Prescription audit: experience in Garhwal (Uttaranchal), India.

A total of 400 prescriptions were randomly audited from Govern Combined Hospital, Srinagar (Garhwal). Various prescribing specific indicators (recommended by World Health Organization and others) were studied and patient compliance was measured. All of the prescriptions were written for outpatients (males 59.25%; females 40.75%). The average number of drugs prescribed was 3.65 and about 51% of the drugs were prescribed by generic names. NSAIDs were the most widely prescribed (89.75%), antibiotics (77.25%), and vitamins (59.74%) in various clinical conditions. The diagnosis was mentioned only in 22.25% of the prescriptions. A total of 59% fixed dose combinations (FDCs) were prescribed. The patient compliance was 71.5%. The injection use was found to be 7% only. Our survey reveals increased drug exposure to the patients, indiscriminate use of NSAIDs, antibiotics and vitamins. Further studies in this area using a larger sample size should be carried out, and a well designed training programme should be conducted on rational drug use.

Efficacy and tolerability of prochlorperazine buccal tablets in treatment of acute migraine.

OBJECTIVES: To study the efficacy and tolerability of prochlorperazine (PCZ) management of acute migraine. DESIGN AND METHODS: A double blind comparative study was conducted to assess the efficacy of buccal PCZ 3 mg compared with oral ergotamine tartarate 1 mg plus caffeine 100 mg (ERG) or placebo (buccal or oral) for treatment of acute migraine. In all, 114 episodes of acute migraine were evaluated. Patients graded symptoms on a four-point scale before and up to 4 hours after treatment. The primary efficacy parameters included headache resolution within 2 hours (grade 3 or 2 to grade 0) and alleviation of other accompanying symptoms of migraine. The supplementary endpoints included improvement in quality of life (QOL). RESULTS: The percentage of patients reporting resolution of headache (to grade 0) was 51.4% for buccal PCZ and 21.7% for buccal placebo, 23.1% for oral ERG and 28.6% for oral placebo, headache tended to recur in both the placebo and ERG groups after initial improvement. Buccal PCZ was well tolerated; no signs of local irritation were evident, and patients found the formulation easy to use. Mild but transient sedation and drowsiness were observed in 41%. CONCLUSIONS: In the present study, PCZ 3 mg via the buccal route produced faster improvement and greater efficacy than placebo (oral as well as buccal) or oral ERG. The global QOL score 2 hours after treatment scores was higher in the PCZ group. Buccal PCZ may represent a particularly effective alternative for acute migraine treatment.

Gastrointestinal protection by NO from NSAIDs induced injury.

One of the most deleterious side effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) is gastric injury. In order to prevent this, attempt has been made to make novel nitric oxide (NO) releasing NSAIDs. The NO-releasing moiety (nitroxybutylester), which is combined with NSAIDs, has been shown to be responsible for gastrointestinal protection. Various NO-releasing NSAIDs have been compared with their parent compounds and marked decrease in gastrointestinal side effects were observed in the former case. Various animal studies have been done in this context. However, exact mechanism of action of NO-releasing NSAIDs is not clear.