A study of use of fixed dose combinations in Ahmedabad, India

Abstract

Objective:The aim of this study was to evaluate the pattern of fixed dose combinations (FDCs) in Ahmedabad, a city in western part of India.Materials and Methods:Over a period of 24 months, prescriptions were collected from 24 pharmacy stores across 6 zones of Ahmedabad city. The information was recorded in pre-formed Data Record Form after written consent from the patients (or relative (s) of the patients). The pattern of use of FDC, rationality and seasonal variation in their use were analyzed. At the end of study, results were analyzed using Chi-square test.Results:Out of the total 1170 prescriptions, 941 (80.3%) contained 1647 FDC formulations. The average number of FDCs prescribed was 1.41 ± 1.04 (mean ± SD). The FDCs were more frequently prescribed in the age group of 31 to 40 years (23.7%) and in males (54.4%). FDCs were most commonly prescribed by oral route (92.7%). As per drug category analysis, a higher number of FDCs containing nutritional supplements (20.2%), and those for CNS (18.1%) complaints were prescribed. A seasonal analysis showed that FDCs were commonly prescribed for respiratory complaints (23.4%), central nervous system (CNS) complaints (20.3%) and as nutritional supplements (22.4%) in winter, monsoon and summer months, respectively. Only 5.8%, 9.8% and 10.9% FDCs prescribed were included in WHO (2010), National (2011) and Gujarat State (2011) Essential Medicines Lists (EML), respectively (P < 0.0001). Irrational FDCs that are banned or FDCs containing irrational active ingredients were 1343 (81.5%) and 203 (12.3%), respectively.Conclusion:FDCs are widely prescribed with seasonal influence in their use. FDCs containing banned or controversial ingredients are prescribed widely.

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“…sulfamethoxazole with trimethoprim), reduced adverse effects (eg levodopa with carbidopa), increased patient compliance (eg. antitubercular drug combination) and reduced cost 8 . However, certain disadvantages like incompatible pharmacokinetics, inflexible dose ratio and contraindication to one component of the FDCs decrease their utility 8 .…”

“…antitubercular drug combination) and reduced cost 8 . However, certain disadvantages like incompatible pharmacokinetics, inflexible dose ratio and contraindication to one component of the FDCs decrease their utility 8 . It was observed from the study that the postgraduate students had the knowledge that FDCs can lead to improvement in patient's compliance and increase in efficacy of individual drugs but irrational prescription can lead to drug resistance also.…”

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“…Fixed-Dose Combination (FDC) is defined as a combination of two or more active ingredients in a fixed ratio of doses 1 . According to Food and Drug Administration USA defines a fixed-dose combination product as a product composed of any combination of drug and device or a biological product or a drug, device and biological product used for treatment 2 It must be safe and efficacious for the claimed indication 3 .…”

Drug utilization 90%: an innovative method in assessing quality of drug prescription with specific reference to non-steroidal anti-inflammatory drugs prescription

“…17 A similar combination of NSAID FDCs were also prescribed in Ahmedabad study. 18 However many combination of NSAID as FDCs is not recommended as these combinations have no drug synergism and moreover the combination can increase the chances of adverse events and overall cost of prescribing. 19 Nevertheless some useful analgesic combinations do exist, such as combination of tramadol with paracetamol.…”