Current Index Of Medical Specialties Research Articles

Cost Analysis Study of Topical Anti-Acne Drugs Currently Available in Indian Pharmaceutical Market

Acne vulgaris is a chronic inflammatory skin disease that affects approximately 90% individuals between puberty and 30 years of age at some point with peak prevalence in adolescence. According to Global Burden of Disease study conducted in 187 countries in 2010, acne is among top ten most prevalent disease worldwide and skin conditions are top cause of years lived with disability. The aim of the study was to analyze cost variations of different brands of topical medications used in Acne vulgaris in India. This analytical study was conducted in the Department of Pharmacology at Assam Medical College and Hospital over a period of 3 months. ‘‘Current Index of Medical Specialities (CIMS)’’ April - July, 2023 and “Drug Today India April –July 2023’’ drug manuals were used to compare cost of different formulations of topical acne medications. Drugs manufactured by only 1 company were excluded. Cost ratio (Maximum cost/ Minimum cost) and percentage cost variation ([{Max cost – Min cost}/ Min cost] *100) were calculated. For single preparations, the percentage cost variation was maximum for Clindamycin 1% 20 grams gel (1126.66%) with maximum cost ratio followed by Tretinoin 20 gm 0.025% (cream) 721.428. Percentage cost variation was minimum with Adapalene 0.1 % cream 15gm (32.69). Among the combination topical drugs, the percentage cost variation was maximum for Clindamycin 1% + Adapalene 0.1% 15 grams gel (1843.589) and it had maximum cost ratio of 19.43. Percentage cost variation was minimum with combination of Benzoyl Peroxide 2.5% + Clindamycin 1% 20gm gel(41.025).This study highlights price variation among different brands of drugs in CIMS, Drug Today and Pharma Sahi Daam app. Keywords Cost Analysis, Acne vulgaris, Percentage Cost­Variation, Pharma Sahi Daam

A STUDY OF COST VARIATION ANALYSIS OF ORAL HYPOGLYCEMIC DRUGS AVAILABLE IN INDIAN PHARMACEUTICAL MARKET

Objectives: A large number of oral hypoglycemic drugs as single or fixed dose combinations are available for the treatment of diabetes mellitus which has a wide range of price variation and becomes a constraint in the treatment for both physician and patient. However, very few studies have been done to reveal such price variations. The objective of this study was to find out the cost variation among the different brands of various classes of oral hypoglycemic drugs in similar strength and dosage forms of single therapy and fixed-dose combinations. Methods: Cost of a particular drug being manufactured by different companies in the same strength, number, and dosage form was compared from the Current Index of Medical Specialties (CIMS) (January 2022–April 2022) and Indian Drug review 2022. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and the percentage variation in price was calculated. Results: Among single drug therapy, Glimepiride (1 mg) shows a maximum percentage variation in price of 3450%. Among Sulfonylureas-glimepiride (1 mg) shows a maximum price variation of 3450%, in Biguanides–metformin (500 mg), in Thiazolidinediones – Pioglitazone (15 mg) shows a maximum price variation of 900%, and 300%, respectively, and among the glucosidase inhibitors, Voglibose (0.3 mg) shows maximum price variation of 571.2%. Among combination formulation, glimepiride (1 mg) + metformin SR (500 mg) shows a maximum percentage of price variation of 262.1%. Conclusion: It is observed from our results that there is a wide variation in prices of drugs manufactured by different pharmaceutical companies. Hence, it is very necessary for regulatory authorities to regulate the wide variation in drug prices to maximize the benefits of the treatment. It is recommended that the appraisal and management of marketing drugs should be well-regulated.

PHARMACOECONOMIC STUDY OF VARIOUS BRANDS OF ANTI-EPILEPTIC DRUGS AVAILABLE CURRENTLY IN INDIA

Objectives: (a) Compiling a comprehensive list of the available dosage forms and strengths of various antiepileptic drugs marketed in India. (b) Calculating the percentage cost variation of individual drug formulations produced by different pharmaceutical companies. (c) Evaluating the percentage cost variation of these drugs. Methods: The cost of an exact drug (cost per 10 tablets) in the same strength and amount of forms being manufactured by different companies were got from the latest editions of “Current Index of Medical Specialties” and “Indian Drug Review.” The percentage price difference and cost ratio for each formulation were intended. Result: Among single drugs, the highest price variation was found in the drug pregabalin available in the form of capsules (75 mg and 150 mg), and a cost ratio of 6.64 and 5.87 was calculated which was significant. Among combination drugs, tablet Na valproate+valproic acid with the cost ratio of 1.91 was found to be the highest. Conclusion: Our study shows that there is very high price variation in some of the brands of anti-epileptic drugs. Generic prescribing should be promoted in the whole country by creating awareness and implementing proper regulatory guidelines.

Cost variation analysis of various oral cephalosporins available in the Indian market

Background: Cephalosporins stand as one of the most frequently prescribed antibiotics for combating infectious diseases. This group has proven to be effective in the treatment of both gram positive and gram negative infections. Analysis of price discrepancies among various brands of oral cephalosporins. Offers guidance for prescribing cost-effectively, which turns out to be beneficial for both the patient and the prescribing physician. A cost-effective prescribing pattern ensures good patient compliance and better treatment outcome. Aims and Objectives: The objectives of the study were to analyze price variation of various single oral cephalosporin formulations available in the Indian market. Materials and Methods: The prices of oral cephalosporins, produced by different pharmaceutical companies in India, with the same strength, were acquired from the current index of medical specialties, January-April 2023. The cost of generics was obtained from the official website janaushadhi.gov.in. The disparity between the highest and lowest prices of the identical formulation manufactured by different companies, the difference between the maximum and minimum prices of brand-name versus generic versions of the identical formulation, as well as the cost ratio and percentage cost variation, were computed. Results: Total number of brands range from 3 to 79 for various drugs. A large price variation was seen across the different brands. The maximum price variation 521.11% was seen with 100 mg of Cefixime and minimum price variation of 14.13% was seen with 125 mg of cefdinir. Conclusion: With the high variation in prices seen among the different drugs it is important to consider the affordability of the patient before prescribing the drug to ensure completion of the course and better treatment outcome.

A Cost Variation Analysis of Oral Contraceptive Pills Available in the Indian Market

Background: Oral Contraceptive Pills (OCPs) are highly effective contraceptives if used regularly and adequately, and they also have added non-contraceptive benefits. This gives way to their increasing use in recent years, which has led to the introduction of numerous brands of drugs with different costs in the Indian market. Hence the current study was conducted to analyze the cost ratio and cost variation of different brands of OCPs available in the Indian market and to compare the cost of branded and generic drugs.
 Materials and Methods: The cost of the drugs was obtained from the Current Index of Medical Specialties (CIMS) - 44th Year April – July 2022 and from the website https://www.mims.com/india/. The Cost Ratio (CR) and Percentage Cost Variation (CV) was calculated. The cost of generic drugs was obtained from the website http://janaushadhi.gov.in/SortingView.aspx.
 Results: 124 brands of various OCPs were available in the Indian market. Among all the regular OCPs available, the CR and CV were highest for Ormeloxifene 30mg at 10.19 and 919.4%, respectively, and they were lowest for Dienogest +Ethinylestradiol which comes under combined OCPs with the results of 1.007 and 0.73% respectively. The cost of all generic OCPs was lesser when compared with brand OCPs, and the difference in cost was maximum for Ulipristal.
 Conclusion: There is wide variation in the cost of Oral Contraceptive Pills available in the Indian market, and the cost of brand drugs is higher than their generic counterparts. Physicians have to be made aware of this price difference so that they can prescribe drugs that are more affordable to the patients to improve their adherence to the regimen.

COST VARIATION ANALYSIS OF ANTIMALARIAL DRUGS : A REVIEW

Background: Malaria has been a major issue in India for ages. There are numerous antimalarial brands available on the market. Costly medications can place an economic burden on patients, resulting in lower compliance or even noncompliance. Noncompliance leads to insufficient therapy, which increases morbidity. Increases in patient pharmaceutical costs were found to be related to worse adherence to prescribed medicine. As a result, this study was conducted to analyze the cost variation of malaria drug-therapy. Methods: Price in Indian rupees (₹) of antimalarial drugs manufactured by different pharmaceutical companies in India, in the same strength and in same dosage form were obtained from Current index of medical specialties (CIMS) January-April 2023. Cost ratio and cost variation percentage were calculated and data was analysed. Results: The highest cost ratio and percentage cost variation were observed for Quinine injection 300mg/ml, with a cost ratio of 7 & a percentage cost variation of 599.65%.The lowest cost ratio was found for Mefloquine tablet 250mg injection, with a cost ratio of 1.01 and a percentage cost variation of 1.35%. Overall, the injectable antimalarial medications showed a considerable cost ratio and cost variation Conclusions: Ceiling cost of drugs are fixed by national pharmaceutical pricing authority (NPPA) government of India in accordance with DPCO 2023.Despite this there exists a wide variation of drug costs within one drug with the availability of various brands

A Cost Variation Analysis of Hypolipidemic Drugs Available in the Indian Market

Background: Cardiovascular diseases are amongst the prime reasons of increasing morbidity as well as mortality worldwide. Dyslipidemia is an important and modifiable risk factor of CVD and statins are extremely endorsed in its treatment. Method: Data was acquired from the online edition of “Current Index of Medical Specialties” (CIMS), 1mg, netmeds. The percentage cost variation as well as cost ratio were calculated. Result: Percentage cost variation was recorded highest in atorvastatin 10mg (3668.50%) whereas, the least percentage cost variation was recorded for pravastatin 10mg (3.61%). Conclusion: To reduce the burden on patients, the government should cover as many as possible drugs under the drug price control order (DPCO) and develop uniformity in the pricing of the drugs. Keywords: Hypolipidemic drugs, cardiovascular diseases, cost variation, statins, brands

Cost-Minimization Analysis of Medications Used in the Management of End-stage Renal Disease

Abstract: Aim/Background: Several branded pharmaceuticals and generic medicines are available in the market for the management of End-Stage Renal Disease (ESRD) as a supportive care, and clinicians are unaware of the cost minimization and cost consequences aspects of these medications. Thus, this study aimed to compare the prices of branded versus generic medicines for ESRD treatment and to present the cost savings with a generic alternative. Materials and Methods: A prospective observational study was conducted among ESRD patients from three different tertiary care teaching hospitals in South India. The cost of branded pharmaceuticals were determined using the most recent current index of medical specialties, while the prices of generic medicines were accessed using the Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana scheme, 2022. Results: The data were collected from 385 patients with ESRD. All Jan Aushadhi generic medicines were less expensive when compared to the branded medicines. The cost of ESRD medicines accessible in India varies greatly. The greatest difference in percentage cost savings were noted with amlodipine 5 mg tab (93.03%), voglibose 0.2mg/tab (88.10%), calcium carbonate + Vitamin D3 supplements 500 mg tab (80.27%), torsemide 10 mg tab (78.01%), and hematopoietic agent, erythropoietin 2000 U/inj (75.38%). Conclusion: The haematopoietic medicines and antidiabetic insulin injections were the most expensive medicines among the study population. Our research indicates that replacing the generic medicines with the branded medicines could help in reducing the cost burden. Healthcare professionals may consider prescribing generic medicines for cost-savings. Keywords: Pharmacoeconomics, Cost minimization, End stage renal disease, Antibiotics, Insulin, Jan Aushadhi.

A Pharmacoeconomic Outlook of the Biological Drugs Marketed in India: A Cost Variance Analysis.

Introduction Biologic drugs are used to treat various illnesses like autoimmune diseases, cancers, hormonal irregularities, anemia, etc., and to prevent various diseases as vaccines. Though various biologic drugs are already available, they are still not within reach of the common man due to financial constraints. Through many search engines, studies evaluating the cost variation of different brands of biologics were investigated; however, only a few studies that address this problem were found. Hence, this study was planned with the objective of addressing the cost variation of various brands of biologic medicines available in the Indian market. Methods The website for the Current Index of Medical Specialties (CIMS) for India's location was used to obtain the prices of the different brands of biologic medicines in Indian National Rupee (INR) currency, which different manufacturers market with identical forms in strength and dosage. The percentage cost variation and cost ratio were calculated with the help of the minimum and maximum prices of various brands of biologic drugs. Results The prices of biologics belonging to six different classes that are available in 23 formulations were analyzed. The highest cost variability was shown by pegfilgrastim 6 mg at 1,022.92%, and the minimum-cost variation was shown by darbepoetin alfa 200 mcg at 13.07%. Conclusion Our research found a vast variance in the costs of various brands of biologic medicines in India. The government should address this cost variation problem by developing various policies, such as breaking the monopoly of manufacturers, providing tax incentives to nonprofit generic medicine manufacturers, and incorporating more biologic drugs under the protection of the Drugs Prices Control Order (DPCO).

Cost analysis of antipsychotics marketed in India – A pharmacoeconomic study

Background: Psychiatric disorders are one the leading causes of non-fatal disease in India. Among them, schizophrenia is one of the most common, distressing, and costly psychiatric disorders worldwide. There are large price differences between different brands of the same antipsychotics marketed and prescribed in India. Escalating drug costs are one of the causes of drug non-compliance, which can lead to adverse health outcome. Aims and Objective: The purpose of the study was to analyze the cost variability of different brands of oral antipsychotics marketed in India. Materials and Methods: The present study was an observational analytical one. The highest and lowest price of each antipsychotic drugs in the same strength, marketed by different pharmaceutical companies, were collected from the current index of medical specialties (CIMS), January to April 2023. Calculations were done in Indian Rupees per 10 tablets/capsules. For each antipsychotic drug, the cost ratio and percentage of price variation (PPV) were calculated. Results: The costs of a total of 14 drugs (10 single and 4 combined preparations) available in 337 dissimilar strengths were analyzed. Among typical antipsychotics, chlorpromazine 50 mg had the highest cost ratio and PPV of 5.36% and 435.62%, while haloperidol in the strength of 20 mg had the lowest cost ratio and PPV of 1.09% and 9.41%, respectively. On the other hand, atypical antipsychotic risperidone 1 mg had highest cost ratio and PPV of 6.97% and 596.99%, clozapine in the strength of 50 mg had lowest cost ratio and PPV of 1.13% and 13.18%, respectively. Among fixed-dose combinations, risperidone + trihexyphenidyl (2+2) mg had highest cost ratio and PPV of 2.47% and 147.53%, while trifluoperazine + trihexyphenidyl (10+2) mg had lowest cost ratio and PPV of 1.05% and 4.53%, respectively. Conclusion: This study showed large differences in cost ratio as well as PPV between various brands of the same antipsychotics. To reduce the financial burden and improve drug compliance, physicians must prescribe less expensive drugs. Furthermore, for the benefit of patients in general, MBBS students, future community prescribers, should also be trained in pharmacoeconomics to make them aware of the cost differences of the same drugs from different brands.

Variation in Cost Among Anticancer Drugs Available in India: A Cross-sectional Study

Introduction: Cancer is an abnormal growth of cells, and it encompasses over 100 types of cancers that affect humans. Cancer management often involves a combination of radiation therapy, surgery, chemotherapy, and targeted therapy. Anticancer drugs, in general, tend to be more expensive compared to other categories of drugs, significantly contributing to the overall drug expenditure incurred by patients. Aim: To analyse the percentage variation in cost among different brands of anticancer drugs available in the Indian market. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Symbiosis Medical College, Symbiosis International University, in Pune, Maharashtra, India. The study duration was six months, from March 2021 to August 2021. Data on the prices of anticancer drugs were collected and analysed using the October 2020 to January 2021 edition of the Current Index of Medical Specialities (CIMS). A total of 29 anticancer drugs with different strengths were considered. The cost of a particular anticancer drug with the same dose and dosage form produced by different companies was compared. Drugs were selected based on their strength and dosage forms. The cost of one tablet, capsule, or injection was calculated in Indian Rupees (INR). The cost of a single unit was compared, and the difference between the maximum and minimum costs was calculated. Subsequently, cost ratios and the percentage of cost variation were determined. The study findings were recorded in both Microsoft Word 2016 and Excel 2016, and they were expressed as absolute numbers and percentages. Results: Bortezomib 3.5 mg was the costliest among anticancer drug which was priced at INR 18,988.00, while the cheapest was methotrexate 2.5 mg tablet, priced at INR 1.886. Among the anticancer drugs, pacilitaxel 260 mg injection had the highest cost ratio of 1 29.3055, whereas cisplatin 10 mg injection had the lowest cost ratio. Regarding cost variation, pacilitaxel 260 mg injection showed the highest percentage of cost variation at 2830.5555%, while cisplatin 10 mg injection showed the lowest at 0%. Conclusion: This study revealed a significant variation in prices, cost ratios, and cost variation among different anticancer drugs, providing insights into the price discrepancies observed in the market. The findings can help physicians and policymakers become aware of the cost variations among these drugs and make informed decisions regarding pricing.

Cost variation analysis of various non-steroidal anti-inflammatory drugs available in the Indian market

Background: Non Steroidal Anti Inflammatory Drugs (NSAIDS) are used to treat a variety of conditions associated with pain and inflammation. Analysis of price variation among different brands of NSAIDS provides a guide for cost - effective prescribing and helps to reduce the financial burden on the patient and improves patient compliance. Aim: To analyze price variation of various single NSAID’s formulations available in the Indian market. Material & Methods: Price of NSAIDs manufactured by different pharmaceutical companies in India of same strength was obtained from Current Index of Medical Specialties, January-March 2022. Difference between maximum and minimum price of the same formulation, cost ratio and percentage cost variation was calculated. Results: Large price variation was seen with Celecoxib 100mg capsule (476.6%) followed by Celecoxib 200mg capsule (402.3%),Nimesulide 100mg tablet (358.33%) and Paracetamol 500mg tablet (285.06).Price variation was lowest for Mefenamic acid 250mg tablet (8%). Among the syrup formulations, it was seen that there was a price variation of 29.5% for Paracetamol 125mg/5ml, 54.15% for Ibuprofen 100mg/5ml and 37.1% for Mefenamic acid 100mg/5ml. Among the injectable NSAID’s, price variation was maximum for Diclofenac 75mg/ml (441.39%). Diclofenac 1%w/w 30gm gel showed price variation of 264.86% among the topical NSAID’s.

A Cost-Variation Analysis of Drugs Available in the Indian Market for the Management of Diabetic Nephropathy.

Background Diabetic nephropathy is associated with polypharmacy and increased out-of-pocket expenditure for the patients. Multiple brands of each prescribed drug are available in the market. Hence, there is a need to evaluate the cost variation of the available brands of prescribed drugs. Methodology All drugs prescribed to the 282 patients with diabetic nephropathy from our previous cross-sectional observational drug utilization study were included. Data regarding the cost of various brands of the prescribed drugs were obtained from Current Index of Medical Specialities (CIMS) android application version 3.1.2 and Indian online pharmacies. The percentage price variation and cost ratio for these drugs were determined. A correlation analysis was conducted between the number of brands and percentage price variation. Results A high percentage price variation (>1,000%) and cost ratio (>10)was observed for 19 out of 39 drugs that were evaluated. The highest price variations were seen with amlodipine (16,799%), metformin (11,240%), and glimepiride (10,525%). The highest cost ratios were seen with amlodipine (168), metformin (113.40%), and glimepiride (106.25%). There was a negligible correlation between the number of brands and percentage price variation. Conclusions The above findings indicate that drug price variations need to be monitored more strictly. The present study may aid physicians in understanding the degree of price variation among medications used for the treatment of diabetic nephropathy, thereby necessitating the selection of a P-drug to increase the affordability of drugs for patients.

A COST VARIATION ANALYSIS OF ORAL AND TOPICAL ANTIFUNGAL AGENTS AVAILABLE FOR THE TREATMENT OF SUPERFICIAL FUNGAL INFECTIONS IN INDIA – AN INSIGHT TO THE RISING TREATMENT COST

Objective: This study objective was to evaluate the cost variation among systemic and topical antifungal drugs used for superficial fungal infection which is available in India. Methods: This cross-sectional study assembled the cost of individual antifungal agents belonging to the same strength and dosage forms being manufactured by different pharmaceutical companies in India were documented in Indian Rupees (INR). The study tools were the latest edition January–April 2022 of Current Index of Medical Specialties and 1 mg online application. The study parameters were minimum and maximum cost, difference in maximum and minimum cost, and percentage cost variation. Results: A total of 14 antifungal agents, including seven orals and seven topical, were analyzed. Fluconazole 50 mg tablet is manufactured by 67 companies and has the maximum cost variation of 2695.8%. This is followed by capsule itraconazole 100 mg (cost variation – 1900%) and is manufactured by largest number of companies, that is, 1039. Luliconazole 30 g cream has highest cost ratio of 13.75 and cost variation of 1275% which was manufactured by largest number of companies, that is, 211. There was a linear relationship seen in linear regression analysis between number of manufacturing companies and percentage cost variation (p=0.0204). Conclusion: A rationale prescription should always consider the most economical treatment depending on the patient. Adequate information to medical practitioner about cost variation of drugs and strict actions and coordination of regulatory authorities will overcome the problem of huge cost variation.

Cost variation analysis of various brands of anti-retroviral agents currently available in Indian market: an economic perspective study

Background: The aim was to analyze the percentage cost variations among different brands of the commonly prescribed anti-retroviral agents in the treatment of human immunodeficiency virus.Methods: The cost of different brands of commonly used Anti-Retroviral agents was sorted out by referring latest Indian drug index online, drug today, current index of medical specialties, Indian drug review.Results: The percentage variation in the cost was above 100% with most of the commonly used anti-retroviral agents. Overall sequinafir 500 mg shows maximum cost variation of 1490.3%, while nelfinavir (625 mg) shows minimum cost variation of 6.1% in single drug therapy. Lamivudine 300 mg and tenofovir 300 mg combination shows maximum cost variation of 14055% whereas, lamivudine 150 mg, zidovudine 300 mg and efavirenz 600 mg shows minimum cost variation of 10% in combination drug therapy.Conclusions: HIV is the most common infectious, life-threatening disease and drugs are to be prescribed for life-long period. If a costly brand is prescribed, the patients cannot afford to pay more money for their treatment. This also leads to poor patient compliance, dissatisfaction and failure of the treatment. Ideally, therefore, the drugs should be prescribed in such a way, to save the patient's economic burden and enhance the compliance of the treatment.

Analyzing Drug Utilization in Ophthalmology Outpatients in a Private and Public Health Facility as well as Cost Variation of Selected Ophthalmological Medicines

Abstract: Background: The rationale behind this study conduction was; 1. To analyze ‘drug use’ and 2. To analyze ‘cost variation’. First could facilitate improving drug utilization patterns and prescribing practice, and second, could justify and improve rational drug utilization. Materials and Methods: This study was a descriptive, cross-sectional study. Selected ‘World Health Organization’ drug use indicators and cost variation of ophthalmological medicines were analyzed from ‘prospectively collected patient and, prescription data’ and ‘basic cost data of medicines from Current Index of Medical Specialties’, respectively. A total of the ‘449’ patients’ data were considered in the study, out of which ‘231’ and, ‘218’ were from ‘public’ and, ‘private’ health facilities respectively. Results: Out of the total sample, ‘1.36’ was the count of drugs per prescription. The ‘drug percentage’ prescribed by generic name and, from the Essential Medicines List was 31.59% and, 56.35%, respectively. 75.72% of prescriptions were prescribed antibiotics, while 82.41% of patients had correct knowledge of dosage. ‘Eye strain’, ‘conjunctivitis’ and, ‘cataract’ were the common eye problems. ‘Antibiotics’, ‘corticosteroid’ and, ‘ocular lubricants’ were commonly prescribed. From the total of ‘614’ drugs prescribed, ‘171’ was the combination formulations. The study showed high-cost variation among multiple available branded options of single ophthalmological medicine. Conclusion: A rational drug use pattern was found in both the study sites. However, there is a wide variation of the indicators values between them. It is recommended to improve and, periodically update healthcare drug policies along with frequent drug utilization and cost monitoring studies. Key words: Drug Utilization (DU), Cost Analysis, Drug Use Indicator, Ophthalmological Medicines, Ophthalmology Outpatient, Essential Medicines, World Health Orgnization (WHO).

PHARMACOECONOMIC ANALYSIS OF VARIOUS BRANDS OF COMMONLY PRESCRIBED ORAL ANTIHYPERTENSIVE MEDICINES IN INDIAN MARKET

Objectives: The objective of the study was to analyze the percentage cost variations among various brands of the commonly prescribed antihypertensive medicines in India. Methods: Cost of a particular medicine (cost per 10 tablets) in the same strength and dosage forms being produced by various pharmaceutical companies was taken from Current Index of Medical specialties and Drug Today. Difference between the highest and lowest cost of the same drug manufactured by various pharmaceutical industries was obtained and percentage cost variation was calculated. Results: The percentage variation in the price was above 100% with almost all of the commonly prescribed antihypertensive medicines. The cost of a total of 23 drugs (14 single and nine combination preparations), available in forty nine different formulations were studied. Overall, Amlodipine (5 mg) shows highest price difference of 982.3%, while Nifedipine (5 mg) shows lowest price difference of 39%. Telmisartan + Hydrochlorthiazide (80+12.5 mg) combinations shows highest price variation of 318.9%, while Amlodipine + Losartan (5+50 mg) shows lowest price difference of 50%. Conclusion: The average percentage price difference of the same antihypertensive medicine manufactured by various pharmaceuticals company in India is very huge. Hence, Government, Pharmaceutical companies, prescribing health care workers should educate themselves about huge variation in price of brand drugs in comparison with their cheap generic counterpart to provide maximum benefits with minimum financial burden to the patients receiving antihypertensive drugs.

Paediatric dosage ‘need of hours among family physicians/other speciality physicians’

Dear editor, We read the article with bated breath by Sil et al.[1] ‘A study of knowledge, attitude and practice regarding administration of paediatric dosage forms and allied health literacy of caregivers for children’. It is an essential topic because it serves as a reminder to prescribers to emphasise the dose pattern to caregivers. They have very nicely concluded that Physicians must be mindful of the limitations of their knowledge as well as the likelihood of incorrect administration practices among childcarers. Medication errors can be reduced by taking corrective action in this area. Paediatricians, for example, are notorious for emphasising and stressing dosage, approach and patterns. Other speciality physicians are forced to manage paediatric cases in low-developed countries such as India, where paediatricians are few in rural settings. In the current pandemic crisis, dextromethorphan is often used to treat dry cough in in-patients or as a prescription for out-patients. Because its dosage is based on age rather than body weight, there is a lot of variation in the amount of medicine given.[2] The clinical effectiveness of syrup or any other formulation of dextromethorphan for treating acute cough is unknown, and the American Academy of Paediatrics does not recommend it. With this as a backdrop, we tried to focus on current issues that have been highlighted in the media and by India’s drug regulatory authorities. It is with reference to the recent news and official order given by Directorate General of Health Services (DGHS) of India regarding the report of dextromethorphan poisoning admitted at Kalawati Saran Children Hospital in New Delhi.[3] There is another crucial factor to consider with respect to the advisory as per the National Formulary of India (NFI) and Current Index of Medical Specialities (CMIS). In NFI, the age for which drug dextromethorphan advised is 2–12 years with dosage mentioned in Table 1. In CIMS India the dosage for 2–12 years is mentioned and provided information that individualized dose for children up to 2 years has to be followed.Table 1: Information regarding dextromethorphan for childrenIn all the drug resources, there is an indication with a clear distinction between giving doses to children and prescribing doses to adults. Even though, depending on the amount or the components of the exact formulation taken, the medicine dextromethorphan might cause a variety of side effects, the majority of cases with dextromethorphan abuse improve just with supportive care. However, seriously affected patients may need more attention. Because dextromethorphan is typically misused in younger age groups, early detection and treatment of dextromethorphan abuse may be critical in preventing broader substance dependence in these kids.[4] In light of the foregoing, we were intrigued to investigate the labelling of a few pharmaceutical items available at a nearby pharmacy. Again, it is surprising to our knowledge that just a small percentage of the preparations still contain children aged 2 and up. This banning of dextromethorphan for children less than 4 years of age is also an alert for all the family Physicians and Paediatricians and provides us a signal to be vigilant before prescribing any paediatric drug and by sticking to the guidelines or drug dosage information in existence from time to time. As a result, it is now required to follow the DGHS’s new instructions on the use of children above the age of four, regardless of the label. It is also an earnest request for all the prescribers to update knowledge over the over the counter drugs. Ethical approval Not required Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. I would like to submit the letter entitled ‘PAEDIATRIC DOSAGE ‘NEED OF HOURS AMONG FAMILY PHYSICIANS/OTHER SPECIALITY’ to letter to editor, in your esteemed journal. I declare there is no conflict of interest and no completing financial support is required for this work. And also, I confirmed that the manuscript has been read and approved for submission by all the named authors.

Information on migraine drugs in commonly available Indian drug information sources - Whether we satisfied the community needs?

Drug information can be obtained from various drug information sources that were available as government (National Formulary of India [NFI]; Central Drugs Standard Control Organization [CDSCO]), as well as commercial documents (Current Index of Medical Specialties [CIMS] and Monthly Index of Medical Specialties [MIMS]). Irrational drug usage may happen due to wide variation in the information available in these sources. In this study, we tried to assess these variations in a sample of drugs for the acute-specific management of migraine with ergot and Triptans antimigraine drugs in drug information sources such as NFI, CIMS, MIMS, and CDSCO. Scoring was done for various drug information based on the completeness of information about drugs used in acute-specific management of migraine. The scores for the completeness of drug information about the selected antimigraine drugs are 18.37% for CIMS (Ergotamine, Sumatriptan, Rizatriptan, and Zolmitriptan), 21.1% for NFI (Dihydroergotamine, Sumatriptan), 72.79% for MIMS (Ergotamine tartrate, Sumatriptan, Rizatriptan, Naratriptan, zolmitriptan, Almotriptan) and 21.77% for CDSCO (Ergotamine tartrate, Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan, eletriptan and almotriptan). The information for the antimigraine drugs available from various sources found to so much deficient. Necessary steps need to be taken in case of government public or hard documents to streamline drug information available with them as well the commercial documents as to provide reliable drug information uniformly for promoting rational use of the drug.

Cost analysis of antiamoebic drugs marketed in India: An observational study

Background: Amebiasis is a common recurring infection of the gastrointestinal tract caused by Entamoeba histolytica, affecting 15% of Indian population, related to poor sanitation and socioeconomic condition. No studies have been performed yet on cost analysis of antiamoebic drugs. Aim and Objective: The aim of the study was to analyze cost variations of different brands of antiamoebic drugs marketed in India. Materials and Methods: It was an observational and analytical study in which maximum and minimum costs in rupees per 10 tablets/capsules of each antiamoebic drug in same strength, manufactured by different pharmaceutical companies in India, were obtained from the Current Index of Medical Specialties (October 2021–January 2022), Drug Today (October 2021–January 2022), and Indian Drug Review (Issue 5, 2021). Cost ratio and % cost variation were calculated for each antiamoebic drug. Results: Metronidazole 200mg had highest cost ratio of 12.1 and 1110.73% cost variation, while Diloxanide furoate 500 mg had lowest cost ratio of 1.69 and 69% cost variation. Among fixed dose combinations, Tinidazole + Norfloxaxin (600 + 400) mg had highest cost ratio of 17.89 and 1689% cost variation, while Metronidazole + Norfloxacin (600 + 400) mg had lowest cost ratio of 1.21 and 21.22% cost variation. Conclusion: Our study showed significant cost variation in different brands of the same antiamoebic drugs. To lessen economic burden and to improve adherence to treatment, it is desirable for physicians to prescribe cheaper brands/generic drugs, to meet the health-care needs of patients. Furthermore, the government should make regulations to decrease cost variation of different brands of same antiamoebic drugs.