1) Chinese manufactured generic drugs & 2) drug regulations

[onebir]

1) I was recently prescribed some antibiotics. The doc said there were two kinds, imported (RMB160) and Chinese made (40RMB). Sounds like a no-brainer, but she recommended the imported version - she said the molecules of the locally made version tended to be in larger clumps, were less easily absorbed, and more likely to cause side effects. (And this wasn't to make the hospital more money - she later got me some for free somehow (sh))

I doubt very much these differences exist for all drugs - it probably only affects newer ones, or those with more complex manufacturing processes. But it's probably worth asking the doc about if you're prescribed any western medicine you've never heard of before...

2) Before actually taking up that prescription, I was prescribed two different quinolone antibiotics which had both been taken off the market in the US due to reports about serious permanent side effects (neuropathy, and tendon rupture). Despite the fact there's research (in Chinese) indicating that the safer drug I was finally prescribed should be effective against the (likely) relevant bacteria, and that the doctors prescribing it were specialists, the more dangerous drugs still seem to be agents of choice.

So if you get prescribed western medicine here, it might be an idea to google it before deciding whether you want to take it - the drug regulators seem to be a good few steps behind on monitoring side effects, and getting that information out to the medical profession. Given this could be done quite well by monitoring and translating US/European regulatory bulletins, this is a crying shame. Particularly in a country this size where hundreds of people could be suffering permanent damage as a result of side effects with very low incidence.

[Lugubert]

1) I suppose this refers to crystals. If a drug appears as large crystals, these necessarily are absorbed slower. Smaller crystals (= more crystals, and a larger area of exposure to body fluids) could thus cause blood concentrations peaks that will lead to more adverse reactions. After a few days of therapy, the difference might be minimal.

2) The most serious problems of quinolones are with young persons, because of their immature cartilage. Otherwise, they sometimes do wonders. They shouldn't, however, be used automatically and/or indiscriminately when there are alternatives, because of the serious possibility of contributing to bacteria antibiotics resistance.

Anecdote, but anyhow: My ex-fiancée had a serious respiratory tract infection with a temperature of ca. 42 deg C (ca. 108 F) during holidays in Greece. Afterwards, doctors said that at the point of admittance, they weren't certain that they could save her. Quinolones (ciprofloxacin) were instrumental in the success.

[cdn_in_bj]

We were recently given the flu shot at work. The nurses were quite proud to point out that they were using the imported shot made by Sanofi-Avantis (and which cost 70 RMB per dosage), and showed us the packaging as "proof". They said the domestically-produced flu shot had more chance of side-effects. Sure enough, I only suffered some minor soreness which went away the same day, and so far I have not gotten the flu either (knock on wood).

With regards to antibiotics, I find that doctors here are very quick to administer antibiotic drips for seemingly minor infections. Is this a matter of doing things the "quick and easy way"?

[Madot]

Not sure if this is the best thread for this question, but here goes...

Allergic to all but 2 antibiotics, I brouight those with me last time I went to China for 3 months. Having run out, however, I needed a repeat and had the Devil's own time trying to get it. Eventually, a friend got it for me from one of the foreign clinics far away from the uni in downtown Beijing. The simple one week course of a common antibiotic cost $100. My question is-- how else can you get specific antibiotics? With the help of translator-friends I visited dozens of pharmacies, but they said they didn't have Western medicines. And this was in BJ! I am now planning to go to Zhengzhou for 3 months. What is one supposed to do? I have gathered that there is jno primary health care system. If you are ill, you go to the Chinese medicine doctor (at the pharmacy) and if you are VERY ill, you go to the hospital, but with limited Chinese... Any suggestions?

Thanks.

Mado:help

[onebir]

I suppose this refers to crystals. If a drug appears as large crystals, these necessarily are absorbed slower. Smaller crystals (= more crystals, and a larger area of exposure to body fluids) could thus cause blood concentrations peaks that will lead to more adverse reactions.

My doctor friend made the opposite point - larger crystals make for poorer absorbtion, & I guess in the case of anti-biotics, higher concentrations in gastric juice & more GI side effects. But I guess with crystal size it could cut both ways. Other things the domestic producers could get wrong are impurities and in some cases chirality of the final product. (Chemists could probably add a few points.)

They [quinolones] shouldn't, however, be used automatically and/or indiscriminately when there are alternatives, because of the serious possibility of contributing to bacteria antibiotics resistance.

Some of their side effects, although rare according to the collected statistics - which are probably subject to significant under-recording - are permanent & disabling. Why use them as first line treatments in non-life-threatening situations?

[onebir]

Allergic to all but 2 antibiotics

... I am now planning to go to Zhengzhou for 3 months. What is one supposed to do? I have gathered that there is jno primary health care system. If you are ill, you go to the Chinese medicine doctor (at the pharmacy) and if you are VERY ill, you go to the hospital, but with limited Chinese... Any suggestions?

Madot, my recent investigation suggests there are hundreds of antibiotics out there - are you sure you're allergic to all but two? There's a good chance you're not allergic to other antibiotics in the same class, which should widen your choice a bit.

If you google for the "[name of the antibiotic that's are ok for you] 中国" the results will generally include the chinese name - look for the same characters repeated over and over. Then print out (or perhaps get a friend to write it down for you).

Looking at your unfortunate story, I think the problem could be the kind of pharmacies you went to. Here in Kunming, the hospital pharmacies seem to have a pretty wide range of western medicines. Getting a repeat should just be a matter of turning up with the name of the drug in chinese (plus perhaps an explanation) & showing it to a doc so you can get a prescription. Might be an idea to bring someone along to translate for, especially the first time - the procedure's a bit confusing - or if you need to communicate anything more than "I need X" to the doc. The pharmacies in Kunming don't have docs, so hospital docs seem to be used to treating quite minor things. I imagine Zhengzhou's the same, so don't feel you need to be very ill to go to a hospital.

[Madot]

Dear Onebir,

Thanks SO much! Really appreciate the advice!

I was warned by my family doctor to only take 2 particular antibiotics because the others either caused rashes or serious gastro effects, but if I can google and get the Chinese name, I should be okay. There should be someone who can come to the hospital pharmacy with me to help with the language and as a respected 'foreign expert' in a relatively 'small' city, I suspect I'll get better treatment than I did as an anonymous student in BJ. Thanks again.

Mado

[xianu]

This may not be the appropriate place to post this, but this thread makes me wonder how much of this recommending to take the western medicines come from the belief that imported goods in general are better than domestic (Chinese made) stuff. Sort of like anything that is made or sold in China is going to be inferior to stuff that is either imported or is made for export (out of China). Way back in the 90's everyone - Chinese included - said that Qingdao made for export was better tasting (i read "better quality") than the stuff they save for domestic distribution. Not having lived in China for a very long time, I wonder if this perception still exists? Or is this perception still valid? For some stuff, like clothing, or beer, I really don't care if it is "export" or "international" quality, but for things like antibiotics and drugs, I kind of would rather err on the side of caution. Any ideas?

[onebir]

Madot - another thing, head for the "shi di yi renmin yiyuan" (市第一人民医院) or "sheng di yi renmin yiyuan" (省第一人民医院), unless advised otherwise by people in Zhengzhou - these should be the best hospitals around. & if possible find someone with hospital guanxi to take you along; it'll save a lot of hassle with queues.

Way back in the 90's everyone - Chinese included - said that Qingdao made for export was better tasting (i read "better quality") than the stuff they save for domestic distribution. Not having lived in China for a very long time, I wonder if this perception still exists?

I saw shops called "export clothing" in Beijing in 06, so that (general) perception was still around then. Doubt it's changed much in the last 18 months...

[cdn_in_bj]

Not having lived in China for a very long time, I wonder if this perception still exists? Or is this perception still valid? For some stuff, like clothing, or beer, I really don't care if it is "export" or "international" quality, but for things like antibiotics and drugs, I kind of would rather err on the side of caution. Any ideas?

It's no secret that regulations here are poorly enforced, not to mention the people doing the regulating being easily "influenced". And the fiascos from not too long ago where people unfortunately died after being given fake antibiotic drips (in hospitals) as well as the official in charge of the drug regulation who was sentenced to death for taking bribes to approve new drugs just reinforces this. Why take the risk? If the imported version isn't available, at least go with locally-made drugs that are produced by international drug companies (Bayer, etc.).