Evaluation of efficacy and safety of clobazam as an add-on drug in the treatment of generalized tonic-clonic seizure not controlled with valproic acid monotherapy.

BACKGROUND: Epilepsy is one of the major neuron-damaging neurological disorders. Generalized tonic-clonic seizure (GTCS) is the commonest one. Refractory patterns cannot be controlled by simple monotherapy with antiepileptic drugs (AEDs). Valproic acid (VPA) is one of the widely prescribed AEDs but it may not control many cases up to its maximum tolerable doses. In this study, we have seen the safety and efficacy of clobazam to control seizure in the adult population as an add-on drug over valproate, in cases of valproate uncontrolled seizures. MATERIALS AND METHODS: Patients on VPA monotherapy but not responding to it were recruited after applying inclusion and exclusion criteria and clobazam was added. There were two follow-ups at the interval of 6 months each. Seizure frequency and quality of life inventory in epilepsy-31 items (QOLIE-31) score were recorded to denote efficacy, and the occurrence of any adverse effect was also noted to elicit safety. RESULTS: Out of 101 patients, 78 were male and 23 were female. The most common age group was 18-30 y. Seizure frequency from 2.99 ± 0.95 decreased significantly on the third visit to 0.25 ± 0.43. QOLIE-31 scores of seizure worry, overall quality, emotional well-being, and cognition improved in the second follow-up. Fatigue, somnolence, and weight gain were the major side effects. CONCLUSION: Clobazam could be a good choice as an add-on in GTCS not controlled with VPA monotherapy. Clobazam definitely reduces seizure frequency and seizure worry and improves cognitive function and overall quality of life.

Pregabalin and Amitriptyline as Monotherapy or as Low-Dose Combination in Patients of Neuropathic Pain: A Randomized, Controlled Trial to Evaluate Efficacy and Safety in an Eastern India Teaching Hospital.

OBJECTIVES: The main objective is to compare efficacy and safety of pregabalin and amitriptyline monotherapy with their low-dose combination in patients of neuropathic pain (NeuP). METHODOLOGY: In this parallel-group, open-label interventional study at the Neurology Outpatient Department of Bankura Sammilani Medical College, a total of 147 patients were randomly allocated into three groups and were prescribed the following drugs - Group P (n = 42) pregabalin 150 mg once daily, Group A (n = 34), amitriptyline 25 mg once daily, and Group Z (n = 37) = pregabalin (75 mg) + amitriptyline (10 mg) as combination once daily. They were followed up after 4, 8, and 12 weeks. Efficacy was assessed by NeuP symptom inventory score (NPSI) and safety was assessed by treatment-emergent adverse events. RESULTS: Final assessment was done on 92 patients (P = 31, A = 31, Z = 30). Males were predominant (71.7%). NPSI score significantly decreased in every group from baseline (P < 0.0001). There was no difference of NPSI score between groups at any level of follow-up. Percentage of adverse drug reactions were maximum (44.9%) in amitriptyline monotherapy group and lowest in combined group. However, amitriptyline monotherapy was the cheapest treatment option among these three. CONCLUSION: Combining pregabalin and amitriptyline at low doses proved to be equally effective but more tolerable compared to individual higher dosage monotherapy. However, if tolerability is good, amitriptyline monotherapy can be an attractive choice in economically challenged group of patients.

Pharmaco-epidcemiology of drugs utilised for cataract surgery in a government medical college and hospital.

Prescription audit is a powerful tool for rational prescription. To evaluate pharmaco-epidemiology of drugs utilised for cataract surgery, a retrospective study was conducted in the department of pharmacology, RG Kar Medical College, Kolkata. Data from bed head tickets of one year, available in medical record section, were collected in case report forms and analysed. Utilisation pattern of drugs like dosage form, dose, route and frequency of administration and duration of therapy were audited. Drug prescription versus therapeutic indication was also evaluated. Price of the prescribed drugs was evaluated for rationality towards cost-effective prescription. For 848 cases of cataract surgery, drugs were prescribed pre-, per- and post-operatively. Different fluoroquinolone antibiotics, anti-inflammatory and mydriatic-cycloplegic agents were prescribed. High or low cost drugs were prescribed both in generic (52%) and brand (48%) names. Few Latin abbreviations were used in directions. Different parameters and study results were discussed from various aspects to explore their social impacts. Though prescription pattern was almost rational, some parts need improvement. Healthcare provider should be aware of cost-effectiveness of the prescribed drugs for the benefit of patients to provide a rational prescription.