Irrational fixed dose combinations in Nepal: Need for intervention

Abstract

A large proportion of drugs available are of little importance in terms of ful¿ lling primary healthcare needs. Combination drugs increase the risk of side effects, lead to an ineffective dosage and liability to abuse and may also needlessly increase the cost. Drug combinations make it more dif¿ cult to ¿ nd the causative agent responsible for the adverse reactions. In many cases their stability is doubtful, reducing the ef¿ cacy of many preparations. The Fifteenth WHO model list of essential medicines (March 2007) contains only 25 approved ¿ xed dose combinations, whereas in Nepal, there are innumerable examples of irrational drug combinations, which are easily available and can be bought even without a prescription. A system of screening the drug combinations that are already licensed and available in the market is implemented in many developed and developing countries. Rational combinations can be of immense help to the health care system. These combinations may improve the quality of life for many and increase compliance. But irrational ¿ xed dose combination products can be equally harmful.

Regarding the article “Irrational fixed dose combinations in Nepal: Need for intervention” (KUMJ, Vol 6, No. 3, Issue 23, p. 399-405)

“…In the last issue of the KUMJ we reviewed the availability of irrational ¿ xed dose combinations (IFDCs) in Nepal 1 . At this point, we would like to mention the ¿ ndings from a market survey conducted by us in six major cities of Nepal on the availability of IFDCs.…”

“…Both of the antibiotics belong to same class namely penicillins acting at the same site by same mechanism offering no synergism 1 . Similarly, ampicillin is inactive against Staphylococcus and cloxacillin is inactive against Streptococci.…”

To assess awareness regarding rational drug therapy and fixed dose combinations amongst interns and II MBBS students in tertiary care teaching hospital in Maharashtra, India

“…Last decade witnessed about one-third fixed dose combinations among the new products brought in the market worldwide. 1 FDCs contain two or more drugs in a fixed dose ratio. Clinicians claim better patient compliance while prescribing fixed dose drug combinations.…”

A study to assess and increase awareness regarding fixed dose combinations among medical undergraduates at Indore and Sagar, Madhya Pradesh, India

“…2 Fixed Dose Combinations (FDCs) are seen to improve medication compliance by decreasing the pill burden of patients. Pill burden is not only the number of pills needing to be taken, but also the associated burdens such as keeping track of several medications, understanding their various instructions, etc.…”