Be careful with certain hospitals and KETOConazole!

[expatjustice]

TO MODERATOR: I have removed any and all mentions to the hospital in question. Also this post could save others from being given a medicine which can potentially cause permanent liver damage!

 

Well here's the story. 

 

We went to A CERTAIN HOSPITAL in Bangkok (not gonna mention the name) for an outpatient consultation at the gynecology department. Miss hadn't been feeling that well down there for a couple of days, and the diagnosis at the hospital was that it was vaginal infection caused by the fungus candida albicans (also known as candidiasis). Pretty simple thing, really. 

 

The whole visit took less than an hour, they gave her some prescriptions and we left back home. So far so good... 

 

Now, here things do start to go wrong. After just 2 days taking the pills strictly as indicated in the prescription she started constantly feeling nauseous, her skin which is under normal circumstances fairly white turn yellowish (almost like Spongebob, lol), and even the white in her eyes turned completely yellow (a condition called jaundice). Then on the third day she started vomiting, and vomited at least 3 times in a single day. 

 

Now I didn't even bother to check the pills that they had given her, because it is not our task since we are not medical professionals and they were given by one, so we though we should trust them. Now the fun thing starts, I decided to ask my aunt back in my home country who is a doctor (General Medicine to be more accurate). And much to our astonishment her reply was that this particular medicine had several warnings by the American FDA and their European counterpart that it should only be given when there are no other options, since the drug is quite strong and can cause liver damage!!! Upon further research at Google, I found out that the drug in question was completely banned by the Chinese CFDA! The medicine in question is Fungazol/Nizarol (which is made of KETOconazole)

 

Here I will attach pictures of the prescription, the pills, and evidence that this drug is not to be given for whatever reason. It was her first occurrence of such infection and she had not had tried any other drug for treating it, this was the first one. 

 

To sum up, sometimes using a tank to kill a fly is not the best way to do it. So if you ever are given this drug, or know someone who has, please be very careful, IT IS a serious matter.

 

 

 

------- SOURCES ------- 

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-prescribing-nizoral-ketoconazole-oral-tablets-unapproved

 

https://www.medscape.com/viewarticle/863550

[Oldie]

"Now I didn't even bother to check the pills that they had given her, because it is not our task since we are not medical professionals and they were given by one, so we though we should trust them."

 

Always check what they give you. Check what can happen if you take other medications in addition. Check what happens if you drink alcohol while taking the medication. And check what happens if you drink juices that contain for instance grapefruit, cranberry, orange or apple juice or if you eat such fruits. Especially grapefruit can alter how some medication works. And last but not least - check if you can't get the medication cheaper outside of the clinic. 

[Sheryl]

What you attach is not "evidence that this drug is not to be given for whatever reason". It is advice that it should be used only for serious fungal infections for which no other treatment is available/effective. Very, very different. There is no need to exaggerate. Some people do indeed need to take it. (And majority do not suffer ill effects).

 

That said, there are topical treatments (vaginal suppositories) that can treat vaginal candidiasis and work in most cases and that should certainly have been tried first before resorting to systemic  anti-fungal with the attendant risks.

 

I hope your GF is now being monitored by a liver specialist.

 

I do find that Thai doctors tend to be dismissive of drug adverse effects, contraindications etc  and it is important to do your own research before taking any medication.

[expatjustice]

1 hour ago, Sheryl said:

What you attach is not "evidence that this drug is not to be given for whatever reason". It is advice that it should be used only for serious fungal infections for which no other treatment is available/effective. Very, very different. There is no need to exaggerate. Some people do indeed need to take it. (And majority do not suffer ill effects).

 

That said, there are topical treatments (vaginal suppositories) that can treat vaginal candidiasis and work in most cases and that should certainly have been tried first before resorting to systemic  anti-fungal with the attendant risks.

 

I hope your GF is now being monitored by a liver specialist.

 

I do find that Thai doctors tend to be dismissive of drug adverse effects, contraindications etc  and it is important to do your own research before taking any medication.

 

 

Well, I didn't exaggerate it. I only said that this medicine has certainly been completely banned in China by the country's health authorities, this together with the several warnings by FDA and EMA make it reasonable to believe even for someone who is not a medicine professional that there is absolutely no need to treat a first infection ever of this kind with such a strong drug WITHOUT having tried anything else first. 

 

I do understand that strong antifungals and antibiotics are there, and sometimes when dealing with serious infections they do need to be used, nevermind the side effects. I just criticize the fact that they gave it without reason, having other alternatives (as you mentioned vaginal supositories). 

 

And on the other hand, yes. We were completely naive and rather fool for blindly trusting. After seeing the side effects it caused in only 2 days, (specially the jaundice was somehow scary when I first saw it)..., I hope that this post will help anyone else who might find him/herself in the same situation do their good nice research before taking it!

[ChaiyaTH]

If i learned one thing in Thailand, it is to never take any of the drugs they are trying to sell and give me. I have gotten so many pills for various things, including anti-biotics, each time I lied about saying I was taking them while I did not. And yet I recovered just fine on my own.

 

I would at least do a second opinion if I do really have to take something. I also do not consider them equal doctors compared to back home here by standards and degree, many are clueless to most, one wonders how they passed exams (money).

Edited November 22, 2020 by ChaiyaTH

[1FinickyOne]

thanks for sharing and best of luck to your GF... 

[alianware]

Report it to medical board in thailand or you can even sue the doctor since FDA and CFDA made Warning for this drug. 

And she actually had another option to give.

[ChouDoufu]

1 hour ago, expatjustice said:

 

 

Well, I didn't exaggerate it. I only said that this medicine has certainly been completely banned in China by the country's health authorities, this together with the several warnings by FDA and EMA make it reasonable to believe even for someone who is not a medicine professional that there is absolutely no need to treat a first infection ever of this kind with such a strong drug WITHOUT having tried anything else first. 

 

I do understand that strong antifungals and antibiotics are there, and sometimes when dealing with serious infections they do need to be used, nevermind the side effects. I just criticize the fact that they gave it without reason, having other alternatives (as you mentioned vaginal supositories). 

 

And on the other hand, yes. We were completely naive and rather fool for blindly trusting. After seeing the side effects it caused in only 2 days, (specially the jaundice was somehow scary when I first saw it)..., I hope that this post will help anyone else who might find him/herself in the same situation do their good nice research before taking it!

 

not sure it's banned by china.  it's available for purchase on taobao!

 

i was advised to take some for eczema by a bangkok doctor, picked up the recommended pills at a local pharmacy without a prescription.

 

checked the interwebs for drug interactions first, though! 

ketoconazole is not to be used in conjunction with statin drugs.

[Boomer6969]

My wife took Fungazol for 5 days, some 3 weeks ago, with no side effect other than some dryish skin, which may have been unrelated anyhow. We've also shared one or two bottles of wine during her treatment, which, I admit, wasn't the wisest thing to do either. 

 

I guess she would take it again, as yeast infections aren't optimal for a good sex life.

Edited November 27, 2020 by Boomer6969

[Boomer6969]

On 11/22/2020 at 7:05 PM, expatjustice said:

I just criticize the fact that they gave it without reason, having other alternatives (as you mentioned vaginal supositories). 

These vaginal suppositories are widely used and bought OTC by millions of Thai ladies; my guess would be that most doctors here would assume that any local girl especially the younger ones would consult only after having self medicated. When something goes wrong "down there" Thai girls consult their "big sisters" before seeing a doctor.

[paulbj2]

I retired to Thailand in part because of the great international reputation of the medical services over there (in contrast to some other places I could have gone to retire).

 

Some years after moving there, I fell down a flight of stairs and broke a bone in my arm really badly necessitating surgery to plate and screw it back together. The op was done in an expensive private hospital in Chiang Mai. Some months later, I returned to my home in Luxembourg.

 

On the way home, the Thai repair job on my arm gave way; in Suvarnabhumi airport in fact, and I then had a 3 day journey back home  whilst being in absolutely unspeakable agony. I was booked on Sri Lankan Airways with an overnight in Sri Lanka, then I had an overnight on arrival in London before finally flying out to Luxembourg via Zurich on the 3rd day. On landing at Luxembourg, someone drove me directly to Accident & Emergency where they x-rayed it and told me it had re-broken (like I didn't know that), put some temporary strapping on it and sent me home. The next day I saw an orthopaedic surgeon who was very uncomplimentary indeed about the work that had been done in Thailand. This is extremely unusual in Luxembourg; there is a convention here that doctors never voice any criticism of other doctor's work even if it was done overseas. Eventually, I ended up seeing 5 different specialists; two of whom were of the opinion that it needed completely redoing as the original work was so poorly done. The one I saw most recently described the Thai surgeon as "an absolute butcher".

 

This, along with many other horror stories I have heard about medicine in Thailand, has rather shaken my confidence in Thai medicine and I most certainly will not be returning the LOS.

 

As a result of the extremely poor treatment I received, I will be mildly handicapped for the rest of my life, I experience quite severe pain if I stress the area where the break occurred and, according to the surgeons here, I will have a permanent weakness in the bone I broke due to the Thai surgeon having put way too many screws in it (which substantially weakens the bone)! The surgeon said there are 9 screws in the repair and, he said, "That's crazy! I would only have used 4"

[NancyL]

18 hours ago, Boomer6969 said:

These vaginal suppositories are widely used and bought OTC by millions of Thai ladies; my guess would be that most doctors here would assume that any local girl especially the younger ones would consult only after having self medicated. When something goes wrong "down there" Thai girls consult their "big sisters" before seeing a doctor.

Not just the Thai ladies or young ladies.  I've learned that the female pharmacists really know their stuff, esp when it comes to "female matters". 

 

After experiencing my second urinary tract infection in three years, with expensive testing and meds from a private hospital only to find it was e-coli infection (well, duh, not really a surprise), the pharmacist sold me an antibiotic powder, to be dissolved in water and taken at the first sign of a UTI.

 

At the start of the Covid outbreak, Hubby and I started to take our temperatures every morning.  One day mine was a little elevated and I thought that maybe, just maybe, I was coming down with a UTI.  The previous UTI had been "silent", at least until a raging fever developed.  I dosed up with the powder from the pharmacist and the next day my temp was back to normal.

 

She also sold me some small red pills to take one daily.  She said they're like drinking a glass of cranberry juice daily, which is what those of us prone to UTIs do in the U.S.  Can't really do here because cranberry juice is so expensive and they don't have a sugar-free version.  I didn't ask about this; she offered it. 

[internationalism]

Ketokonazole was withdrawn in EU only in 2014 (still was available to buy till July 2018, when the last production batch expired) and some dr still write prescriptions (unaware of availability). 

It's an old medicine, cheap but with possible effects (as all anti-fungal medicines, even the modern ones).

Vomiting 3x or jaundice are not serious side effects of taking this (and so many other) medicines. Doesn't mean permanent liver damage. Jaundice clear by itself within a week.

Ketokonazole is also used by Cushing Syndrome patients - daily and for tens of years, all their life.

 

As to vaginal candida - nystatin capsules 100k, in every pharmacy.

I would rather first self-medicate with basic medicines.

Thai doctors always try to give antibiotics or steroids (the last time I went I was prescribed both for a mild skin condition) and other drugs - forcing to buy them at the hospital pharmacy at inflated price.

 

Vaginal fungus infections might happen after taking antibiotics. Even with antibiotics taken by a partner and transmitted by sperm

[Kiujunn]

57 minutes ago, internationalism said:

Vomiting 3x or jaundice are not serious side effects of taking this (and so many other) medicines. Doesn't mean permanent liver damage. Jaundice clear by itself within a week.

If jaundice occurs you should stop taking ketoconazole.

 

As to whether you should take ketoconazole in the first place here is what the FDA thinks:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-prescribing-nizoral-ketoconazole-oral-tablets-unapproved