Drug utilization pattern during pregnancy in North India.

BACKGROUND: Pregnancy is a special physiological condition, where drug treatment presents a special concern. AIMS: To evaluate the drug utilization pattern during pregnancy and to evaluate the effect of the educational and economic status on it.. DESIGN: The retrospective cross-sectional study. SETTING: The postgraduate Department of Pharmacology and Therapeutics of a medical college. and the antenatal clinic of the institution. MATERIALS AND METHODS: Medical students filled 405 questionnaires after interviewing pregnant women (243 primigravida and 152 multigravida). All the collected questionnaires were analysed for various study parameters. STATISTICAL ANALYSIS USED: Inter-group comparison was done using chi-square test. P value < 0.05 was considered statistically significant. RESULTS: A total of 700, 1086 and 686 drugs, with an average of 1.73, 2.89 and 2.49 drugs per pregnant women, were used during first, second and third trimester of pregnancy, respectively. A majority of the drugs used, were from category-A, followed by category-B and category-D. However, category C and X drugs constituted 2.90 (20) and 5.71% (40) of drugs used during the third trimester and first trimester, respectively. Herbal/homeopathic drugs constituted 6.42 (45), 3.68 (40) and 1.46% (10) of the drugs used in the first, second and third trimester of pregnancy, respectively (P=649). 33.33% (135) women believed that drug use during pregnancy is dangerous to both mother and child and 37.03% (150) believed that drugs are dangerous throughout pregnancy. 55.55% (225) females advocated the use of iron/folic acid during pregnancy. 24.69% (100) of women had knowledge about barrier contraceptives. Self-medication and homeopathic/ herbal drugs use was found more in graduates than in undergraduates; as well as, it was more in the higher socioeconomic group than the lower socioeconomic group. CONCLUSION: There is a need to educate and counsel women of child-bearing age, regarding the advantages and disadvantages of drug use during pregnancies, with special reference to alternative therapies and self-medication.

Comparative Effect of Timolol, Levobunolol and Betaxolol on IOP in Patients of Chronic Simple Glaucoma

In this prospective randomized parallel study we compared the effects of topical timolol maleate, levobunolol hydrochloride and betaxolol hydrochloride on intraocular pressure (IOP) in the patients of primary open angle glaucoma after 16 weeks of instillation as 1 drop 12 hourly in 0.5% concentration. 23 eyes of 16, 19 eyes of 12 and 20 eyes of 12 patients were included in timolol, levobunolol and betaxolol groups respectively. Timolol, levobunolol and betaxolol lowered IOP by 13.05 ± 1.53, 14.05 ±1.47 and 7.58 ± 0.90mmof Hg respectively after 6weeks and by16.12±1.67,16.28 ±1.85 and 8.535 ± 0.983 mm of Hg respectively after 16 weeks (P<0.001). Both levobunolol and timolol produced greater reduction in IOP than betaxolol (P<0.001). The results of our study indicated that betaxolol is less efficacious in lowering IOP in Indian patients and could only be preferred over timolol in glaucoma patients with associated chronic obstructed pulmonary disease (COPD) or bronchial asthma. However, Levobunolol could be a better alternative to timolol , as being a longer acting agent with IOP control for 24 hrs after single instillation and can be used as once a day instillation with better safety profile.

Antihypertensive Efficacy of Carvedilol and Amlodipine in Patients of Mild to Moderate Hypertension – A Comparative Study

In this prospective randomized parallel study, the antihypertensive effect of oral carvedilol and amlodipine was evaluated on systolic blood pressure (SBP) and diastolic blood pressure(DBP) in patients of mild to moderate hypertension over a period of 12 weeks. Eighty two patients who fulfilled the inclusion criteria were randomized to receive amlodipine (n=42) 5-10mg/day and carvedilol (n=40) 25-50mg/day. Blood pressure was recorded in the sitting and standing position during follow up visits at 2,4,8 and 12 weeks using mercury sphygmomanometer. Dosage adjustments if needed were made at 4 and 8 weeks of study. Both carvedilol and amlodipine produced a statistically significant (P<0.001) and dose related fall in SBP and DBP , which became evident at two weeks of initiation of therapy and continued till 12 weeks. On comparative analysis of the effect of carvedilol and amlodipine on BP, amlodipine produced a greater fall in sitting and standing SBP at all study intervals as compared to carvedilol, with statistically significant fall at 8 and 12 weeks (P<0.01). However, the fall in sitting and standing DBP was statistically comparable with both the drugs. The findings of the present study indicate that carvedilol has become an alternative treatment for mild to moderate hypertension.