An evaluation of fixed dose combinations and it’s practices at medicine department of tertiary care hospital, Nepal

Rajeev Shrestha; Sushmita Gurung

doi:10.18203/issn.2454-2156.IntJSciRep20200197

Authors

Rajeev Shrestha Department of Pharmacy, Lamjung District Community Hospital, Lamjung, Nepal http://orcid.org/0000-0003-1822-3969
Sushmita Gurung Department of Pharmacy, National Model College for Advance Learning, Kathmandu

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20200197

Keywords:

Oral FDC, Medicine department, Nepal

Abstract

Background: A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital.

Methods: A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study. Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms.

Results: Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.

Conclusions: The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.

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References

Bangalore S, Kamalakkannan G, Parkar S and Messerli FH. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007;120:713-9.

Poudel A, Ibrahim M, Mishra P, Palaian S. Prevalence of Fixed-Dose Combinations in Nepal: A Preliminary Study. J Clin Diagnos Res. 2010;4(2):2246-52.

Bedwal A, Aravinda V, Rajarathna K. Assessment of knowledge, attitude and practice of prescribing fixed dose combinations among postgraduate medical students-a cross sectional survey. Int J Pharma Sci Res. 2016;7:4565-71.

Poudel A, Ibrahim MIM, Mishra P, Palaian S. Assessment of the availability and rationality of unregistered fixed dose drug combinations in Nepal: a multicenter cross-sectional study. Global Health Res Policy. 2017;2:1-13.

Poudel A, Ibrahim MIB, Mishra P, Palaian S. Evaluation of the registration status of fixed‐dose drug combinations in Nepal. J Pharma Health Serv Res. 2018;9:41-6.

Shah S, Patel J, Desai M, Dikshit R. Critical analysis of antimicrobial and respiratory fixed dose combinations available in Indian market. Int J Med Public Health. 2015;5:161-4.

Pradhan S, Panda A, Sahu S and Behera JP. An evaluation of prevalence and prescribing patterns of rational and irrational fixed dose combinations (FDCs): a hospital based study. Int J Med Sci Public Health. 2017;6:58-63.

India Go. Drug and Cosmetic Act 1940. In: Health Do, (ed.). 2005.

Gupta R, Malhotra P, Malhotra A. Assessment of knowledge, attitude, and practices about prescribing fixed dose combinations among doctors-An observational study. National J Physiol Pharm Pharmacol. 2018;8:347-52.

Dakappa A, Narayanardeddy M. A cross-sectional study to assess the rationality of fixed dose combinations prescribed in geriatric patients in a tertiary care hospital. Int J Basic Clin Pharmacol. 2016;5.

Nepal Go. National List of Essential Medicines In: Administration DoD, (ed.). Fifth ed. 2016.

Organization WH. WHO model list of essential medicines, 20th list (March 2017, amended August 2017. 2017.

Balat JD, Gandhi AM, Patel PP and Dikshit RK. A study of use of fixed dose combinations in Ahmedabad, India. Indian J Pharmacol. 2014;46:503.

Mohanty B, Aswini M, Hasamnis A, Patil S, Murty K and Jena S. Prescription pattern in the department of medicine in a tertiary care hospital in south India. J Clin Diagn Res. 2010;3:2047-51.

Rayasam S, Dudhgaonkar S, Dakhale G, Hire R, Deshmukh P, Gaikwad N. 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.

Poudel A, Ibrahim MIM, Mishra P, Palaian S. Assessment of utilization pattern of fixed dose drug combinations in primary, secondary and tertiary healthcare centers in Nepal: a cross-sectional study. BMC Pharmacol Toxicol. 2017;18:69.

Dalal K, Ganguly B, Gor A. Assessment of rationality of fixed dose combinations approved in CDSCO list. J Clin Diagnos Res. 2016;10:5.

Gautam CS, Saha L. Fixed dose drug combinations (FDCs): rational or irrational: a view point. Br J Clin Pharmacol. 2008;65:795-6.

Poudel A, Palaian S, Shankar PR, Jayasekera J and Izham M. Irrational fixed dose combinations in Nepal: need for intervention. Kathmandu Univ Med J. 2008;6:399-405.

Ravichandran A, Balamurugan J, Shankareshwari, Sekar R. Knowledge, attitude and prescriptional practice about fixed dose combinations among medical practitioners in tertiary care hospital. Int J Basic Clin Pharmacol. 2017;6:1937-42.

McGettigan P, Roderick P, Mahajan R, Kadam A and Pollock AM. Use of fixed dose combination (FDC) drugs in India: central regulatory approval and sales of FDCs containing non-steroidal anti-inflammatory drugs (NSAIDs), metformin, or psychotropic drugs. PLoS Med. 2015;12:e1001826.