IPSIndian Journal of Pharmacology
Home  IPS  Feedback Subscribe Top cited articles Login 
Users Online : 1422 
Small font sizeDefault font sizeIncrease font size
Navigate Here
  Search
 
  
Resource Links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »  Article in PDF (264 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)

 
In This Article
 »  References

 Article Access Statistics
    Viewed1225    
    Printed69    
    Emailed2    
    PDF Downloaded136    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
 Table of Contents    
LETTER TO THE EDITOR
Year : 2011  |  Volume : 43  |  Issue : 3  |  Page : 358-359
 

Are drugs prescribed rationally and according to standard guidelines in India?


Department of Pharmacology, American University of Caribbean, School of Medicine, St. Maarten, Dutch, West Indies

Date of Web Publication24-May-2011

Correspondence Address:
Ravindra S Beedimani
Department of Pharmacology, American University of Caribbean, School of Medicine, St. Maarten, Dutch
West Indies
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7613.81487

Rights and Permissions



How to cite this article:
Beedimani RS. Are drugs prescribed rationally and according to standard guidelines in India?. Indian J Pharmacol 2011;43:358-9

How to cite this URL:
Beedimani RS. Are drugs prescribed rationally and according to standard guidelines in India?. Indian J Pharmacol [serial online] 2011 [cited 2019 Sep 21];43:358-9. Available from: http://www.ijp-online.com/text.asp?2011/43/3/358/81487


Sir,

Paracetamol is the most common cause of intentional and unintentional poisoning in most parts of the world. Hepatotoxicity associated with paracetamol overdose is well recognized and so I appreciate the efforts of authors of "Therapeutic misadventure with paracetamol in children" in your Nov-Dec, 2010 issue for raising the issue of overdose of paracetamol in children. [1] I strongly believe that physicians, especially general practitioners and pediatricians, should educate parents about the potential for hepatotoxicity with paracetamol overdoses. Patients (or parents in case of pediatric patients) should always be given clear instructions on the appropriate dose and suggested formulations and also be made aware of the many over-the-counter paracetamol preparations that contain combination formulations.

The US Federal Drug Administration is currently evaluating paracetamol regarding the following:

  1. Safe dose of paracetamol for adults and children.
  2. Safe dose of paracetamol in combination with other drugs and alcohol.
I have some queries and comments for the authors and other interested readers.

  1. I think the six pediatric clinical case histories are inconsistent, incomplete, and unacceptable in many ways. For example, the weight of the children is missing in cases #2, #4, and #6 and there is no standard format used to describe the case histories, which makes comparison unnecessarily difficult.
  2. I would have found it more helpful had the real values of laboratory data like CBC, LFT, and renal parameters been presented with the normal values in parenthesis in standard format rather than being random.
  3. The dose, duration, and route of administration of N-acetylcysteine (NAC) were not clearly mentioned in the last five cases.
  4. For case #1, it was mentioned that the child was prescribed oral NAC but the medication was not administered. Why was this?
  5. I think the treatment plan was based on [Figure 1], but there was no citation provided to assess its validity.
  6. Liver function abnormalities are nearly universal in dengue fever, a situation seen in case #5. Why were the findings attributed to paracetamol in this case?
  7. According to reference #9 citing guidelines from Australia and New Zealand, the patients in cases #5 and #6 do not fit into the category of receiving a toxic dose that requires treatment with NAC.
In addition, this article opens up a Pandora's Box concerning the use of mefenamic acid in children as seen in cases #4 and #6. The discussion of mefenamic acid and its use in children illustrates an important issue in child health care. Mefenamic acid is quite often prescribed as an antipyretic for children in India. This happens despite the unfavourable risk/benefit ratio of mefenamic acid, availability of safer drugs and doubts about its safety in children. [2] Even if the physicians, other health care personnel, or parents have not experienced any adverse effects of mefenamic acid, the question still remains whether the risk of using the drug is worth any benefit for children. Meta analyses of many clinical studies and standard text books of pharmacology do not recommend the use of mefenamic acid in children. [3] I think these sources and standard guidelines should be given more weight in making recommendations on treatment in the absence of clear evidence that mefenamic acid is safe and effective.

I would like to conclude with a question. Are drugs being prescribed rationally and accordingly to the standard guidelines in India?

 
 » References Top

1.Shivbalan S, Sathiyasekeran M, Thomas K. Therapeutic misadventure with paracetamol in children. Indian J Pharmacol 2010;42:412-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Balasubramanian S, Sumanth A. Mefenamic acid-role as antipyretic. Indian Pediatr 2010;47:453.   Back to cited text no. 2
    
3.Burke A, Smyth E, FitzGerald GA. Analgesic-Antipyretic and Anti-inflammatory Agents; Pharmacotherapy of Gout. In: Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 11 th ed. New York: McGraw Hill; 2005. p. 671-716.  Back to cited text no. 3
    



This article has been cited by
1 Authorsę reply
Shivbalan, S., Sathiyasekeran, M., Thomas, K.
Indian Journal of Pharmacology. 2011; 43(3): 359
[Pubmed]



 

Top
Print this article  Email this article
 

    

Site Map | Home | Contact Us | Feedback | Copyright and Disclaimer
Online since 20th July '04
Published by Wolters Kluwer - Medknow