Monday, 21 April 2014

Oh how I love the Germans and their ingenious organic chemists!

I've come across three painkillers that the Germans use that we don't (and by "we", I mean Aussy and other English-speaking countries); albeit these drugs are also used in other non-English speaking countries, I'm picking on Germany as these three drugs are all used in this country and are all prescription-only medicines there. They were also all first synthesised there. Plus Germany is, according to the United Nations, the 2nd most developed country with a population of over 50 million (1st is the US) in the world.1 If you'd like some more information about Germany I might as well give you some while I'm talking about it.

Some background on Germany

Germany has a population of 81 million (which is the highest population of any country in all the European Union) and its population has been fairly stable over the past few years. Its currency is the Euro (€), they drive on the right, they speak German (funny eh?; it belongs to the same family as English, Dutch and Afrikaans, that is, the West Germanic languages); its Government is similar to the U.S.'s in that they do have presidents (whom is presently, Joachim Gauck), although they also have chancellors; its capital and largest city is Berlin (~3.5 million people), 2nd largest is Hamburg (~1.8 million) and 3rd largest is Munich (~1.35 million). It has 16 states and has a free healthcare system and is also one of the places where my ancestors, the Ashkenazi Jews, lived for a significant period of time. In fact Ashkenazi is the Yiddish (a Jew language, a variant of Hebrew) word for "Germany".2
Figure 1: World Map with Germany highlighted in red
Figure 2: Albert Einstein
It's funny how we all tend to remember the worst people in Germany's past (such as Adolf Hitler, Joseph Mengele, etc.), yet they also gave us many of our greatest minds including: Albeit Einstein, Max Planck (a quantum physicist), Werner Heisenberg (a quantum physicist), Gabriel Daniel Fahrenheit (discoverer of the unit, Fahrenheit), Max Born (quantum physicist), Wilhelm Röntgen (the discovery of X rays), Otto Hahn (the discoverer of nuclear fission), Robert Koch and Ferdinand Cohn (microbiologists), Fritz Haber (a Nobel prize winning chemist), Carl Friedrich Gauss, David Hilbert, Bernhard Riemann and Gottfried Leibniz (a co-founder of calculus, along with Isaac Newton) who are all mathematicians, Friedrich Wegener (a doctor after whom Wegener's granulomatosis, a condition that causes one's immune system to attack healthy tissues, is named), Eduard Heinrich Henoch and Johann Lukas Schönlein, two famous doctors after whom the condition Henoch–Schönlein purpura is named.

Figure 3: Henoch–Schönlein purpura

Germany's healthcare system

In Germany drugs are regulated by the Federal Institute for Drugs and Medical Devices, the standard medical degree for doctors is the M.D. (Medicinae Doctor, Latin for "Teacher of Medicine" which is also the standard medical degree in the US and Canada; some Aussy universities offer it, although, most Aussy doctors have a M.B.B.S. [offered at JCU] or M.B.B.Ch. both of which are bachelor degrees that usually take 6 years to obtain; M.D. is a master's degree in effort; usually 8 years of university are required  4 years for a bachelor degree in biology/related fields that gets you into a M.D. program which is usually 4 years long) and German websites have the "top level domain" (TLD) of .de (i.e. their URL usually has .de in it). University education in Germany, is also free from what I can tell (my German friends can feel free to correct me in this or any other mistake I've made in this status). English is the most common second language in Germany. German isn't one of the six languages of the U.N.2

Figure 4:  Federal Institute for Drugs and Medical Devices logo
Figure 5:  Federal Institute for Drugs and Medical Devices

Germany's drugs

Now onto the drugs; the three painkillers that I've come across that's used in Germany but not in most English-speaking countries are metamizoletilidine and piritramide. All three of these drugs were also initially synthesised by Germans.

Metamizole (dipyrone is another name it sometimes goes by, especially in English-speaking countries), was once marketed in the U.S. and Australia, but has since been taken off the market amidst concerns that it causes potentially fatal blood disorders in between 1 in 100 and 1 in 10,000 patients (the estimate varies so much as there's a number of different variables that seem to influence this risk); it was taken off the market in English-speaking countries ~1970 but was before then (since 1922) a popular over-the-counter painkiller much like paracetamol, aspirin and ibuprofen (Nurofen). Metamizole is now a prescription-only medicine in Germany, most commonly used in the setting of severe post-surgery or internal organ-related pain. It possesses properties most similar to paracetamol; it relieves pains and fevers without much in the way of anti-inflammatory effects and also possesses some antispasmodic effects which means it is ideal for pain related to spasms (cramps) such as kidney colic.

Figure 6: Metamizole
Tilidine and piritramide are opioid painkillers (narcotic painkillers with similar properties to morphinecodeine and heroin) that are synthetic and less potent than morphine (i.e. a higher dose of these drugs is required to produce the same painkilling effect as morphine). Tilidine is a weak opioid (putting in the same class as codeine and tramadol) that is usually given orally (i.e. by mouth as a tablet/oral liquid), although rectal (i.e. suppositories) and injectable formulations are available in some countries (although not in Germany); often (especially so in Germany) in combination with naloxone (a drug that blocks the receptors the opioids use to produce their effects) in order to prevent people from abusing the drug. See naloxone is unable to enter the bloodstream to any significant degree when taken orally and hence if the drug is taken the way it is meant to be, that is, orally, it doesn't produce any significant inhibition of the opioid effects of tilidine, but if it is injected into a vein by addicts to get high it rapidly precipitates opioid withdrawal.3,4 Piritramide, on the other hand, is strong opioid that is solely given parenterally (i.e. by injection) for pain, especially for the rapid relief (within two minutes) of severe, cancer-related, operation-related or injury-related pain in adults or kids over the age of 2.5
Figure 7: Tilidine
Figure 8: Piritramide

Reference list (WP style):

  1. "Table 1: Human Development Index and its components". United Nations Development Programme. United Nations. 2012. Retrieved 22 April 2014.
  2. "The World Factbook". Central Intelligence Agency. United States Government. 11 April 2014. Retrieved 22 April 2014.
  3. "Tilidin N Sandoz® DP Lösung zum Einnehmen" (PDF). Google Drive. Wooden Churches: Sandoz Pharmaceuticals GmbH. December 2012. Retrieved 22 April 2014.
  4. Jage, J; Laufenberg-Feldmann, R; Heid, F (15 April 2008). "Medikamente zur postoperativen Schmerztherapie: Bewährtes und Neues". Der Anaesthesist (in German) (Springer) 57 (5): 491–498. doi:10.1007/s00101-008-1327-9. PMID 18409073.
  5. "FACHINFORMATION (Zusammenfassung der Merkmale des Arzneimittels)" (PDF). Janssen - Cilag Pharma GmbH (in German). November 2013. Retrieved 22 April 2014.

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