Review
SUNDERLAND, England, Aug. 11 -- A 64-year-old woman nearly blinded herself by taking a steroid she purchased online without a prescription, doctors here reported.
The woman bought prednisolone from an online pharmacy based in Thailand. She had been taking 10 mg to 40 mg of the drug daily for four years to treat her self-diagnosed chronic fatigue syndrome, said Philip Severn, MRCP, and Scott Fraser, FRCOphth, of the Sunderland Eye Infirmary here.
The woman was not aware of the well-documented ocular side effects of steroids, according to the doctors' case report in the Aug. 12 issue of The Lancet.
After six months of steadily losing sight in both eyes, the woman finally visited the eye infirmary. A clinical exam revealed a clear case of steroid-induced glaucoma and cataract. She was immediately put on ocular antihypertensive treatment.
"When last seen in July 2006, she was awaiting cataract extraction," the doctors wrote. "The patient is likely to remain under ophthalmic review for the rest of her life for monitoring of intraocular pressure."
Their curiosity piqued by this case, the doctors went online and, with the search engine Google, found that prednisolone in doses ranging from 1 mg to 50 mg was readily available to Web-surfers without a prescription.
"Practitioners need to be more aware of the problems associated with self-directed internet-purchased medications," the doctors said.
As their case illustrates, patients who self-diagnose and buy drugs online without a prescription are probably not aware of the medication's side effects or potential interactions with other drugs. These patients also lack the safeguard of careful medical monitoring, the doctors said.
In addition, patients should be warned that drugs purchased online "can be counterfeit and contain a concoction of compounds that bear little resemblance to the drug named on the bottle," the doctors said.
"As the Internet evolves so should our method of taking a medical history-it is increasingly reasonable to ask, 'Are you on any medication prescribed by your doctor or any other practitioner, or purchased over the counter or from an online pharmaceutical Web site?'" they said.
In the United States, patients who want to know how to distinguish between safe, legitimate online pharmacies and those lacking safeguards to protect customers can be referred to the four criteria set forth by the FDA. These say that legitimate pharmacies should:
Be licensed by the state board of pharmacy in the state where they operate
Have a licensed pharmacist to answer patient questions
Require a prescription for the medication from a licensed doctor
Have a way for customers to talk to a person if there is a problem
Some Internet pharmacies offer an "online consultation" with a doctor, in which the patient fills out a medical questionnaire which is reviewed by the doctor, who then writes a prescription. But the legality of this arrangement in the United States is unclear, because while federal law prohibits dispensing medication without a "valid prescription," it is up to individual states to define a valid prescription.
Nevertheless, the so-called online consultation does not meet appropriate standards for medical care, according to the FDA. "As a result, patients may receive a drug that is inappropriate for them to use and may sacrifice the opportunity for a correct diagnosis or the identification of an underlying medical condition for which use of the prescription drug may be dangerous," the agency warned.
