Prescribing Trends and Rationality of Fixed Dose Combinations in a Tertiary Care Hospital: An Observational Study

Abstract

This investigation aimed to review the prescribing trends of fixed dose combinations, to assess their rationality and inclusion in essential medicines list and national list of essential medicines. Medication charts of 1000 in-patients from general medicine department were reviewed for 12 months excluding casualty and ICUs. The data on morbidities and drugs prescribed were documented and assessed for fixed dose combinations prescribed, their inclusion in WHO essential medicines list and national list of essential medicines and approval by regulatory bodies such as US FDA and DCGI. Rationality of the prescribed fixed dose combinations were determined based on WHO guidelines. The drug-drug interactions with fixed dose combinations were analyzed. Descriptive statistics was used to express results in numbers and percentages. Out of 1000 case sheets studied a total of 435 fixed dose combinations were prescribed, all by their brand names during hospitalization. Fixed dose combinations given for infectious diseases were 29.57 % and for respiratory disorders 20.82 %. Those included in WHO essential medicines list 2017 were 11.72 %, while 10.57 % were in the national list of essential medicines 2015 and 17.7% were approved by the US FDA, 56.78 % by DCGI. Rational fixed dose combinations were 38.62 % and 61.37 % were irrational. In the discharge medication chart, miscellaneous agents (19.72 %) and drugs for infectious disorders (15.80 %) were the commonly prescribed fixed dose combinations. Among these 8.25 % were listed in WHO essential medicines list 2017, 6.78 % in the national list of essential medicines 2015 and 15.04 % fixed dose combinations were approved by the US FDA, 53.98 % by the DCGI. Rational combinations were 36.87 % and 63.12% were irrational. Rationality in combining drugs as fixed dose combinations and their appropriate use can reduce pill burden, cost and improve patient adherence.