Evaluation of an outpatient department (OPD)-based prescribing pattern of fixed-dose combinations in a tertiary care institute in Central India
-
Satish Chandel
,
Sadashivam Balakrishnan
Abstract
Background
Fixed-dose combinations (FDCs) are being widely prescribed for the treatment of various disorders in India. However, not all FDCs are rational. To know the awareness of physicians in prescribing rational FDCs was the need of the hour in order to assess the prescribing trends and rationality of FDCs. Eventually, this will help to formulate the guideline for rational use of FDCs.
Methods
This was a prospective observational study conducted in All India Institute of Medical Sciences Bhopal, MP, India. Prescriptions were collected over a period of 2 months by the convenience sampling method from hospital pharmacy. The data were subjected to descriptive analysis using Microsoft Excel and Graph Pad Prism. Results were expressed in mean ± standard deviation (SD), percentages and 95% confidence interval.
Results
A total of 2496 drugs were prescribed in 1008 prescriptions, of which 945 (37.82%) were FDCs with an average of 0.93 ± 0.94 (mean ± SD) per prescription. Of 945, 67 (7.09%) were included in National List of Essential Medicine 2015 considered as rational. The number of prescriptions containing one or more FDCs was 629 (62.40%). FDCs were more frequently prescribed to male patients (54.92%) and in the age group of 18–30 years (33.44%). FDCs containing a proton pump inhibitor were prescribed most frequently (16.29%) followed by nonsteroidal anti-inflammatory drugs (13.96%) and multivitamins (7.83%).
Conclusions
Prescribing irrational FDCs was very common, and hence there is an obvious need to update our prescribers about the irrationality of FDC and motivate them to develop a habit of rational prescribing.
Acknowledgments
We are thankful to our medical superintendent Dr K. C. Tamariya for allowing us to perform our study. We also extend our thanks to In-House Pharmacy for helping our researchers in collecting required data.
Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Informed consent: For this type of study formal consent is not required.
Ethical approval: This study protocol was approved by Institutional Human Ethics Committee, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India. Approval No. IHEC LOP/2016/IM0091.
References
[1] World Health Organization. The use of essential drugs. WHO Technical Report Series 825. Geneva, 1992.Suche in Google Scholar
[2] Gautam CS, Saha L. Fixed dose drug combinations (FDCs): rational or irrational: a view point. Br J Clin Pharmacol 2008;65:795–6.10.1111/j.1365-2125.2007.03089.xSuche in Google Scholar PubMed PubMed Central
[3] McGettigan P, Roderick P, Mahajan R, Kadam A, Pollock AM. Use of fixed dose combination (FDC) drugs in India: central regulatory approval and sales of FDC containing non-steroidal anti-inflammatory drugs (NSAIDs), metformin, or psychotropic drugs. PLoS Med 2015;12:e1001826.10.1371/journal.pmed.1001826Suche in Google Scholar PubMed PubMed Central
[4] National List of Essential Medicines 2015 Govt. of India, Ministry of Health and Family Welfare, Directorate General of Health Services, New Delhi. Available at: https://cdsco.gov.in/opencms/opencms/system/modules/CDSCO.WEB/elements/download_file_division.jsp?num_id=MTUyNw==. Accessed: 1 Jan 2018.Suche in Google Scholar
[5] World Health Organization (WHO) Model List of Essential Medicines 2015. 19th list. Available at: http://www.who.int/medicines/publications/essentialmedicines/EML2015_8-May-15.pdf. Accessed: 1 Jan 2018.Suche in Google Scholar
[6] Nigam MP, Fernandes VLG, Rataboli VP. Fixed dose combinations: to prescribe or not to prescribe: a dilemma of medical profession. Int J Basic Clin Pharmacol 2014;3:105–13.10.5455/2319-2003.ijbcp20140212Suche in Google Scholar
[7] Wirtz VJ, Mol PG, Verdijk J. Use of antibacterial fixed- dose combinations in the private sector in eight Latin American countries between 1999 and 2009. Tropical Med Int Health 2013;18:416–25.10.1111/tmi.12068Suche in Google Scholar PubMed
[8] Jadav SP, Parmar DM. Critical appraisal of irrational drug combinations: a call for awareness in undergraduate medical students. J Pharmacol Pharmacother 2015;2:45–8.10.4103/0976-500X.77117Suche in Google Scholar PubMed PubMed Central
[9] Balat JD, Gandhi AM, Patel P. A study of use of fixed dose combinations in Ahmedabad, India. Indian J Pharmacol 2014;46:503–9.10.4103/0253-7613.140581Suche in Google Scholar PubMed PubMed Central
[10] Rayasam SP, Dudhgaonkar SS, Dakhale GN. The irrational fixed dose combinations in the Indian drug market: an evaluation of prescribing pattern using WHO guidelines. Int J Basic Clin Pharmacol 2013;2:452–7.10.5455/2319-2003.ijbcp20130820Suche in Google Scholar
[11] Hindoliya M, Sharma PK, Dhaneria SP. Prescribing trends of fixed dose combinations in teaching and non teaching hospitals of Ujjain district. J Pharm Res 2012;5:3503–5.Suche in Google Scholar
[12] Rational use of medicines. Good pharmacy practice – I.P.A. – C.D.S.C.O. – W.H.O. India Country Office 2013;3:52–6.Suche in Google Scholar
[13] Connor J, Rafter N. Do fixed combination pills or unit of use packaging improve adherence. Bull WHO 2004;82:935–9.Suche in Google Scholar
[14] Wertheimer AI, Morrison A. Combinations drugs: innovation in pharmacotherapy. Pharmacol Ther 2002;27:44–9.Suche in Google Scholar
[15] Niederman MS. Appropriate use of antimicrobial agents: challenges and strategies for improvement. Crit Care Med 2003;31:608–16.10.1097/01.CCM.0000050464.70382.D6Suche in Google Scholar PubMed
[16] Sarkar C, Das B. Prescribing trend of fixed dose drug combinations in a tertiary hospital in Nepal. J Inst Med 2000;22:1–7.10.59779/jiomnepal.136Suche in Google Scholar
[17] Sharma T, Dutta S, Dhasmana DC. Prescribing pattern of NSAIDs in orthopaedic OPD of a tertiary care teaching hospital in Uttaranchal. JK Sci 2006;8:160–2.Suche in Google Scholar
[18] Burke A, Smyth E, Gerald GA. Analgesic-antipyretic agents; pharmacotherapy of gout. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman’s the pharmacological basis of therapeutics, 11th ed. New York: McGraw Hill, 2006:685.Suche in Google Scholar
[19] Awodele O, Fadipe A, Adekoya M, Adeyemi O. Prescribing pattern of non-steroidal anti-inflammatory drugs at the outpatient pharmacy department of a university teaching hospital in Nigeria. Ghana Med J 2015;49:25–9.10.4314/gmj.v49i1.5Suche in Google Scholar PubMed PubMed Central
[20] Sreedhar D, Menthan D, Jawodia, Ligade VS, Mohapatra S, Ganguly R, et al. FDC: rational or irrational? Current status. Int J Basic Clin Pharmacol 2008;95:5813.Suche in Google Scholar
[21] Chakraborti A. Prescription of FDC drugs for diarrhea. Indian J Med Ethics 2007;4:165–7.Suche in Google Scholar
[22] Drugs Banned in India. Available at: https://cdsco.gov.in/opencms/opencms/system/modules/CDSCO.WEB/elements/download_file_division.jsp?num_id=MTY4Mg==. Accessed: 16 Jan 2017.Suche in Google Scholar
[23] Cazzola M, Matera MG. Fixed pharmacology and therapeutics of bronchodilators. Pharmacol Rev 2012;64:450–504.10.1124/pr.111.004580Suche in Google Scholar PubMed
[24] Harvey NC, Biver E, Kaufman JM. The role of calcium supplementation in healthy musculoskeletal ageing. Osteoporos Int 2017;28:447.10.1007/s00198-016-3773-6Suche in Google Scholar PubMed PubMed Central
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- The use of Huperzia species for the treatment of Alzheimer’s disease
- Original Articles
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- Effect of endogenous sulfur dioxide on spatial learning and memory and hippocampal damages in the experimental model of chronic cerebral hypoperfusion
- Allium cepa fraction attenuates STZ-induced dementia via cholinesterase inhibition and amelioration of oxidative stress in mice
- Ameliorative effect of methanol stem extract of Parquetina nigrescens (Afzel) bullock on scopolamine-induced sub-chronic cognitive deficit in mice
- Redox modulating effects of grape juice during aging
- Cytoprotective effects of the aqueous extract of the Ziziphus jujuba fruit on TBHP-induced damage on human fibroblast cells
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- Solanum leaves extracts exhibit antioxidant properties and inhibit monoamine oxidase and acetylcholinesterase activities (in vitro) in Drosophila melanogaster
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