Medicine availability in Thailand

[davhend25]

Hello all,

 

I am currently trying to find a fast acting nitroglycerin product, either tablets or spray.  What I am being told by my local pharmacy and a large pharmacy in Bangkok, is that these particular products, i.e. Nitrostat, Nitroject, Nitromint, are no longer being imported into Thailand. 

 

What exactly does this mean? Does it mean that these products are no longer legal in Thailand, or just that there are no companies willing to import them for general distribution. Why couldn't a local pharmacy order the product for me from another country where they are available? 

 

Sorry if these are dumb questions.

 

The longer acting forms of this drug are something totally different. They seem to be readily available here, i.e., Nitroderm TTS transdermal patches, Hartsorb (Isosorbide Dinitrate) but these take 30 minutes to several hours to work, and are not practical for regular exercise (on demand) or emergency applications. I don't leave my house without a small bottle of nitroglycerin tablets in my pocket. 

 

Any information about the importation question would be helpful. They are prescription medications in most parts of the world, so ordering online will probably not be possible, unless I can get a prescription locally here in Thailand. But would my ordering online even be legal?

 

Thanks in advance for any replies.

 

DH

 

[bert bloggs]

The sprays have not been available for years ,like nitralingual but you can get isorem 5 or 10mg to put under your tongue ,they are fast acting and cheap ,you can get them at Farcino in Pattaya no problem .

[Sheryl]

It means the manufacturer no longer imports them here, probably because of low sales. May also mean the product is no longer registered here, there are fees manufacturer has to pay to keep something ion market.

 

A pharmacy cannot readily just import something, very complicated process and might even be impossible if the manufacturer has opted not to keep the product registered here.

 

Re ordering online: it is nto technically legal to import a medication for personal use by mail as any import other than bringing it in with you when you come requires an FDA license, which you cannot get. However in practice, customs usually lets small quantitites of non-control drugs through if sent by regular mail (definitely not a courier).

 

 

[moontang]

I found WWW.DRUGS.COM to be a helpful tool in figuring out the pharmacy maze...it is country specific.

[davhend25]

3 hours ago, bert bloggs said:

The sprays have not been available for years ,like nitralingual but you can get isorem 5 or 10mg to put under your tongue ,they are fast acting and cheap ,you can get them at Farcino in Pattaya no problem .

Thanks for your kind reply to my question. "Isorem," however, is not a fastest acting form of nitroglycerin. I took this drug many years ago after my first heart attack at the age of 34.

 

My present research indicates a sublingual form that you mention, which does work more quickly than the extended release version, but is still not the immediate action of the nitro spray or tablet. The available transdermal patch would have the same limitations as the Isorem.

 

I'm still scratching my head as to why this quick acting medication is not available here. Heart disease, and its associated pain manifestations, must not be the problem in Thailand that it is in the U.S. and other more affluent countries. Which, by the way, is a good thing.

 

Thanks again for your helpful reply. 

 

DH

 

[Sheryl]

Oh, there is plenty of heart disease here.

 

Thai doctors just do not tend to use ntg.

 

I really don't know why,

[moontang]

here is the site specifically for HCP to figure out and cross reference pharmacy matters:  https://www.mims.com  It is specific to Thailand.

Edited June 9, 2018 by moontang

[davhend25]

1 hour ago, Sheryl said:

Oh, there is plenty of heart disease here.

 

Thai doctors just do not tend to use ntg.

 

I really don't know why,

Thanks as always, Sheryl, for the answers to my questions regarding the general availability of fast acting nitroglycerin here in Thailand. And what "no importation" actually means. And why local pharmacies here will not (can not) order it.

 

Especially in a country where so much of the population are distanced from quality emergency care, the lack of this self-treatment (potentially life saving) option is incomprehensible. 

 

Also, thanks for the "heads up" on my ordering it online and having it mailed to me here. 

I'll keep that in mind if I am able to eventually do this.

 

And here I thought getting my insulins was going to be my major problem retiring here. I could never have imagined that nitro tabs wouldn't be available.

 

Unfortunately, if I can't source this medicine here, I will have to finish my retirement back in the U.S. I can't continue to live here without it.  Especially when the nearest hospital is nearly an hour away and we don't own a car. 

 

Thanks again for the wonderful advice you supply, to the forum members here, on medical issues. I can assure you that it is much appreciated!

 

DH

 

 

 

 

[davhend25]

3 hours ago, moontang said:

I found WWW.DRUGS.COM to be a helpful tool in figuring out the pharmacy maze...it is country specific.

Yes, this is a great website for drug related information. I have used it many times. Thanks for mentioning it.

 

DH

 

[davhend25]

1 hour ago, moontang said:

here is the site specifically for HCP to figure out and cross reference pharmacy matters:  https://www.mims.com  It is specific to Thailand.

Thanks again. I am also familiar with this site, which, by the way, shows "Nitromint" as an available medicine in Thailand.

 

Thanks,

 

DH

 

[bert bloggs]

On 6/9/2018 at 9:30 PM, davhend25 said:

Thanks for your kind reply to my question. "Isorem," however, is not a fastest acting form of nitroglycerin. I took this drug many years ago after my first heart attack at the age of 34.

 

My present research indicates a sublingual form that you mention, which does work more quickly than the extended release version, but is still not the immediate action of the nitro spray or tablet. The available transdermal patch would have the same limitations as the Isorem.

 

I'm still scratching my head as to why this quick acting medication is not available here. Heart disease, and its associated pain manifestations, must not be the problem in Thailand that it is in the U.S. and other more affluent countries. Which, by the way, is a good thing.

 

Thanks again for your helpful reply. 

 

DH

 

Hi ,i myself had a heart attack in my 30s and a by pass almost 30 years ago ,luckily my doctor in the UK still supplies me with nitroglycarin spray ,and my familly send it or i pick it up when i go over ,but i am suprised that you dont find isorem quick acting , after i "discovered" it here in Thailand i find it very quick ,luckily i seem to still not have much of a problem with angina ,so perhaps i am just one of the lucky ones.

[Sheryl]

Thanks as always, Sheryl, for the answers to my questions regarding the general availability of fast acting nitroglycerin here in Thailand. And what "no importation" actually means. And why local pharmacies here will not (can not) order it.
 
Especially in a country where so much of the population are distanced from quality emergency care, the lack of this self-treatment (potentially life saving) option is incomprehensible. 
 
Also, thanks for the "heads up" on my ordering it online and having it mailed to me here. 
I'll keep that in mind if I am able to eventually do this.
 
And here I thought getting my insulins was going to be my major problem retiring here. I could never have imagined that nitro tabs wouldn't be available.
 
Unfortunately, if I can't source this medicine here, I will have to finish my retirement back in the U.S. I can't continue to live here without it.  Especially when the nearest hospital is nearly an hour away and we don't own a car. 
 
Thanks again for the wonderful advice you supply, to the forum members here, on medical issues. I can assure you that it is much appreciated!
 
DH
 
 
 
 

Living an hour away from the nearest hospital without a car is in any case a bad idea, especially for someone with known heart condition.

Emergency services in Thailand are basic at best. Nothing at all like in the west. Often what will respond is a pick up truck. Even if an actual ambulance it will not be equipped and staffed for the level of emergency care normal in the West.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[NickJ]

What about finding out if it is available in Malaysia or Singapore. Fly there and buy a large supply.

[davhend25]

1 hour ago, bert bloggs said:

Hi ,i myself had a heart attack in my 30s and a by pass almost 30 years ago ,luckily my doctor in the UK still supplies me with nitroglycarin spray ,and my familly send it or i pick it up when i go over ,but i am suprised that you dont find isorem quick acting , after i "discovered" it here in Thailand i find it very quick ,luckily i seem to still not have much of a problem with angina ,so perhaps i am just one of the lucky ones.

Hello, yes, my 2nd bypass was 22 years ago. It left me with a small artery that subsequently couldn't be stented because of its small size, but basically it was a good operation. I have angina with a certain amount of exercise. It's very predictable and mild if I pop a nitro tab under my tongue. I can then continue my treadmill walk pain free. I rarely need the nitro in everyday life, but always carry it to be safe. 

 

My health plan (Medicare and a retirement supplement plan) in the U.S. doesn't cover prescription medication if I am outside the U.S. So there is no way my family can get this medication to send to me. Fortunately, I had built up a stockpile of this before I came here and still have a pretty good supply, but since I exercise everyday I use one tablet every day and eventually I will run out.

 

I have never tried Isorem or Hartsorb which I believe is the same generic medicine, Isosorbide Dinitrate, but it is not quite the same as straight up sublingual nitroglycerin in terms of speed of action. However, the sublingual forms of this drug apparently are quicker acting than the oral forms or the nitro patches that are available here in Thailand.

 

I am going to try and get some Hartsorb sublingual and try it before exercise. It might do the trick and let me preserve my regular nitro to carry for emergencies.

 

Thank you for your reply. I think you may be right with regard to Isorem/Hartsorb as an effective alternative for my situation.

 

DH

 

 

 

 

 

[davhend25]

16 minutes ago, NickJ said:

What about finding out if it is available in Malaysia or Singapore. Fly there and buy a large supply.

Not a bad idea...I hadn't really thought about that.  Certainly better than flying back to the U.S. lol. 

 

Thanks for the suggestion!

 

DH

 

[davhend25]

32 minutes ago, Sheryl said:

Living an hour away from the nearest hospital without a car is in any case a bad idea, especially for someone with known heart condition.

Emergency services in Thailand are basic at best. Nothing at all like in the west. Often what will respond is a pick up truck. Even if an actual ambulance it will not be equipped and staffed for the level of emergency care normal in the West.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

100% agreed, Sheryl.

 

It is, and has been, my biggest concern since coming here.

 

My Thai wife and I are currently looking for a place in or close to Pattaya. They seem to have some decent hospitals there, and it would also be much closer to Bangkok.

 

But your point is well taken.

 

Thank you.

 

DH