Current Index Of Medical Specialties Research Articles

Assessment of Drug Prescribing Pattern and Cost Analysis for Skin Disease in Dermatological Department of Tertiary Care Hospital: An Interventional Study

Objective: To study and assess the prescribing pattern and cost analysis in dermatology outpatient department (OPD) in a tertiary care hospital. Methods: Data was collected for three months by reviewing OPD cards and prescription data and rationality and cost were assessed by WHO/DSPRUD Indicators and WHO Recommended clinical guidelines 2013 (Diagnosis and treatment manual). Average per prescription cost was calculated. For cost analysis, we used Cost-Minimization method. Although we only considered total drug treatment cost. All drugs cost were calculated in Indian rupee from the Current Index of Medical Specialties (CIMS). For each drug cost was calculated in as either cost per μg, mg, gm or ml as appropriate. We further divided total drug cost into two parts, first the total cost of drugs which are purchased from Paid pharmacy shops and second, the total cost of drugs which are freely available in Free OPD pharmacy. Findings: Pre and post interventional data analysis showed that, average no. of drugs prescribed was 2.95/ prescription and 2.62/prescription respectively. Before Intervention average cost of drugs per prescription was found to be 376.97 INR and after intervention average cost of drugs per prescription was found to be 299.20 INR. During pre-intervention study period, combination preparations (28.54%) were the most commonly prescribed class of drugs followed by others(Multivitamins, topical Vasodialators, antipyretic, retinoid etc.) (18.86%) and antihistamines (17.69%) while during post-intervention study period, combination preparations (32.37%) were the most commonly prescribed class of drugs followed by antifungals (19.42%) and antihistamines (17.62%). Conclusion: Clinical pharmacist can conduct such periodic audit to rationalize the prescription, reduce errors and suggest a cost effective management of skin diseases. The programs should conduct into the hospital for Physicians and Post graduate students, to show comparison and benefits of generic versus branded drugs also to improve generic prescribing practice and to make therapy economic to the patients.

Pharmacoeconomic analysis of drugs used for peptic ulcer in India

Background: Acid peptic disorders are common medical problems in daily clinical practice leading to a significant economic burden on healthcare expenses. Due to lack of information on comparative drug prices and quality, it becomes difficult for physicians to prescribe the most economical treatment. So the present study was planned to analyse the price variations of various anti-ulcer drugs available in India. Methods: The cost of a particular anti-ulcer drug being manufactured by different companies, in the same dose and dosage forms, was obtained from latest issue of ‘‘current index of medical specialties’’ January to April, 2016. The difference between the maximum and minimum prices of same drug was analysed and percentage variation in the prices was calculated. Results: Overall, the prices of a total of 12 anti-ulcer drugs belonging to four different categories available in 38 different formulations were analysed. Among the proton pump inhibitors, pantoprazole (40 mg; EC tablet) showed the maximum price variation of 500.75%. With regard to H2 blockers, ranitidine (50 mg; injection) showed the maximum price variation of 989.92%. The maximum price variation among various formulations of ulcer protective was seen with sucralfate (1000 mg; tablet) of 166.00% while misoprostol (200µg; tablet) was the only drug present in prostaglandin analogues and it showed a price variability of 14.33%. Conclusions: The average percentage variations of different brands of the same anti-ulcer drugs in same dose and dosage form manufactured in India were very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-ulcer drugs and thereby minimizing the economic burden on the patients.

Difference in described indications of medicines among drug information sources in India: An issue urgently to be addressed.

Background:Drug information can be obtained from various sources such as National Formularies, drug package inserts (PI), other sources such as Monthly Index of Medical Specialities (MIMS), Current Index of Medical Specialities, and the information available with the regulators. Any variation in the information available in different sources can promote irrational drug use. In this study, we assessed this variation in a sample of commonly used drugs.Materials and Methods:Fifty commonly used drugs were analyzed for any variation (both quantitative and qualitative) in information on indications as mentioned in commonly used drug information sources such as Central Drugs and Standards Control Organization (CDSCO) website, National Formulary of India (NFI), MIMS, and PI of medicines.Results:We observed a variation in average number of indications per drugs given in CDSCO (2.2 ± 0.25), NFI (3.51 ± 0.42), MIMS (2.98 ± 0.29), and PI (3.18 ± 3.52). The CDSCO and NFI did not contain information about indication for 10 and 17 drugs, respectively, while MIMS and PI contained information about all the selected drugs. A subset analysis was done for 24 such drugs which were mentioned in all the four sources and it was found that NFI had listed the maximum number of indications per drug (3.79 ± 0.53), followed by PI (3.08 ± 0.44), MIMS (3.04 ± 0.51), and CDSCO website (2.66 ± 0.37) and this difference was found to be statistically significant (P = 0.02). We also observed some gross qualitative variation regarding drug information given in different sources.Conclusion:Variation exists in the quantity and quality of information available on indications about drugs available in various sources. Necessary steps need to be taken to harmonize drug information available across various sources so as to provide reliable and uniform drug information thereby promoting rational drug use.

Cost analysis of antiepileptic drugs available in India

Background: Epilepsy is one of the major causes of morbidity, mortality and needs long-term treatment. There is a wide range of variation in the prices of drugs marketed in India. Thus, a study was planned to analyse out cost variations of antiepileptic drugs available in Indian market. Methods: Minimum and maximum costs in rupees (INR) of antiepileptic agents manufactured by different companies, in the same strength and dosage forms were obtained from “current index of medical specialties” January ‑ April 2016. The cost ratio and percentage cost variation were calculated for each generic antiepileptic agent. Results: There is a wide variation in the prices of different brands of same antiepileptic agent in Indian market. The highest cost ratio and percent cost variation was found for divalproex 500 mg [(1:3.17) and 216.7], followed by lamotrigine 25 mg [(1:2.5) and 150], clobazam 10 mg [(1:2.47) and 147.3] and clonazepam 0.5 mg [(1:2.46) and 145.9]. Conclusions: The average percentage price variation of different brands of the same oral antiepileptic drugs in Indian market is very wide. Treatment of epilepsy has a long course with compliance being a key factor for successful treatment. Improved adherence to the treatment can be ensured by decreasing the cost of therapy, by changes in the government policies and regulations and creating awareness among treating physicians for switching to cost effective therapy.

Study of variation in prices of oral antiplatelet drugs available in Indian market

Background: Coronary artery disease is one of the most prevalent causes of death and disability in developed and developing countries. There is a wide variation in the prices of oral antiplatelet drugs marketed in India. Thus, a study was planned to find out the variation in cost in the oral antiplatelet drugs available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same antiplatelet drug by calculating percentage variation in cost. Methods: Cost of oral antiplatelet drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “current index of medical specialties” October 2015-January 2016. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost per 10 tablets was calculated. Results: Percentage variation in cost for oral antiplatelet drugs marketed in India was found to be-clopidogrel 75 mg (1067.3%), clopidogrel 150 mg tablet (148.7%), prasugrel 5 mg (94.4%), aspirin 150 mg (69.8%), prasugrel 10 mg (54.8%), aspirin 75 mg (51.5%), clopidogrel 300 mg tablet (42.9%) and ticlopidine 250 mg (32%). The lowest percent cost variation found is ticagrelor 90 mg (0%). In combination therapy the highest price variation (235.6%) was found for aspirin (75 mg)+clopidogrel (75 mg) followed by aspirin (150 mg)+clopidogrel (75 mg) (24.2%). Conclusions: There is a wide difference in the cost of different brands of oral antiplatelet drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.

Are we too reluctant about irrational nutraceutical combinations?

Background: The objective of the study was to study the rationality of Vitamins and minerals combinations available in India and to provide comprehensive data of irrational combinations having excess and sub sufficient quantity of vitamin and minerals than recommended by National Guidelines of India. Methods: This observational study and analysis was done between June and August 2016. Data was collected from current index of medical specialties and drug India. Rationality assessment was done using National list approved drug combinations by Central drug standard control organization (CDSCO) and essentially was cross checked using World Health Organization essential drug list 2015. Adequacy was analysed using Dietary reference intake (DRI) for Indians by Nutrional council of India draft guidance. Results: In our analysis, we have found 1184 irrational nutraceutical preparations available in India market. Out of 461(38.9%) are based on fat soluble vitamins, 190 (16.4%) based on B-complex vitamins based and 5339 (45.1%) related to essential minerals. Among 461 fat soluble vitamins, 104 contain excessive level, 334 contain substandard levels. Similarly 128 and 62 Vitamin B-Complex based preparations are having excess and less quantity than recommended levels respectively and almost all the mineral combinations except four are not prepared following guidelines. None of these combinations were included in National essential list of medicines. Conclusions: Multivitamins are generally considered safe; these are irrationally prescribed and taken as self-medication by public. Many of the ill effects are often unnoticed and under reported. Government of India should regulate the manufacture and sale these nutraceuticals to promote rational use of drugs and to promote wellbeing and safety of Indian population which is primary objective of ‘Health for all’.

Variation of Cost among Anti-cancer Drugs Available in Indian Market.

Although cancer remains a major health problem all over the world, its treatment is limited by affordability of patients in a developing country like India. Information generated from cost analysis studies will be helpful for both the doctors in choosing the correct medicine for their patients and also for policy makers in successfully utilizing the meager resources that are available. The aim of the present observational study was to analyse the price variations of anti-cancer drugs available in India. The cost of a particular anti-cancer drug being manufactured by different companies, in the same dose and dosage form, was obtained from latest issue of "Current Index of Medical Specialties" (CIMS) January-April, 2016. The difference between the maximum and minimum prices of various brands of the same drug was analysed and percentage variation in the prices was calculated. The results of the study were expressed as absolute numbers and percentages. Overall, the price of a total of 23 drugs belonging to 6 different categories available in 52 different formulations were analysed. Among alkylating agents, oxaliplatin (50mg; injection) showed the maximum price variation of 125.02%. In anti-metabolites, methotrexate (2.5mg; tablet) showed the maximum price variation of 75.30%. The maximum price variation among natural products was seen with paclitaxel (260 mg; injection) of 146.98%, among hormonal drugs, was seen with flutamide (250mg; tablet) of 714.24%, among targeted drugs was seen with imatinib mesylate (100mg; film coated tablet) of 5.56% and among supportive drugs, granisetron (1mg; tablet) showed the maximum price variation of 388.68%. The average percentage variations of different brands of the same anti-cancer drug in same dose and dosage form manufactured in India is very wide. The government and drug manufacturing companies must direct their efforts in reducing the cost of anti-cancer drugs and minimizing the economic burden on the patients.

PDB30 - Cost Analysis Study of Anti-Diabetic Fixed Dose Combination Drugs: An Indian Scenario

To compute the annual cost of FDC drugs used in the treatment of Type2 Diabetes Mellitus (T2DM) and study the variation in the costs. Indian Council of Medical Research (ICMR) and International Diabetes Federation (IDF) guidelines were used to understand the treatment of T2DM. Current Index of Medical Specialities (CIMS) Oct- Jan 2015 issue and Indian Drug Review (IDR) issue 1, Jan 2015 were used to capture the prices of medicines available in the Indian market. The annual cost of treatment and variation in the annual cost of drugs was studied. Recommended first line FDC according to International Diabetes Federation is metformin + sulfonylurea. If we initiated the treatment with metformin + glimepiride (500mg + 1mg) OD, then annual cost of treatment was found to be Rs.438-2744. A maximum variation of 533% was noted in the least-highest cost of treatment. A minimum of 1% variation was observed for metformin + glipizide (2.5mg + 400mg) OD, among combination therapy in its least-highest cost of treatment. Likewise, if the treatment is initiated with other combination therapy, say metformin + pioglitazone (500mg +15mg) BD, then annual cost of treatment was found to be Rs.1387-6935. This showed a maximum variation of 665% in its least-highest cost of treatment. On the other hand metformin + voglibose (500 + 0.3mg) combination showed a minimum price variation of 86% only. It was concluded that a maximum of 6 fold variation was observed in the least-highest costs of treatment with metformin + voglibose (500mg + 0.3mg). A wide variation exist in the minimum and maximum price of anti-diabetic FDC manufactured across the different brands available in the Indian market.

PRM198 - Cost Analysis Study of Oral Anti-Diabetic Drugs Available in Indian Govt Generic (Jan Aushadhi,Jeevandhara ) Drugs and Brand Drugs Market in Rural / Urban Area of Guntur, Andhrapradesh, India

To analyze the cost variation of oral anti-diabetics of different generic drugs sold at Jan Avushadhi and jeevanadhara and Retail pharmacy available brand names of single compound and combination compounds to evaluate the difference in cost , percentage variation of cost. Cost of single and combination compound drugs manufactured by different companies, in the same strength, number and dosage form was obtained from Current Index of Medical Specialties” July-October 2014 and jan avushdhi,jeevandharaa drugs were compared upto February -2015. In Single compound drug usage, among sulfonylurea group of drugs, Glibenclamide (2 mg) shows maximum price variation of 1980%, while Glipizide (10mg) shows variation of 55.61%. In Biguanides & Thizolidinediones groups Of drugs Metformin (1000 mg) show Maximum price variation is 125.37%, Metformin (500 mg) leat variation is 30 % and Piglitazone (30mg) show Maxmum variation 3060.97% and least variation Pioglitazoe (15 mg) is 3275 respectively. . In α-glucosidases inhibitor group of drugs,Miglitol shows maximum price variation of 135.50 % and Minimum variation is 41.93 %. Meglitinides group of drugs. In this group, Rapaglinide (0.5 mg) shows Maximum price variation of 79.25 % and Minimum variation is 60 % respectively. Dipeptidyl peptidase IV inhibitors (e.g., Sitagliptin), group Sitagliptin (100 mg) shows Maximum price variation of 902.3 %. In combination therapiesGlibenclamide + Metformin (5 mg+ 500 mg) combination shows the maximum variation up to 2400 % and Glipizide + Metformin (2.5mg + 250mg) showed minimum price variation of 28.60% respectively. study has concluded that the cost variation increases when competition between the manufacturing companies and generic companies. cost which company providing less cost and whether these drugs are available janavushadhi or jeevandhara or generic pharmacy shops. So that we can minimize the cost burden on consumers.

Direct-to-physician and direct-to-consumer advertising: Time to have stringent regulations.

Direct to physician advertisements and direct to consumer advertisement (DTCA) is a well-known marketing strategy of pharmaceutical companies. Studies from the West and also from the Indian sub-continent revealed several lacunae in such advertisements. The present study was carried out to understand the international and national scenario regarding the lacunae in drug advertisements and the opinion of both physicians and patients regarding DTCA. The present study was conducted after obtaining approval from the institutional ethics committee. Warning letters (WLs) issued to pharmaceutical companies by United States Food and Drug Administration (USFDA) and Therapeutic Goods Administration (TGA) due to discrepancies in the advertisements were analyzed for reasons that were grouped into one of the following categories: overstatement of efficacy; unapproved indication; lack of adequate directions to use; omission of adverse effects; misleading claims; advertisement made for an unapproved drug (investigational new product). Drug advertisements in Current Index of Medical Specialties (CIMS) April-July 2014 issue was also analyzed for lacunae depending on categories as mentioned above. Physicians and patients in a tertiary care medical college and hospital were administered a validated questionnaire exploring their views about crucial aspects of DTCA. Descriptive statistics was used for each of the categories. A total of 93 WLs issued by USFDA and 36 by TGA were assessed. Majority of the WLs by USFDA were issued for omission of adverse effects (61/93, 65.6%) followed by misleading claims (54/93, 58.1%). Similarly, WLs by TGA were also mainly issued for the presence of misleading claims (35/36, 97.2%) followed by overstatement of efficacy (26/36, 72.2%) and CIMS evaluation had revealed that 78/92 (84.8%) advertisements omitted adverse effects, 20/92 (21.7%) had misleading claims, 9/92 (9.8%) had unapproved indications and 7/92 (7.6%) overstated the efficacy. With regard to the opinion regarding DTCA, 69.9% physicians had a patient discussing DTCA that was clinically inappropriate. One hundred (64.5%) out of 155 physicians opined that DTCA encourage patients to attend physicians regarding preventive healthcare. On the contrary, 82/155 (52.9%) physicians felt that DTCA would damage the same. Similarly, 69 out of the total 100 patients felt that drug advertisements aid them to have better discussions with their treating physicians. Surprisingly, a large majority (91/100) were of the opinion that only safe drugs are allowed to be advertised. To conclude, from the findings of this study both the physicians and patients should be cautious and not overzealous while dealing with drug advertisements or promotional literature. More stringent scrutiny and issue of WLs or blacklisting of indulging pharmaceutical companies are mandatory by the regulatory agency to contain the same.

Cost analysis of antiretroviral agents available in India

Background: AIDS is one of the most prevalent causes of death due to infectious origin which requires a lifelong therapy. There is variation in prices of antiretroviral drugs available in Indian market. Thus, a study was planned to find out variation in prices of antiretroviral drugs either as a single drug or in combination and to evaluate the difference in cost of various brands of the same antiretroviral drugs by calculating percentage variation in cost in Indian rupees. Methods: Cost of antiretroviral drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October 2014 and “Indian Drug Review” Vol. XXI, Issue No. 4, 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost was calculated. Results: Percentage variation in cost for antiretroviral drugs marketed in India was found to be zidovudine (100 mg) - 436%, lamivudine (100 mg) - 268%, tenofovir (300 mg) - 149.5%, didanosine (250 mg) - 73.75%, indinavir (400 mg) - 35.26%. Among the combination therapy, price variation was lamivudine + zidovudine (150 + 300 mg) - 314%, lamivudine + stavudine (150 + 40 mg) - 105%, lopinavir + ritonavir (133.3 + 33 mg) - 25%. Conclusion: There is wide variation in the prices of antiretroviral agents available in the market. Regulatory authorities, pharma companies, physicians should maximize their efforts to reduce the cost of drugs.

Study of variation in price of various antidiabetic drugs available in Indian market

Background: Diabetes mellitus in early age is on the alarming rise in India, requiring lifelong treatment. There is a wide range of variation in the prices of antidiabetic drugs marketed in India. Hence, we decided to study price variations in the oral antidiabetic drugs available, either singly or in combination, and number of manufacturing companies for each, and to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October 2014 and “Indian Drug Review” July 2014. The difference in the maximum and minimum price of the same drug, manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: Percentage price variation among different group of drugs was found to be as follows: in sulfonylureas, it was highest in glimepiride 2 mg 836.44%, among biguanides - metformin 500 mg 245.55%, among thiazolidionediones-pioglitazone 15 mg 600%, among α glucosidase inhibitors - voglibose 284.61% and meglitinides - repaglinide 0.5 mg 181.40%. Among combination therapy glimepiride 1 mg + metformin 500 mg 366.66%, pioglitazone + metformin 207.51%, pioglitazone + glimepiride 268.42% showed maximum variation in price. Conclusion: The average percentage price variation of different brands of the same oral antidiabetic drug manufactured in India is very wide. The appropriate changes in the government policy, sensitizing the prescribers about cost of therapy and proper management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative economic consequences.

Fluoroquinolones in India—Are we prescribing it right: A cost variation study

Background: Quinolones are the fastest growing antibacterial agents worldwide as they are being used in both the hospitals and community practices to treat infections. Ciprofloxacin and levofloxacin dominate the market mostly, which together charge 65% ($3.3 billion) of global sales. Quinolones such as ciprofloxacin, levofloxacin, and moxifloxacin have been found to possess enormous market capacity and sales volume. Fluoroquinolones in India comprise 30% share of Global Pharmaceuticals Market counterparts. Aims and Objective: To find out the cost of various oral fluoroquinolones available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of same fluoroquinolone by calculating percentage variation in cost in Indian rupees. Material and Methods: Cost of oral fluoroquinolones manufactured by different companies, in the same strength and dosage forms, was obtained from Current Index of Medical Specialties, July–October 2014, and Indian Drug Review, Vol. XXI, Issue No. 4, 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated. Result: Percentage price variation for various fluoroquinolones was as follows: ofloxacin (200 mg) 869%; sparfloxacin (200 mg) 648%; gemifloxacin (320 mg) 477%; norfloxacin (400 mg) 291%; ciprofloxacin (500 mg) 290%; levofloxacin (250 mg) 264%; lomefloxacin (400 mg) 104%; and moxifloxacin (400 mg) 60%. Among the combination therapy, price variation was norfloxacin + tinidazole (400 + 600 mg) 983%; ofloxacin + cefixime (200 + 200 mg) 232%; levofloxacin + ornidazole (250 + 500 mg) 211%; ofloxacin + ornidazole (200 + 500 mg) 156.60%; and ciprofloxacin + tinidazole (500 + 600 mg) 150%. Conclusion: The average percentage price variation of different brands of same oral fluoroquinolones manufactured in India is very wide. As India is a developing country, clinicians must prescribe fluoroquinolones keeping in mind the cost of therapy.

Cost analysis of oral antidepressant drugs available in India

Background: Depression is a disorder that disrupts the public health through factors such as its occurrence, distress, ill health, and economic burden. There is a wide variation in the prices of antidepressant drugs marketed in India. Aims and Objective: To find out the price variations in the oral antidepressant drugs available in India either as a single drug or in combination and to evaluate the differences in the cost of various brands of the same oral antidepressant drug by calculating the percentage variation in cost in Indian rupees. Materials and Methods: The cost of a particular drug being manufactured by different companies, in the same strength and dosage forms, was obtained from “Current Index of Medical Specialties” July–October, 2014, and “Indian Drug Review, 2014;21(4)”. The difference between the maximum and minimum prices of the same drug and the percentage variation in the prices was calculated. Result: The prices of a total of 25 drugs (21 single and 4 combination preparations) available in 66 different formulations were analyzed. In single drug therapy, among tricyclic antidepressants, reboxetine (2 mg) showed the maximum price variation of 900%. In atypical antidepressants, bupropion hydrochloride (150 mg) showed the maximum price variation of 447.94%. In selective serotonin reuptake inhibitors (SSRIs), paroxetine (37.5 mg) showed the maximum price variation of 1116.66%. In serotonin norepinephrine reuptake inhibitors (SNRIs), Venlafaxine hydrochloride (37.5 mg) showed the maximum price variation of 246.15%. In monoamine oxidase (MAO)-A inhibitors, moclobemide (150 mg) showed the maximum price variation of 246.15%. In combination therapies, chlordiazepoxide with amitriptyline showed the maximum price variation of 227.23%. Conclusion: The average percentage variations of different brands of the same drug manufactured in India is very wide. The management of the marketing drugs should be directed toward maximizing the therapeutic benefits to the community and minimizing the economic burden.

Cost analysis of long established and newer oral antiepileptic drugs available in The Indian Market

Background: Large number of pharmaceutical companies manufactures antiepileptic drugs in India. The price variations among the marketed drugs are wide. Aims: The present study was aimed to find the cost of different oral antiepileptic drugs available in Indian market as monotherapy, combination therapy and number of manufacturing companies for each, to evaluate difference in cost of different brands of same dosage of same active drug by calculating percentage variation of cost. Methods and Materials: Cost of a drug being manufactured by different companies, in the same strength and dosage forms was obtained from “Indian Drug Review” Vol. XXI, Issue No.4, 2014 and “Current Index of Medical Specialties” July-October 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: The percentage price variation noted of long-established drugs was – Phenytoin (50mg): 140%, Carbamazepine (100mg): 1033%, Phenobarbital (30mg) : 730%, Valproic acid (300mg) : 420%. Newer drugs –Levetiracetam (250mg): 75%, Lamotrigine (25mg): 66%, Topiramate (50mg): 108%, Zonisamide (100mg): 19%. Combination drugs – Phenobarbital + Phenytoin (30+100) mg: 354.55%. Conclusion: The percentage price variation of different brands of the same commonly used long-established oral antiepileptic drug manufactured in India is very wide. The formulation or brand of Antiepileptic drugs (AED’s) should preferably not be changed since variations in bioavailability or different pharmacokinetic profiles may increase the potential for reduced effect or excessive side effects. Hence, manufacturing companies should aim to decrease the price variation while maintaining the therapeutic efficacy.

Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal.

BackgroundCommunity pharmacies in Nepal serve as the first point of contact for the public with the health care system and provide many services, including administering injections. However, there is a general lack of documented information on pharmacy practice and injection use in these pharmacies. This study aims to provide information about pharmacy practice in terms of service and drug information sources, and injection use, including the disposal of used injection equipment.MethodsA mixed method, cross-sectional study was conducted in 54 community pharmacies in Pokhara city. Data was collected using a pre-tested, semi-structured questionnaire, and also by the direct observation of pharmacy premises. Interviews with pharmacy supervisors (proprietors) were also conducted to obtain additional information about certain points.ResultsInterviews were carried out with 54 pharmacy supervisors/proprietors (47 males and 7 females) with a mean age and experience of 35.54 and 11.73 years, respectively. Approximately a half of the studied premises were operated by legally recognized pharmaceutical personnel, while the remainder was run by people who did not have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. The ‘Current Index of Medical Specialties’ was the most commonly used source for drug information. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste (including sharps) was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste.ConclusionsCommunity pharmacies in Pokhara offer a wide range of services including, but not limited to, drug dispensing, counseling, dressing of wounds, and administering injections. However, the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered. Therefore, the health authorities should take the necessary measures to upgrade the qualifications of the personnel and to improve the infrastructure for the sake of good pharmacy practice and the safer use of injections.

Cost analysis study of oral antihypertensive agents available in Indian market

Background: Hypertension is one of the major causes of morbidity, mortality and needs lifelong treatment. There is a wide range of variation in the prices of antihypertensive drugs marketed in India. Thus, a study was planned to find out price variations in the oral antihypertensive drugs available either singly or in combination and number of manufacturing companies for each, also to evaluate the difference in cost of different brands of same active drug by calculating percentage variation of cost. Methods: Cost of a particular drug being manufactured by different companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July‑October 2013 and “Indian Drug Review” September 2013. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in price was calculated. Results: Percentage price variation of the commonly used drugs found was amlodipine (5 mg): 1128.57%, atenolol (12.5 mg): 683.53%, enalapril (10 mg): 394.67%, telmisartan (20 mg): 288.33%. Among the combination therapy, amlodipine + atenolol (5 + 50 mg): 673.79%, amlodipine + losartan (5 + 50 mg): 284.61%, telmisartan + hydrochlorothiazide (40 + 12.5 mg): 293.85%, losartan + hydrochlorothiazide (50 + 12.5 mg): 384.62% variation. Conclusion: The average percentage price variation of different brands of the same oral antihypertensive drug manufactured in India is very wide. The appraisal and management of marketing drugs should be directed toward maximizing the benefits of therapy and minimizing negative personal and economic consequences.

Cost analysis of oral hypolipidemic agents available in India

Background: Cardiovascular diseases are the most prevalent cause of death and disability in developed and developing countries. There is a wide variation in the prices of hypolipidemic drugs marketed in India. Thus, a study was planned to find out variation in cost in the oral hypolipidemic drugs available in India either as a single drug or in combination and to evaluate the difference in cost of various brands of the same oral hypolipidemic drug by calculating percentage variation in cost in Indian rupees. Methods: Cost of oral hypolipidemic drugs manufactured by different pharmaceutical companies, in the same strength and dosage forms was obtained from “Current Index of Medical Specialties” July-October 2014 and “Indian Drug Review” Vol. XXI, Issue No.4, 2014. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies and percentage variation in cost per 10 tablets was calculated. Results: Percentage variation in cost for hypolipidemic drugs marketed in India was found to be atorvastatin (10 mg): 1108.33%, simvastatin (5 mg): 709.09%, rosuvastatin (10 mg): 431.91%, lovastatin (10 mg): 287%, fenofibrate (200 mg): 163.58%. Among the combination therapy, variation in cost was atorvastatin + fenofibrate (10+160 mg): 233.33%, atorvastatin + ezetimibe (20+20 mg): 132.90%, rosuvastatin + fenofibrate (10+145 mg): 105.56%. Conclusion: There is a wide difference in the cost of different brands of oral hypolipidemic drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.