Indian Journal of Pharmacy and Pharmacology

37-41

Authors: Ashok Kumar*,Vasant R.Chavan,Mohammaed Arshad,Raghunanadan M,Mohammed Fayazuddin

Introduction: Osteoarthritis (OA) is a major cause of chronic pain and lower extremity disability among the elderly due to its predilection for lower extremity joints such as the knee and hip. The treatment of pain and inflammation is an important area of therapeutics. Over the past two decades, non steroidal anti-inflammatory drugs (NSAIDs) have played a central role in these indications. NSAIDs constitute the largest single group of drugs used worldwide, constituting more than 20% of all drug prescriptions. In India over 400 formulations of NSAIDs are marketed, resulting in wide spread exposure of patients to this class of drugs and its adverse effects, For all these reasons, studies that evaluate the pattern, extent and frequency of NSAID prescriptions are valuable. Periodic evaluation of drug utilization studies provides the information for suitable modifications in the prescription of drugs in order to increase the therapeutic benefit and decrease the adverse effect associated with drug. Materials and Methods: A prospective, observational study was conducted on newly diagnosed as well as old treated patients with osteoarthritis from orthopaedic outpatient department in a tertiary care teaching hospital. A total of 428 were enrolled after screened for the inclusion and exclusion criteria. Data was recorded in a specially designed proforma which include information regarding the demographic profile of the patients and about the pattern of drugs prescribed. Results: Four hundred and twenty-eight patients with the diagnosis of Osteoarthritis visited the orthopedic outpatient department during the period of six months in which the data was collected. Prescriptions of all 428 patients were analyzed. Osteoarthritis was found to be more common in males (56.07%) compared to that of females (43.92%). Results also revealed that, OA was more prevalent in middle age group of 51-65 years (45.32%),with knee joint (66.58%) being most commonly effected, majority of patient were treated with Combination therapy (80.80%) over Monotherapy (19.19%). Most of patients were treated as first line with NSAIDS (79.75%) and Paracetamol (20.10%), was under prescribed. Aceclofenac (32.85%) was the most common NSAID used followed by Diclofenac sodium (25.49%). Gastroprotective agents were used in 12.28% along with Non-selective NSAIDS to prevent gastrointestinal adverse effects, out of which Ranitidine (53.47%) was most preferred, followed by Pantoprazole (16.66%), Various other drugs were also used as adjunct therapies that includes, Calcium and Vitamin D3, symptomatic slow acting drugs for OA (SYSADOA) which included diacerin and glucosamine sulfate as combination in (10.15%) of patients. Conclusions: Our study showed Osteoarthritis most common among males affecting knee joint in middle age group, Paracetamol and SYSADOA being under prescribed and NSAIDS are the most frequently used drugs in OA. National drug policy is needed to rationalize the drug use and bring awareness among the prescribing doctors.

45-51

Authors: Rhythm ,Nirav Asarawala,Barna Ganguly*

Context: Long term use of anti-hormonal therapy in breast cancers is effective for extending long term survival rates but simultaneously can lead to various side effects affecting quality of life. Aims: Aim of this study was to assess the utilization of hormonal treatment in patients suffering from breast cancer with specific objective of reviewing their quality of life with relation to side effects. Settings and Design: This was an OPD based cross sectional study, conducted in Shree Krishna Hospital, Karamsad. Methods and Materials: Prior permission from institutional ethics committee was taken. Utilization part of the study was a record based study, from the case files available in record section of cancer OPD. For quality of life part of the study, written informed consent was taken from the participants and were interviewed according to quality of life questionnaires. Statistical Analysis Used: Data were analyzed as per descriptive statistics and results were presented in form of percentage and range. Mean scores for various quality of life subscales were calculated using EORTC scoring manual. Results: Out of total 38 patients of breast cancer, 26(68.42%) patients were on treatment with letrozole, 12(31.57%) were on tamoxifen. We found better role functioning and cognitive functioning subscales in breast cancer patients of tamoxifen group as reflected in the highest mean score of 93.74 in functional scale. Mean sexual functioning scores in both letrozole and tamoxifen groups were on lower side. Percentage of patients experiencing systemic therapy side effect (dry mouth, hot flushes, hair loss, headache, dysgeusia) were found to be more in tamoxifen group. Conclusions: Overall, the parameters of quality of life in breast cancer patients on hormonal therapy, were found to be in better side, except for sexual functioning scores which were on lower side.

56-59

Authors: Roshi*,Vishal R. Tandon,Annil Mahajan

Menopause is an important physiological process in a female's life. It is not free from different variety of symptoms affecting day to day life. With increasing life expectancy, female spends many years with menopausal symptoms. Having knowledge about these symptoms provides us a guide about treatment for various symptoms to be introduced into postmenopausal health guidelines. Materials and Methods: The present study was undertaken in Medicine OPD of Govt. Medical College Jammu. Total 60 patients were divided into two groups and were given tab gabapentin and nortryptiline. The readings were taken at 0 week, 4 weeks and 8 weeks after noting the demographic profile. Results: Most of the females in both the groups were from rural areas, housewives and with natural menopause. Both the study drug were effective in decreasing the postmenopausal symptoms were none was better than the other. Conclusion: both nortryptiline and gabapentin have potential to be used as drugs in postmenopausal symptoms besides other treatment options.

65-72

Authors: Pradeep Javedar,Shrinivas R Raikar*,Prashant Dass

Introduction: Mental disorders form an important public health priority. Less work has been carried out in India on the economic burden of mental illness. Policy makers are increasingly dependent on clinical data to formulate and implement guidelines on Psychotropic drug use. This study aims to further the database of knowledge regarding Psychotropic drugs and their utilisation in mental health disorders in this region. Materials and Methods: After institutional ethics committee approval, a prospective drug utilisation study of 100 out patient prescriptions was undertaken. Preparation of the protocol and conduct of the study was as per the WHO – DUS and the STROBE guidelines. Results: 100 prescriptions were analysed containing 207 drugs, 174 of these were psychotropic drugs. Utilisation from National Medicines List and WHO Essential Medicines List was 54.54% and 45.45% respectively. Average psychotropic drugs per prescription were 1.74±0.066 (SD). 30% prescriptions contained fixed dose combinations. Only 0.48% drugs were prescribed by generic name. Drug utilisation pattern: Commonly prescribed drugs were Haloperidol, Valproate, Dosulepin, and Clonazepam. The PDD/DDD ratio of three drugs – Risperidone, Lorazepam and Amisulpride – was equal to one. The average cost borne by the patient was 385.2 rupees per month. Conclusion: Overall the principles of rational prescribing were followed. Hospital schedule needs to add more SSRIs. Practice of using typical anti–psychotics as first line was as per recommendations. More drugs need to be prescribed by generic name to reduce the economic burden. Use of drugs from essential medicine lists needs to be increased in order to have more rational prescribing.

06-10

Authors: Archanabahen Archanabahen,Jitendra R. Zaveri*

Introduction: The cost of drug play important role in practice of medicine and disease outcome. In Indian market numerous brand available of generic drug. Tuberculosis is curable disease but if proper treatment not taken by patients then lead to development of drug resistance or pulmonary disability. AKT drugs used for the management of tuberculosis. Objective: To compare and analysed cost variation in AKT drugs with different brand name for same dosage form & same active compound. Materials and Methods: The price of the drug with same formulation and same strength (Dosage) was review from Indian drug review issue 3, 2017 (IDR) & CIMS (Apr- Jul 2017). Percentage of cost price variation and Cost ratio is analysed. Result: High percentage of cost variation among first line AKT drugs seen with Ethambutol (474.51%) followed by Isoniazid (432.60%). Least percentage of cost variation seen with streptomycin (1.01%) followed by rifampicin (1.33%). Maximum cost ratio of first line drugs seen with Ethambutol (5.74). Among 2nd line AKT drug Maximum and least percentage of cost variation are seen with levofloxacin 500 mg tablet formulations (1550.84%) and Ofloxacin 400 mg sustained Releases - tablet (1.57%) respectively. Higher percentage of cost variation seen with more manufacture company/ no. of brand. Conclusion: The wide percentage of cost variation is seen with AKT drugs available in Indian market. Regulation of drug price by concerned agencies and by government is needed. Rational drug prescription with low cost is important for treatment adherence and disease outcome.

14-17

Authors: Padmavathi Vutukuru,Kranti Tekulapally*

Introduction: Hyperlipidemias are recognized as one of the major risk factors for the development of Coronary Artery Disease (CAD). Statins are the most potent lipid lowering agents currently available that significantly lower the morbidity and mortality associated with CAD. Aim: To compare the cost of various statins of different brands by calculating the percentage variation of cost. Materials and Methods: Prices of different statin preparations per 10 tablets/ capsules in rupees were reviewed from Drug today April-June 2018 issue and www.drugsupdate.com for analysis. Maximum and minimum price difference of the same drug manufactured by different pharmaceutical companies was calculated. Percentage variation was calculated as per the following formula Drug formulations manufactured by only one company and those whose price could not be obtained from the sources were excluded from analysis. Results: Maximum companies are manufacturing single drug atorvastatin 10mg (192) and atorvastatin 5 mg + ezetimibe 10mg (40). Highest percentage variation in cost is found with atorvastatin 5 mg (900%) and in atorvastatin 10mg + amlodipine 5 mg (1488%). Conclusion: There is wide variation in the cost of various statins available in India, which increases the economic burden on patients. Government of India should take more consumer friendly steps to control the cost of drugs. Physicians should maintain a P-drug list and prescribe low cost and effective drugs to improve compliance to drug therapy and ensure effective treatment of the disease.

22-27

Authors: Bajaj V A,Turankar AV*,Thakre M,Tiple PG,V M. Motghare

Introduction: Psychomotor performance results from the coordination of sensory and motor system through the integrative and organizational process of brain and central nervous system. Psychotropic drugs may adversely affect work performance which depends on psychomotor activities. Both valproate and flunarizine are widely used drugs in prophylaxis of migraine and they are known to have effect on psychomotor performance. Hence this study was carried out to evaluate the effect of valproate & flunarizine on psychomotor performance in patients of migraine with the help of battery of subjective & objective psychomotor tests over a period of 8 weeks. Materials and Methods: Patients were allocated to one of the two groups on first day of examination. Baseline psychomotor tests were measured using battery of tests including critical flicker fusion test (CFFT), hand steadiness test (HST), arithmetic ability test & reaction time monitoring. At the end of 4 weeks & 8 weeks, again tests using same methods employed previously were performed. Efficacy was calculated by using Migraine dairy template (0, 4, 8 weeks) & CGI Scale (end). A total of 44 patients were recruited with 22 patients in each arm. Results: Flunarizine (n=20) & valproate (n=20) significantly increased CFFT, AAT scores at the end of 8 weeks compared to baseline and significantly reduced HST, RT, Frequency, Duration and severity at the end of 8 weeks compared to baseline. When flunarizine was compared to valproate no statistical significance was found in scores of CFFT, AAT, HST, RT, Frequency, duration, severity, global improvement and efficacy index. Conclusion: Flunarizine & Valproate were found to be equally efficacious to improve psychomotor performance.