Rationale and objective: Proton pump inhibitor (PPI) is one of the most widely prescribed medicines and commonly used in gastric related disorders and there is a huge need to analyze the irrational use of PPI in a country like India. The present study was designed to describe the rational drug use and cost comparison analysis of PPI in a rural tertiary care hospital. Methodology: A prospective observational study was performed among 253 inpatients for a period of 9 months after getting ethical approval. Those who received the PPIs for any of its indications were included in the study without any gender or age restriction. US FDA guidelines were used to analyse the appropriateness of the drug use and cost comparison analysis of the branded versus generic PPIs was also performed. Findings: Among the 253 inpatients, the majority (62%) were male and the mean age was 46±19 years. Mean hospital stay and the number of drugs in prescription were found to be 4.0 ± 1days 4.39 ±1.16 items, respectively. Pantoprazole (76%) was the most prescribed PPI even though the majority (57%) of the patients treated outside the FDA approved indication. Drug interaction has been reported in 14% and ADR in 9% of the population. The average cost of hospital stay estimated as 207.96+149.57 INR, and potential cost saving of INR 41582 was observed with generic replacement. Conclusion: The study inferred irrational drug use of PPI still prevalent, that too without considering the economic impact of it on general populations. Healthcare practitioners should be aware and cautious while prescribing the PPI to identify the actual need and to choose the most cost-effective alternative 1.

Introduction: Hypertension is an important public health concern because of its associated morbidity, mortality and economic impact on society. It is a significant risk factor for cardiovascular, cerebrovascular and renal complications. A number of national and international guidelines for the management of hypertension have been published. The Joint National Committee (JNC) in 2003 published a series of guidelines to recommend the appropriate antihypertensive therapy based on the best available evidence. Objectives: This drug utilization study was intended to find out the preferred drug group prescribed either alone or in combinations and their adherence to the JNC 7 guidelines. Materials and Methods: This was a prospective cross-sectional study. Drug utilization data on 100 hypertensive patients were collected from various hospitals in Nepal. The patients who received antihypertensive drugs during their treatment period in SPSS V. 16.0. The prescribed drugs were compared with JNC 7 guidelines. Results: It was found that 40% of patients were male and 60% were female. The largest subset of female hypertensive patients (45.0%) were in the age group of >60 years and a plurality of male hypertensive patients (45.0%) were in the age group of 40–60 years. It was found that 45% of the patients had Stage 1 hypertension, 32% of the patients were in prehypertension, 17% of the patients had Stage 2 hypertension. The most frequently prescribed antihypertensive drug regimens were angiotensin receptor blockers (ARBs) (32.44%), ARB + thiazide (15.94%), diuretics (11.59%), calcium channel blockers (CCBs) + beta blockers (9.42%) and CCBs (8.7%). Thirty-nine percent received monotherapy while the remaining 61% received combination therapy. Seventy-four percent of the total prescriptions followed JNC 7 guidelines. Conclusion: There is a need to follow official guidelines in managing hypertension as a chronic disease, since these guidelines are based on various clinical trials, and the successful attainment of a target BP in patients will be made much easier by implementing them. National health policymakers should consider the evaluation and treatment of hypertension as a right in the public health system for better outcomes in terms of morbidity and mortality from hypertension.