Adverse drug reactions and cost effectiveness of non-steroidal antiinfl ammatory drugs, muscle relaxants, and neurotropic drugs in patients with low back pain.

Background: The objective was to evaluate the adverse drug reactions (ADRs) and cost effectiveness of different classes of drugs in therapy of low back pain. Methods: A prospective observational study was carried out over a period of 12 months (November 2012 to November 2013) in which a total of 300 patients with low back pain were enrolled and divided equally into three groups – Group 1 (nonsteroidal anti-infl ammatory drugs [NSAIDs]), Group 2 (NSAIDs ± muscle relaxant), and Group 3 (NSAIDs ± muscle relaxant ± neurotropic drugs). Any ADR developed after the initiation of treatment at 3 weeks and 6 weeks was noted. Prescription cost per day was also calculated. Results: There was a male predominance in the study population with a mean age of 39.76±9.40 years. A total of 262 ADRs were noted among which most were seen in Group 3 (119 ADRs). Gastritis was the most common ADR in Group 1. Drowsiness was the most common ADR in Group 2 (30%) and 3 (46%). Prescription cost per day was highest in Group 3 (30.28±11.24 Indian Rupee [INR]) followed by Group 2 (25.92±8.66 INR) and Group 1 (12.22±3.38 INR). Conclusion: Patient on combination of three drugs (NSAIDs, muscle relaxants, and neurotropic agents) had maximum ADRs and their prescription cost per day was highest among the three groups.

Comparative evaluation of effi cacy and safety of carboxymethylcellulose either alone or in combination with non-steroidal anti-infl ammatory drug in the treatment of dry eye in a tertiary care teaching hospital.

Background: Dry eye produces discomfort and reduced vision. The treatment of dry eyes has traditionally involved hydrating and lubricating artifi cial tears. The newer medications include non-steroidal anti-infl ammatory drugs (NSAIDs) for the treatment of dry eye disorders. This study was designed to compare the effect of topical carboxymethylcellulose (CMC) alone or in combination with topical NSAID for the treatment of dry eye in a tertiary care teaching hospital. Methods: A total of 60 patients diagnosed with dry eye were enrolled for a study period of 1 year. Patient of either sex (male/female), age between 18 and 70 years, and all diagnosed cases of dry eye in ophthalmology outpatient department were selected. Patients (n=60) were stabilized on CMC for 2 weeks and thereafter divided into two groups. Group I (n=30) received only topical CMC; Group II (n=30) received CMC+NSAID. The patients were followed up to 12 weeks. Diagnostic tests included Schirmer’s test and tear break up time (TBUT). Ocular Surface Disease Index (OSDI) was used for assessing the Quality of Life. Analysis was done using GraphPad InStat software. p<0.05 was considered signifi cant. Results: This was an open-label study revealing a mean age of 46.0±1.79 years. Females (56.67%) showed a signifi cantly higher prevalence of dry eye symptoms compared to males (43.33%). The mean duration of illness was 1.95±0.16 years. Schirmer’s test, TBUT test values and OSDI score in Group I and Group II at 0 and 12 weeks revealed signifi cant intragroup difference (p<0.0001). At 12 weeks intergroup comparison in Schirmer’s test value (p>0.05) and TBUT test value (p>0.05) showed no signifi cant difference while OSDI score revealed signifi cant difference (p<0.05). Burning, stinging, blurring of vision, photophobia, and hyperemia were among the common adverse effects seen. Conclusion: Both groups showed signifi cant improvement in Schirmer’s test and TBUT test value and OSDI score at the end of the study. Intergroup comparison showed a signifi cant difference with reference to OSDI score. Patients receiving NSAID reported more adverse effects.

Topical nepafenac 0.1% alone versus prednisolone acetate 1% as postoperative anti-inflammatory agents in small gauge vitrectomy.

Aim: To compare the effi cacy of postoperative topical nepafenac (0.1%) with prednisolone acetate (1%) as anti-infl ammatory agents in eyes undergoing Transscleral Sutureless Vitrectomy (TSV). Se􀄴 ings and Design: Prospective, double-blind, randomized, single center clinical study. Materials and Methods: Eighty eyes of 76 subjects, who underwent small gauge vitrectomy, were included in the study. The subjects who fulfi lled the inclusion criteria were randomized to either topical nepafenac only (Group 1) or prednisolone acetate only (Group 2), to be used as postoperative anti-infl ammatory agents. The subjects were reviewed on days 1, 30, and 90. Ocular and adnexal infl ammation was appropriately graded using the standardized classifi cation. Grading of ocular pain was done on the Visual Analog Scale (VAS). Statistical Analysis: The Wilcoxon rank-sum test, using two-sided analysis, was used. Results: During the follow-up, both Group 1 and Group 2 did not have a signifi cant diff erence related to the grade of the anterior chamber infl ammation (P > 0.05) or adnexal infl ammation (P > 0.05). Pain perception was less in the subjects in Group 1 as compared to subjects in Group 2, but was not statistically signifi cant (P > 0.05). Conclusion: Postoperative topical nepafenac was non-inferior to prednisolone acetate in reducing postoperative ocular infl ammation in eyes undergoing TSV.