Friday 13 September 2019

Beardy Beardy Baby

Ah vanity, vanity. What is it with men and their hair?  Rephrase that: What is it with people and their hair?  Comb comb; wash wash; cut cut; frizz frizz; straaaaaaighten; colour; tint. So many ways to spend time and money on the stuff. I last paid money to a barber about 25 years ago when I could get a trim for £2.00.  My regular place closed down and I asked a young buck in the lab next door where he sorted his hair-cutting and went there. That barber feller insisted that he need to to wash my locks first and charged £8! [If I had presented with boobs rather  than moobs, they would have charged €28!] I went round the corner and bought some electric clippers and have managed for myself ever since. They cost £34, paid for themselves in a year and have since saved me about €800, and endless one-way chatter about football and holidays. Male pattern baldness has been late for me which means I have to work to stop myself looking too shaggy to teach. A lot of blokes are really distressed by baldness. Samson's whole sense of strength, potency and manhood was apparently locked up in his locks, which gave Delilah the edge on him. Modern chaps can turn to meds to restore some semblance of fuzz up top. Minoxidil is the go-to formulation and is now widely available OTC without a prescription: ask for Lacovin, Locemix, Loniten, Lonnoten, Lonolox, Lonoten, Loxon or Regain, Regaine, Regaxidil, Regro, Regroe, Regrou, Regrowth, Relive, Rogaine, Rogan. Don't try to wow the pharmacist with the IUPAC name 3-hydroxy-2-imino-6-piperidin-1-ylpyrimidin-4-amine s/he won't be impressed.

Minoxidil has an interesting story. It was first developed by Upjohn 60 years ago as a potential treatment for peptic ulcers. It didn't work for that condition but was revealed as a potent vasodilator and marketed to lower blood-pressure.  In the Phase I clinical trials, one of the side-effects was unexpected hair growth and it started to be marketed off-label for male pattern baldness. Eventually in 1988, 30 years after its first discovery, it was approved by the FDA for hair loss. Seemingly the moribund hair follicles get a new lease of life from a local rush of blood because of the vasodilation.

Meanwhile in a totally different part of Castle Megapharm another smallish molecule was developed for acid reflux and related burp and blooargh problems. This one really does work for peptic ulcers! The inventors called their new drug Omeprazole because IUPAC's 6-methoxy-2-[(4-methoxy-3,5-dimethylpyridin-2-yl)methylsulfinyl]-1H-benzimidazole was too much of a mouthful. It has been around since 1988 and is on the list of WHO Essential Medications. It is long off patent, does the job and has few side-effects so it is one of the most widely prescribed drugs in the US [70 million scripts in any give year] and elsewhere. Every doctor in the Western World will have prescribed Omeprazole - probably as Losec or Prolosec; so it comes to mind when kids present with burpiness. Pediatric medicines which are basically unregulated. Small children have poorly developed livers and kidneys and so drug clearance is a potent problem and makes them radically different from small adults.  It's usually a case of just giving a child a fragment of an adult pill and hoping for the best.

These two completely different drugs collided [El Pais for detail, BBC for exec summary]in the South of Spain this Summer when a dozen infants were taken back to the doctor with hair fuzzing up their faces in a most disconcerting manner. niños con "síndrome del hombre lobo" / werewolfchild was an easy label for lazy headline writers. All these children had been prescribed Omeprazole, and the fine people at Agencia Española de Medicamentos y Productos Sanitarios AEMPS got on the ball really quickly to identify the problem and get the product off the pharmacy shelves.  Turned out that the local manufacturer of the reflux drug - Farma-Química Sur - committed an 'internal error' and somewhere in the process Minoxidil was mislabelled as Omeprazole. I guess it became most obvious first in infants because we expect their skin to be smooth as a baby's bottom. Big Red Face in Farma-Química Sur but I bet none of the QC managers lost their jobs.

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