Usage Pattern of Fixed-dose Combinations at ICMR Network of Rational Use of Medicine Centres across India: Recommendations for Policymakers and Prescribers

Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.

Beneficial role of Avocado oil orally used in Osteoarthritis: experience in a tertiary care hospital of Bihar, India

Background: Osteoarthritis is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. It is a degenerative disorder arising from biochemical breakdown of articular (hyaline) cartilage in the synovial joints.Methods: Total of 90 patients were randomly selected from outdoor and indoor of Orthopaedics department (IGIMS Patna). Study was done in Department of Pharmacology & Orthopaedics at IGIMS Patna. Three groups A, B and C were taken. Each group was consist of 30 patients of both sexes and age groups between 18 to 65 years. Group A was received Multivitamin with Exercise. Group B was received NSAIDS only. Group C was received Avocado oil orally along with Exercises as Muscle strengthening exercises of Quadriceps, Hamstrings, Abductor and Adductor muscles of thigh. We had compared pain thresholds among all these three groups with the help of Visual analogue scale and Oxford Knee score.Results: After 3 months of treatment the patients belonging to group C showed better response as compared to group A and B. When we compared pain threshold among group A, B and C on the basis of Oxford Knee score group C had occupied maximum score, which meant satisfactory joint functions and did not require any formal treatment. we also compared average visual analogue scale and average oxford knee score, Group C showed better response.Conclusions: Avocado oil is a food supplement and does not contain any side effects as compared to NSAIDS [Non-steroidal anti inflammatory drugs], glucosamine sulfate, chondroitin sulfate, sulfasalazine etc so avocado oil can be used for long duration in case of osteoarthritis.

Cost variation analysis of proton pump inhibitors available in Indian market

Background: In now days proton pump inhibitors are prescribing more and more by Indian physicians not only in peptic ulcer,gastroesophageal reflux disease, gastritis but also along with non steroidal anti-inflammatory drugs to overcome the side effects as gastric irritation and discomfort by non steroidal anti inflammatory drugs.There are many brands of PPI drugs available in Indian market. Costly drugs can lead to economic burden which results in decreased compliance or even non-compliance. Non 朿ompliance leads to incomplete treatment which tends to increase morbidity.Increase in the patient medication cost was found to associated with decreased adherence to prescription medication.Hence this study was done to assess the cost variation of proton pump inhibitors [PPI] drugs.Methods: The maximum and minimum price of each brand of the drug in INR was noted by using CIMS January to April 2018 edition Drug Today April to June 2018 Vol-1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of 10 tablets/capsules was calculated in case of oral drug and the cost of one 1 vial or ampoule was noted in case of injectable drug. At last the cost ratio and percentage cost variation of various brands was compared.Results: Percentage variation in cost for proton pump inhibitors marketed in india was found to be tablet/capsule Esomeprazole [20mg]:141.17, tablet/capsule Esomeprazole [40mg]:196.29, capsule/tablet Omeprazole[20mg]: 569.53, Tablet/capsule Pantoprazole[40mg]: 248.8, tablet /capsule Rabeprazole[20mg]: 815.78, capsule/tablet Lansoprazole[30mg]: 173.33, Inj. Esomeprazole [40mg] 1 vial: 81.81, Inj. Omeprazole[40mg] 1vial: 47.95, Inj. Pantoprazole[40mg] 1vial: 66.66, Inj.Rabeprazole [20mg] 1vial: 176.625.Conclusions: Tablet Rabeprazole[20mg] shows highest cost ratio and percentage cost variation as 9.15 and 815.78. While Inj. Omeprazole[40mg] 1 vial shows lowest cost ratio and percentage cost variation as 1.47 and 47.95.

Undergraduate medical students’ perception regarding computer assisted learning in experimental pharmacology practical

Background: Main objective of this study was to find out the students’ perception and to obtain feedback towards the use of Animal Simulator to demonstrate drug effects in terms of its acceptability, advantages and disadvantages of Computer Assisted Learning (CAL) in experimental pharmacology practical as an educational tool.Methods: Questionnaire based study, done on randomly and voluntarily selected ninety-six fourth and fifth semester MBBS Students. Divided into four groups and each group contained 24 students. Students were taught experimental pharmacology practical online using Animal simulator (CAL- Computer Assisted Learning) for 2 hours on different days in three sessions. Questions and their feedback was taken during these sessions and presented in tables. Statistical analysis of data was done using Graph Pad software.Results: Majority of students i.e. 64 (66.67%) agreed that in vitro and in vivo experiments on animals are essential for better understanding and learning of the biological process. Students were agreed to the majority of the statements for CAL like enjoyable and time saving, easy to perform, contributes more to understanding theoretical concepts, no experimental error seen, welcome change and best alternative to laboratory practical and many experiments can be demonstrated in a short time. Students were disagreed on statements like CAL is an effective method of teaching practical aspects and preferred experimentation than laboratory practical. Majority of students given yes/positive response to questions showing advantages of using CAL. Also, positive feedback was obtained regarding questions showing disadvantages of using CAL software.Conclusions: Students’ perception regarding practical with CAL laboratory using animal simulator was good. The overall view was expressed that they found the exercises interesting and educationally beneficial. Computer assisted learning is a feasible and very effective teaching and learning method in pharmacology with huge potential to change the way of learning as it meets the majority of the learning objectives.

Students’ attitudes on personal drug selection exercise in writing prescription

Background: This study was developed to know the students’ views regarding personal drug (P-drug) concept in rational prescription of drugs and also giving them training of creating and using personal drug concept.Methods: 40 medical students (5th semester) divided in four groups were involved voluntarily in a three phase, questionnaire based and prospective study. In first and second phase students were taught and asked to derive P-drug using different standard text books and Current Index of Medical Specialties (CIMS) by analyzing efficacy, safety, cost and convenience of drugs used for type II diabetes mellitus. Third phase was designed to know the students’ perception regarding the exercise and difficulties faced in the process of P-drug selection. It contained demographic and 12 questions with answer using Likert scale.Results: Students selected biguanide (metformin) as a P-drug in terms of efficacy, safety, cost and convenience. 95% (36 out of 40) responded in the questionnaire, out of which 92% (33 out of 36) had given answer with mean score ?4. Overall median score was 4 and Interquartile Range was 4-5. 89% (32) strongly agreed that P-dug selection teaching helped them to understand pharmacology better. Majority (83% or 30) were in favour of introducing P-drug selection exercises in undergraduate pharmacology curriculum.Conclusions: P-drug selection exercise helped students to understand the differences among various drugs used for the treatment of type II diabetes mellitus and given them a strong foundation for developing rational use of the medicine in their future career as a doctor.

Study of changes in serum lipid profile and blood sugar level by perindopril and telmisartan during treatment of systemic hypertension.

Background: This study was designed to compare adverse effects on serum lipid profile and blood sugar level in the treatment with two commonly used drugs perindopril and telmisartan in cases of hypertension. This was an “observational” and “cross-sectional” study. Methods: A total of 100 patients were included in each, Groups A and B. In both groups, half the patients were given perindopril 4 mg OD and half were given telmisartan 40 mg OD for 24 weeks. Total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides (TG), fasting blood sugar (FBS), and postprandial blood sugar (PPBS) level was estimated initially and then at 4th, 12th, and 24th week. Statistical analysis was done using ANOVA. Results: With perindopril initial means of TC, HDL, LDL, TGs, FBS, and PPBS in Groups A and B were 190.32, 49.76, 117.96, 165.04, 84.56, 122.60, and 188.80, 51.64, 118.52, 159.12, 93.92, 133.60, respectively. After 24 weeks, these values were 190.84, 50.68, 118.60, 163.84, 83.48, 120.20, and 190.96, 52.04, 118.28, 157.56, 93.96, 133.68, respectively (p > 0.05). With telmisartan, initial means of TC, HDL, LDL, TG, FBS, and PPBS in both groups were 188.08, 49.76, 118.84, 167.20, 83.72, 120.68, and 188.08, 46.88, 121.96, 167.84, 91.44, 131.72, respectively. After 24 weeks, these values in both groups were 189.36, 49.80, 120.04, 165.96, 82.60, 118.36 and 186.12, 45.28, 121.08, 167.72, 92.76, 129.56 respectively (p > 0.05). Conclusions: It concluded that both perindopril and telmisartan had not any significant adverse effects on plasma lipid profile and blood sugar level in both groups.