Consideraciones para el uso de tramadol en dolor crónico no oncológico en atención primaria de salud (APS)

Introducción: tramadol es un analgésico opioide usado frecuentemente para el manejo del dolor crónico no oncológico (DCNO). En Chile, es parte del arsenal farmacológico de los centros de atención primaria para el tratamiento de patologías como artrosis de cadera y rodilla. Es considerado seguro y efectivo, sin embargo, existen reportes de efectos adversos serios por polimorfismos hepáticos, interacciones farmacológicas, intoxicaciones, adicción y muerte. La dosis óptima de tramadol es paciente dependiente. Por esto, es necesario contar con orientaciones específicas para prescribir tramadol de manera segura y eficaz según las características de cada paciente. Materiales y métodos: se revisaron guías actualizadas, revisiones sistemáticas y guías de sociedades internacionales sobre el uso de opioides en DCNO y el uso de tramadol en patologías de DCNO como artrosis, lumbago crónico, dolor neuropático y fibromialgia. Resultados: tramadol no está indicado en el tratamiento de cuadros de dolor primario como fibromialgia y en DCNO secundario es un fármaco de segunda línea o no está recomendado. En dolor crónico neuropático (DCN) es segunda línea de tratamiento. En osteoartritis de cadera, rodilla y mano, se reporta efecto analgésico modesto. Sopesar riesgos versus beneficios en estos pacientes. En artritis reumatoide y lumbago crónico se desaconseja su uso. Conclusiones: tramadol es un medicamento seguro y efectivo si se indica, administra, supervisa y descontinúa adecuadamente. Sin embargo, puede asociarse a interacciones farmacológicas, efectos secundarios serios, conductas de abuso y usos ilícitos, por lo que es necesario conocer y manejar adecuadamente su farmacología e indicaciones.

Introduction: Tramadol is an opioid pain medicine commonly used for chronic non-cancer pain (CNCP) management. In Chile, it is part of the pharmacological arsenal available in primary care centers for treating specific CNCP pathologies, such as hip and knee arthrosis. Tramadol is considered a safe and effective drug. Nevertheless, there are reports of serious adverse effects of tramadol, such as poisoning, addiction, and death, probably caused by liver polymorphisms and drug interaction. The optimal dose of tramadol is patient-specific. Specific knowledge is needed to prescribe tramadol in a safe and effective way according to the patient's medical backward. Methods: We review updated guidelines, systematic reviews, and guidelines from international societies about the use of opioids and tramadol in CNCP pathologies such as osteoarthritis, chronic low back pain, neuropathic pain, and fibromyalgia. Results: Tramadol has no role in primary pain treatment, such as fibromyalgia, but is a second-line drug for chronic neuropathic pain (CNP) and some secondary pain syndromes. Tramadol has a modest analgesic effect in osteoarthritis patients. Clinicians should always weigh the risks and benefits before prescribing tramadol. Tramadol use is discouraged in rheumatoid arthritis and chronic lumbago. Conclusions: Tramadol is a safe and effective drug if correctly indicated, administered, supervised, and discontinued. However, it may be associated with pharmacological interactions, serious side effects, abuse behaviors, and illicit uses, and it is necessary that clinicians know and manage its pharmacology and indications appropriately.

Knowledge, attitude, and practice of ‘P-drug concept’ among postgraduate residents and interns in a tertiary care teaching hospital in Maharashtra

Background: A P-drug is a clinician’s personal or preferred or priority choice drug. The study aims to evaluate the knowledge, awareness, and practice of P-drug, which helps postgraduates to prescribe medicines rationally. The objective of this study is to assess the knowledge, attitude, and practice of the P-drug concept among postgraduate students at a tertiary care teaching hospital. Methods: The study is a prospective, cross-sectional pre-validated questionnaire-based study conducted in the tertiary care teaching hospital. A total of 300 postgraduates, interns and consultants from Tertiary care teaching hospital from Maharashtra were enrolled and instructed to fill the questionnaire. These filled forms were collected, and data was analyzed. Results: Out of 300 members, 233 filled the questionnaire, and these forms are evaluated. About 49.7% among them are aware of P-drug, 43.4% are aware of P-treatment, 28.4% are not including fixed-dose combinations in their P-drug list, 42% are aware of the advantages of prescribing P-drug, and 48.4% felt that teaching programs are needed for preparing P-drug list. Conclusions: The P-drug concept is requisite for improving the quality of health care and practicing rational use of medicine. As only a few studies have been conducted on the P-drug idea in this institute, the institutional teaching review board should run teaching programs regarding the P-drug concept.

Methodology for the Development of Clinical Practice Guideline for Chinese Patent Medicine（Part 1）： Development Status and Characteristics / 中医杂志

The irrational use of Chinese patent medicines （CPM） is becoming more and more prominent， which makes the demand for clinical practice guidelines of CPM gradually increase. In order to make domestic scholars understand the latest developments and existing problems of the CPM guidelines， and promote its development， this paper introduced the concept of CPM guidelines， summarized the characteristics of the two development modes， namely “taking CPM as the key” and “taking disease/syndrome as the key”， and analyzed the current methodological status of developing and reporting CPM guidelines. Based on the existed problems， three suggestions have been put forward to optimize the quality of CPM guidelines， which were clarifying the target users and scope of CPM guidelines， establishing an open and transparent mechanism of the personnel involvement and process steps， and formulating implementable and operable recommendations for the use of CPM.

Consensus on whole-process pharmaceutical care for iodine contrast medium / 中国药房

OBJECTIVE To explore the whole-process pharmaceutical care model of iodine contrast medium and promote the rational clinical use of iodine contrast medium. METHODS Clinical Professional Committee on Rational Drug Use of China Medical Education Association and Expert Committee on Drug Evaluation and Clinical Research of Guangdong Pharmaceutical Association organized domestic experts to establish a working group on the Consensus on the whole-process pharmaceutical care for iodine contrast medium. The working group conducted literature searches， evidence-based analysis， and discussions on the development process， indications， contraindications， adverse drug reactions， drug interactions， drug use for special population， pharmaceutical care， and other key topics to summarize the content and process of the whole-process pharmaceutical care for iodine contrast medium. This consensus was ultimately formed. RESULTS The consensus on whole-process pharmaceutical care for iodine contrast medium included an evaluation of the patient， renal function， combined drug use， and hydration regimen before examination， the presence of contrast agent extravasation or suspected acute adverse reactions during examination， observation time points and follow-up after examination， and the presentation of specific work in each stage through pharmaceutical care flowchart. The medication monitoring record form was also formed to record the work situation. CONCLUSIONS The consensus has established a whole-process pharmaceutical care system for iodine contrast medium， providing scientific evidence for clinical physicians and nursing staff in the rational use of such special drugs， and also serving as a reference for pharmacists in providing related pharmaceutical care.

Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine（Part 5）： Retrieval and Synthesis of Key Information on Rational Drug Use / 中医杂志

Recommendations for Chinese patent medicine （CPM） based on key information on rational drug use are one of the important conditions for enhancing guideline enforceability as well as facilitating guideline implementation. In this study， we discussed in detail of the key information on the rational use of CPM in five aspects， which are dosage， drug discontinuation， drug-drug and drug-food interactions， safety and economy. Following the process of multi-source search， synthesis and prioritization， it is suggested to collect key information on the rational use of CPM from a multi-source search of drug instructions， policy documents， literature， and clinical experts' experiences. Then the searched information should be summarized and prioritized with the principle that taking drug instructions as the basis and other-sources information for check and supplementation. Finally， methodological recommendations for the retrieval and synthesis of key information on rational drug use in guideline recommendations has been formed.

Research progress in therapy drug monitoring of levetiracetam / 中国药房

Levetiracetam （LEV） is the second generation of broad-spectrum anti-epileptic drug. LEV has the advantages of rapid absorption， short half-life， precise efficacy， good tolerance and few drug interactions. In order to improve the clinical efficacy of LEV， and reduce the occurrence of adverse reactions， children， pregnant women， the elderly， and patients with renal insufficiency should receive therapeutic drug monitoring （TDM）. Clinically， the samples are usually plasma or serum， and the TDM methods are mostly immunoassay or chromatography. There is currently no consensus on the effective concentration range of LEV， and the correlation between plasma concentration and adverse reactions is also unclear. The main factors affecting LEV plasma concentration include age， pregnancy， and patient compliance. How to interpret TDM results and adjust dosage based on the results will be the focus of future work.

Applications and consideration for metformin in pregnancy / 中华围产医学杂志

Metformin is recognized for its dual action in lowering blood glucose levels and enhancing insulin sensitivity, positioning it as the primary oral drug for managing type 2 diabetes mellitus (T2DM). Despite its ability to cross the placenta and expose the fetus, extensive clinical application has not revealed significant adverse effects. Metformin finds widespread application during pregnancy in conditions such as obesity, polycystic ovary syndrome, T2DM, and gestational diabetes mellitus. This article aims to establish an evidence-based perspective on the impact of metformin administered during pregnancy on maternal and fetal outcomes, as well as the long-term health of offspring. Generally deemed safe and effective, metformin is viewed as a means to control hyperglycemia and manage gestational weight gain without conspicuous adverse effects on maternal and fetal pregnancy outcomes. However, metformin alone may not suffice for achieving glycemic control, necessitating the addition of insulin. Besides, the long-term offspring risks of metformin exposure are controversial, long-term follow-up study is urgent to bring certainty into this field. Thus, tight control over indications for metformin use during pregnancy is crucial to ensure optimal maternal and fetal health outcomes. Although not suggested as a first-line agent for glycemic control in pregnancy, it may be considered as an adjunctive option in cases of severe insulin resistance or in low-resource areas where access to insulin is challenging.

The Connotation of Neo-Confucianism in ZHU Danxi Medicine / 浙江中医药大学学报

[Objective]To explore the connotation of neo-Confucianism in ZHU Danxi medicine.[Methods]Combining the research methods of medicine and philosophy,based on ZHU Danxi's medical writings and related knowledge of neo-Confucianism,the connotation of neo-Confucianism of Danxi medicine was discussed from three aspects:"cognition view""sports view""cultivation view".[Results]ZHU Danxi was influenced by the thought of"one principle and different justics"and regarded medicine as the way to practice Confucian ideal.Using the understanding method of"thinking phyics",ZHU Danxi put forward some important medical theories such as"the theory of excess of Yang and deficiency of Yin"and"the theory of fire".Based on the concept of"movement was the heart of heaven and earth",the important significance of Qi movement and constant movement of"Xiang fire"to human life was realized.Based on the sports concept of"extreme things must be reversed"and"the gentleman should be careful to move",the author realized the great harm to the human body caused by the rash movement of"fire"and advocated the idea of"careful movement"for health preservation.Based on the cultivation view of"heart regulating temperament",the author put forward"king fire mastering prime minister fire",emphasized the active role of"heart"of"king fire",cultivated the"nature"of morality,controlled the"emotion"of desire,and maintained the constant movement of"corresponding fire"and supplemented life.Applying the cultivation view of"mastering static without desire"to health but disease required that through tempering appetite and lust,people's natural desires conformed to the Confucian"reason",in order to be no severely ill and spend the whole life.[Conclusion]ZHU Danxi's medical science is rich in connotation,which is a powerful witness of the influence of the reform of Confucianism on medical innovation in Song and Yuan Dynasties.On the one hand,Danxi's"aid theory into medicine"built a strong support for medical innovation,and made his medical theory rise to the height of"heaven theory",so that he was convinced in the Jinyuan period of medical contention;On the other hand,it also demonstrated the all-encompassing universality and supreme authority of"heavenly principles"as cosmic laws.

Rational analysis of the use of antiemetic drugs in tumor chemotherapy patients in our hospital / 中国药房

OBJECTIVE To provide reference for the rational use of antiemetic drugs in tumor chemotherapy patients. METHODS The data of tumor patients who were given antiemetic drugs were collected from 9 departments of our hospital with hospital information system from Oct. 1st to Nov. 30th in 2022， such as oncology department， radiotherapy department， gynecology department， and gastroenterology department. The application of chemotherapy drugs and the use of antiemetic drugs were analyzed statistically， and the irrational use of antiemetic drugs was analyzed. RESULTS A total of 520 patients were included， involving 248 （47.69%） using chemotherapy drugs with a moderate emetogenic risk level and 135 （25.96%） with a high emetogenic risk level. A total of 461 cases （73.06%） of 5-hydroxytryptamine 3-receptor antagonists were used， including palonosetron in 333 cases， ondansetron in 106 cases， tropisetron in 15 cases and granisetron in 7 cases， and only 148 cases of patients were prioritized for the use of nationally procured medicines and national essential medicines （32.10%）. Neurokinin-1 receptor antagonists were used in 170 cases （26.94%）， including fosaprepitant in 112 cases and aprepitant in 58 cases. The use of antiemetic drugs was unreasonable in 162 patients （31.15%）； among the types of irrational drugs， the antiemetic regimen was unreasonable in the largest number of cases （22.40%）， followed by the irrational pharmacoeconomics （19.13%）. CONCLUSIONS The emetogenic risk levels of chemotherapy drugs used for tumor patients in our hospital are primarily moderate to high， and there is irrational use of antiemetic regimen and pharmacoeconomics. Clinicians， nurses， pharmacists and hospital departments should collaborate as multiple teams to strengthen full supervision of the standardization of antiemetic drugs， reasonably select antiemetic drugs based on emetogenicity rating， and improve the compliance of doctors with the guidelines to ensure the safety， effectiveness， and cost-effective of patient medication.

Review of drug utilization research based on real-world data / 药学实践与服务

In recent years, the rapid development of medical information technology has made it critical to analyze large-scale diagnosis and therapeutic data and extract rules based on real medical environment. This has become an essential approach for marketing evaluation and regulatory decision-making of drugs and devices both domestically and internationally. Real world study （RWS）, as a novel methodology for clinical evaluation of drugs in the field of drug utilization research （DUR）, have presented opportunities and challenges for observational studies in assessing actual efficacy or effectiveness. However, despite being a popular methodological approach among scholars in the field, there are still limitations and deficiencies when analyzing population medication characteristics in RWS. Systematic evaluation research methods have not yet been established, leading to inadequate generation of real-world evidence （RWE）. The research design, methodological pathways, evaluation indicators, confounding factors, and bias management involved in DUR based on real-world data （RWD） were reviewed in this artical with the intention of providing guidance for further exploration into DUR.

Establishment and application of drug use evaluation criteria of argatroban / 药物流行病学杂志

Objective To establish the argatroban drug use evaluation(DUE)criteria and provide reference for the rational use of argatroban in clinical practice.Methods Based on the domestic and foreign drug instructions of argatroban,referring to relevant guidelines and literature,the DUE standard rules were established by expert consultation.Using the established standard rules,the medical records of argatroban in the Fuzhou First Hospital Affiliated with Fujian Medical University from August 2020 to August 2022 were evaluated for the rationality of medication.Results A total of 368 medical records were included,the rational rate of drug use was 48.64％,and the irrational drug use was mainly without indications(46.19％)and inappropriate combination of drugs(4.35％).Conclusion The rational rate of argatroban clinical use in the hospital is not high,and the problems mainly include off-indication drug use and unreasonable combination drug use.Through the establishment and clinical application of DUE standard rules,the clinical use of argatroban can be further standardized and the ability of rational drug use can be improved.

Establishment and application of drug use evaluation criteria for roxadustat / 药物流行病学杂志

Objective To establish the drug use evaluation(DUE)standards of roxadustat,and to evaluate its clinical application to promote its rational use.Methods Based on the drug labels,referring to relevant guidelines and expert consensus,the DUE criteria for roxadustat were established through the Delphi method,including items such as drug indications,drug use process and the results of medication.A retrospective study was conducted to evaluate the rationality of cases which included inpatients who used roxadustat for the first time from January 1,2020 to December 31,2022,with a medication period of more than one month in Fujian Provincial Hospital.Results A total of 175 medical records were included,of which 14 records were fully met the clinical application evaluation criteria,and the medication reasonable rate was 8.0％.The unreasonable situation were mainly manifested in the inappropriate clinical outcomes(92.0％),the inappropriate use dosages(52.6％),inappropriate monitoring of adverse reactions(34.9％),inappropriate timing of administration(13.1％),drug interactions(8.7％),inappropriate drug conversion(5.7％),inappropriate efficacy monitoring(4.0％).Conclusion The established DUE standards for roxadustat are scientific,practical and feasible,and the evaluation results show a rate of irrationality in the use of roxadustat in the hospital,and it is necessary to standardize the use of roxadustat in terms of dosage,adverse reaction monitoring,and timing of administration.

Drug use evaluation of ozagrel sodium based on weighted TOPSIS method / 药物流行病学杂志

Objective To establish evaluation of ozagrel sodium by weighted TOPSIS method so as to provide a reference for improving the rational use of ozagrel sodium.Methods Based on the drug instructions,guidelines,relevant literatures and Delphi method,the evaluation criteria for the clinical rationality of ozagrel sodium were formulated.Attribute hierarchical model(AHM)was used to assign weights to the indicators,the weighted TOPSIS method was employed to analyze and evaluate the rationality of 108 patients that discharged from the Third People's Hospital of Henan Province from January 2021 to April 2022.Results The reponse rates of two rounds of expert advice questionnaires were 100％,the authoritative coefficients(Cr)were 0.85,0.83(＞0.70),and the experts fully affirmed the items of the standard.Among the 108 cases evaluated,37 cases(34.26％)were judged to be reasonable,52 cases(48.15％)were judged to be basically reasonable and 19 cases(17.59％)were judged to be unreasonable.The main unreasonable problems were manifested in indications,the timing of administration,drug course and monitoring of efficacy and laboratory parameters.Conclusion The method of DUE of ozagrel sodium based on weighted TOPSIS is more comprehensively and intuitively.The application of ozagrel sodium in the hospital is relatively standardized,but there are problems in the course of medication,indications,and timing of administration.So it is necessary to promote the rational use by strengthening the cooperation between pharmacists and physicians,and improving pharmaceutical intervention.

Establishment and application of drug use evaluation criteria of fibrinogenase for injection / 药物流行病学杂志

Objective To establish the drug use evaluation(DUE)standard of fibrinogenase for injection and provide a reference for the rational clinical application of fibrinogenase for injection.Methods Based on the specification of fibrinogenase for injection,the DUE standard was established from three aspects:drug indication,drug process and drug results,with reference to relevant guidelines and literature,and through discussion with clinical experts.A retrospective survey was conducted to evaluate the inpatients using fibrinogenase for injection from January 2021 to December 2021 in Ningde Hospital of Traditional Chinese Medicine,Fujian Province.Results A total of 256 patients were included,with a medication reasonable rate of 61.72％.The irrational use of drugs was mainly including the inappropriate usage and dosage(3.91％),off-label medication(1.95％),no skin test(8.98％),too long or inadequate course of medication(25.00％).Conclusion The DUE standard established of fibrinogenase for injection is scientific,practical and feasible.The use of fibrinogenase for injection in contraindications and high blood coagulation state,and off-label medication can be further optimized.

Multicenter retrospective investigation and analysis of the rationality of the application of human albumin in cardiac surgery during the perioperative period / 药物流行病学杂志

Objective To investigate the clinical application of perioperative human serum albumin(HSA)in cardiac surgery in multiple regions in China,and to evaluate the rationality of its clinical application in conjunction with the clinical guidelines,in order to provide a reference for promoting the rational application of HSA.Methods The medical records of patients who underwent cardiac surgery from April to June 2019 in eight hospitals across the country were retrospectively collected.The statistical information on patients'general information,the dosage,course of treatment,and cost of HSA,and the serum albumin level before and after medication was analyzed to evaluate the use of HSA.Relevant evaluation criteria were established,and the rationality of its medication was evaluated.Results Data from a total of 449 patients were included for analysis,the appropriate rate of medication was 81.1％.The course of medication was mostly＞2-5 days and the total amount of HSA was mostly 50-99 g.The main purpose of medicaiton were improving colloid osmotic pressure,reducing exudation to improve interstitial edema,postoperative volume expansion.Conclusion Clinical attention should be paid to ensure the rational application of HSA in cardiac surgery during the perioperative period and prevent the abuse of blood products.

Structure-based development of potent and selective type-II kinase inhibitors of RIPK1

Receptor-interacting serine/threonine-protein kinase 1 (RIPK1) functions as a key regulator in inflammation and cell death and is involved in mediating a variety of inflammatory or degenerative diseases. A number of allosteric RIPK1 inhibitors (RIPK1i) have been developed, and some of them have already advanced into clinical evaluation. Recently, selective RIPK1i that interact with both the allosteric pocket and the ATP-binding site of RIPK1 have started to emerge. Here, we report the rational development of a new series of type-II RIPK1i based on the rediscovery of a reported but mechanistically atypical RIPK3i. We also describe the structure-guided lead optimization of a potent, selective, and orally bioavailable RIPK1i, 62, which exhibits extraordinary efficacies in mouse models of acute or chronic inflammatory diseases. Collectively, 62 provides a useful tool for evaluating RIPK1 in animal disease models and a promising lead for further drug development.

Investigation of rational drug use behaviors and knowledge levels of older individuals: a cross-sectional study

SUMMARY OBJECTIVE: The aim of this study was to examine older individuals' rational drug use behavior, their knowledge of rational drug use, and the factors affecting it. METHODS: This study was conducted cross-sectionally with 440 patients aged 65 years who received inpatient treatment in internal medicine and surgery clinics between October 2021 and November 2022 using a Rational Drug Use Scale and rational drug use behavior questions. RESULTS: The findings showed that the mean age of older adults was 72.56±5.84 years, and 51.8% were men. It was determined that 79.1% of the older adults did not check their expiration date before using the medicines, and 85.9% of them retained the remaining medicines after treatment. Results indicated that 77.3% of older adults knew less about rational drug use. Additionally, a significant difference was observed between older adults' marital status, educational status, possession of outdated drugs at home, self-use of antibiotics without examination, and mean score on the Rational Drug Use Scale (p<0.05). CONCLUSION: The results showed that the rational drug use knowledge level of older adults was low and that there were differences in the knowledge levels of rational drug use according to certain behaviors and factors.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Clinical and Laboratory Assessment of the Patient

Abstract The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: History and scenario of patient blood management in the world and in Brazil

Abstract Patient Blood Management (PBM) is a multidimensional approach that seeks to optimize the use of blood and its components in patients. This matter emerged as a response to the need to reduce unnecessary exposure to blood transfusions and their potential risks. In the past, blood transfusion was often overused resulting in complications and high costs. The advent of Patient Blood Management has caused a paradigm shift, highlighting anemia prevention, bleeding control and maximizing the production of blood cells by the organism itself. Patient Blood Management guidelines include the early identification of anemia, strategies to minimize blood loss during surgery, intraoperative blood conservation techniques, preoperative hemoglobin optimization and evidence-based approaches to the rational use of blood transfusions. Aiming to improve clinical outcomes, decrease transfusion-related complications and reduce associated costs, this multidisciplinary approach counts on doctors, nurses, pharmacists and other healthcare professionals. Based on research and clinical evidence, Patient Blood Management continues to evolve thereby promoting safer, more effective patient-centered practices. Its implementation has proven beneficial in various medical contexts thereby contributing to improvements in the quality of care provided to patients. Our goal with this Consensus is to present readers with a broad and diverse view of Patient Blood Management so that they have the building blocks to implement this new technique.

Assessing prescribing practices in Indian health facilities: a comprehensive review

Prescription patterns play a critical role in healthcare delivery, affecting the efficacy of medication therapy and resource utilization. Rational prescribing practices are essential for safe and effective healthcare, necessitating comprehensive prescriptions containing medication details, prescriber information, and patient instructions. This review explores prescription completeness and rationality, utilizing WHO prescribing indicators and other completeness metrics, across Indian healthcare facilities. A systematic search was conducted in PubMed and Google Scholar for original research articles published between 2013 and 2023, focusing on WHO-recommended prescribing indicators and completeness criteria. Inclusion criteria covered articles in English, spanning primary, secondary, or tertiary care settings. Data from selected articles were extracted and analysed. Data were synthesized from sixty-seven studies, depicting various prescribing practices. The assessment encompassed prescribing, patient care, and facility indicators. Findings highlighted challenges such as illegible prescriptions, incomplete details, polypharmacy, brand name dominance, and inappropriate antibiotic use. Despite WHO recommendations, generic prescribing was limited. This review reiterates the need for interventions to enhance prescription quality, patient safety, and cost-effectiveness. Recommendations include adopting electronic prescribing systems, standardizing prescription formats, conducting regular prescription audits, implementing educational programs, promoting generic drug use, and adhering to essential medicines lists. These multifaceted strategies can improve prescribing practices and ultimately contribute to enhanced healthcare outcomes in India.