lifestyle drugs including Viagra for impotence, Reductil for weight loss and Prozac for depression are among the biggest internet sellers. Many internet pharmacies offer online prescriptions allowing patients to consult a doctor by e-mail instead. The British Medical Association is opposed to the practice but it is not against the law.

The General Medical Council has successfully prosecuted doctors for inappropriate prescribing and failing to make adequate diagnoses over the internet.

Websites based abroad, which may use a “.co.uk” address, are not subject to British jurisdiction, and many sell medicines without a prescription as well as controlled drugs, such as stimulants and opiate-based painkillers.
The Medicines and Healthcare Products Regulatory Agency has warned of the growing problem of counterfeit drugs. Every year, the agency seizes £3m of stolen or faked Viagra, the best-selling internet drug.

Dr Fraser said he had heard of the dangers of buying drugs over the internet but it was the first time he had seen the effects. “Most patients aren’t going to say if they have bought drugs over the Net,” he said. “Buying drugs in this way is a gamble. Even if it is the right drug and it is not a counterfeit, because she wasn’t monitored, she suffered the side effects.

“I am not saying doctors must be in control of all prescriptions, but with steroids, although they are life-saving drugs, patients must be monitored because of the side effects, which included diabetes, bone loss and eye problems.”

The woman had catar-acts removed from both eyes and will require treatment for glaucoma for the rest of her life, Dr Fraser added.

The Royal Pharmaceutical Society said it was developing a register of approved online pharmacies.

Available onthe internet

* Viagra, made by Pfizer, for impotence. About £50 for four tablets. Most widely sold prescription drug on the internet.

* Xenical, made by Roche, for weight loss. About £65 for 85 capsules. Marketed as a potential panacea for the obesity epidemic.

* Prozac, made by Eli Lilley, for depression. About £20 for 30 tablets. The best known anti-depressant, with low toxicity compared to older drugs.

* Valium, made by Roche, for anxiety. About £50 for 30 tablets. Known as mother’s little helper, it is effective but addictive.

* Ritalin, made by Novartis, for attention deficit disorder. About £20 for 60 tablets. Abused by students and others to increase concentration.

* Lipitor, made by Pfizer, for high cholesterol. About £40 for 30 tablets. The world’s best-selling drug - counterfeit versions exist.

 from The Independant

Warnings
Pregnancy:
Several studies have suggested an increased risk of congenital malformations associated with the use of diazepam, chlordiazepoxide and meprobamate during the first trimester of pregnancy. Therefore, the administration of diazepam is rarely justified in women of childbearing potential. If the drug is prescribed for a woman of childbearing potential, she should be warned to contact her physician regarding discontinuation of the drug if she intends to become or suspects that she is pregnant.
Precautions
Geriatrics:
Elderly and debilitated patients or those with organic brain disorders have been found to be prone to CNS depression following even low doses. For these patients it is recommended that the dosage be limited to the smallest effective amount to preclude development of ataxia, oversedation or other possible adverse effects.

Use in emotional disorders:
Diazepam is not recommended in the treatment of psychotic or severely depressed patients. Precautions are indicated for severely depressed patients or those who show evidence of impending depression, particularly the recognition that suicidal tendencies may be present and protective measures may be necessary. Since excitement and other paradoxical reactions may result from the use of the drug in psychotic patients, it should not be used in ambulatory patients suspected of having psychotic tendencies.

Use in epileptic patients:
Since diazepam may exacerbate grand mal seizures in some patients, caution is required when it is used in epileptic patients. An adjustment may be necessary in their anticonvulsive medication. Abrupt withdrawal of diazepam in these patients should also be avoided.

Potentiation of drug effects:
Patients should be advised to abstain from alcohol and other CNS depressant drugs during treatment with diazepam. Phenothiazines, barbiturates, MAO inhibitors and other psychoactive drugs may potentiate the action of the drug and should not usually be given concurrently.

Drug dependence:
Abrupt cessation of large doses of diazepam after prolonged periods may precipitate acute withdrawal symptoms and, in these cases, the drug should be discontinued gradually. Caution should be exercised when it is considered necessary to administer diazepam to addiction prone individuals.

Occupational Hazards:
Patients receiving diazepam should be advised to proceed cautiously whenever mental alertness and physical coordination are required.

The usual precautions in treating patients with impaired renal and hepatic functions should be observed. If diazepam is administered for protracted periods, periodic blood counts and liver function tests would be highly advisable.
Adverse Effects
The most common adverse effects reported are drowsiness and ataxia. Other reactions noted less frequently are fatigue, dizziness, nausea, blurred vision, diplopia, vertigo, headache, slurred speech, tremors, hypoactivity, dysarthria, euphoria, impairment of memory, confusion, depression, incontinence or urinary retention, constipation, skin rash, generalized exfoliative dermatitis, hypotension, changes in libido.

The more serious adverse reactions occasionally reported are leukopenia, jaundice, hypersensitivity and paradoxical reactions.

Paradoxical reactions such as hyperexcited states, anxiety, excitement, hallucinations, increased muscle spasticity, insomnia, rage, as well as sleep disturbances and stimulation, have been reported; should these occur, the drug should be discontinued.

Minor changes in EEG patterns have been observed in patients on diazepam therapy. These changes consist of low to moderate voltage fast activity, 20 to 30 cycles/second and are of no known significance.
Overdose
Symptoms:
Drowsiness, oversedation and ataxia. When the effects of drug overdosage begin to wear off, the patient exhibits some jitteriness and overstimulation. The cardinal manifestations of overdosage are drowsiness and confusion, reduced reflexes and coma. There are minimum effects on respiration, pulse and blood pressure unless the overdosage is extreme.

Treatment:
Gastric lavage may be beneficial if performed soon after oral ingestion of diazepam. If necessary, a CNS stimulant such as caffeine or methylphenidate may be administered with caution. Supportive measures should be instituted as indicated, such as, maintenance of an adequate airway, levarterenol for hypotension. Dialysis appears to be of little value.

Anxiolytic - Sedative - Muscle Relaxant

Diazepam is a benzodiazepine with CNS depressant properties and a somewhat flatter dose-response slope than the sedative-hypnotic drugs. In laboratory animals, it produces, in varying doses, taming, disinhibitory, sedative, anticonvulsant, muscle relaxant, ataxic and hypnotic effects.

Diazepam is relatively devoid of autonomic effects and does not significantly reduce locomotor activity at low doses, or depress amphetamine-induced excitation. In high doses, it activates the drug metabolizing enzymes in the liver. Diazepam also possesses dependence liability and may produce withdrawal symptoms, but has a wide margin of safety against poisoning.

Metabolism studies in animals and man have indicated that oral diazepam is rapidly absorbed from the gastrointestinal tract. Peak blood levels are reached within 1-2 hours after administration. The acute half-life is 6-8 hours with a slower decline thereafter, possibly due to tissue storage.

In humans, comparable blood levels of diazepam were obtained in maternal and cord blood indicating placental transfer of the drug. Diazepam may appear in human breast milk.

With the parenteral form, peak blood levels are reached within 15 minutes after i.v. administration and are of the same magnitude as after oral administration. The respective half-life is approximately 2-3 hours.

The distribution and fate of tritium-labeled diazepam in man has indicated that the drug has a rapid and extensive uptake by tissues. Although the radioactivity in the blood appears to represent mainly the intact drug, diazepam was shown to be excreted exclusively in the form of its metabolites. The two major metabolites are oxazepam glucuronide and N-desmethylated diazepam.