DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20162450

A cross-sectional study to assess the rationality of fixed dose combinations prescribed in geriatric patients in a tertiary care hospital

Ahish Dakappa, Mukunda Narayanareddy

Abstract


Background: There is a growing concern about use of irrational fixed dose combinations (FDC) in geriatric patients which imposes unnecessary financial burden, increase the occurrence of adverse drug reactions, hospitalization and ultimately reducing the quality of life. The aim of our study is to assess prescription rate of irrational FDCs in geriatric patients in our hospital.

Methods: A cross sectional observational study was carried out at M. S. Ramaiah hospital for a period of 2 months and the case records of patients aged ≥60 years visiting various departments were retrieved from medical record section. We reviewed their prescriptions and analysed the prescription rate of FDCs and their rationality was assessed by using WHO guidelines for FDCs. Descriptive statistics were used to analyse the data. SPSS Version 20 was used for statistical analysis.

Results: We studied case files of 361 geriatric patients who visited our hospital during our study period. Among them 212 (58.7%) were male and 149 (41.3%) were female patients. Prescription rate of FDCs in our study was 69.8%. A total of 82 FDCs were prescribed in our study. Among these 82 FDCs, 56 (68.3%) were irrational as per WHO guidelines. The commonly prescribed FDCs in our study were combination of anti-asthmatic drugs, multivitamin preparations, antihypertensive combinations, analgesics, and antimicrobial agents.

Conclusions: The prescription rate of irrational FDCs is very high in our hospital. There is a need to educate physicians regarding consequences of use of such irrational FDCs.


Keywords


Irrational, FDCs, Geriatrics, Observational study

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References


Gautam CS, Aditya S. Irrational drug combinations: Need to sensitize undergraduates. Indian J Pharmacol. 2006;38:169-70.

WHO technical report series. WHO expert committee on specifications for pharmaceutical preparations- thirty ninth report. Geneva: WHO, 2005. Available at apps.who.int/prequal/info_general/documents/trs929/who_trs_929.pdf. Accessed 24 November 2014.

Jhaveri BN, Patel TK, Barvaliya MJ, Tripathi CB. Drug utilization pattern and pharmacoeconomic analysis in geriatric medical in-patients of a tertiary care hospital of India. J Pharmacol Pharmacotherapy. 2014;5:15-20.

Gorzoni ML, Fabbri RM, Pires SL. Potentially inappropriate medications in elderly. Rev Assoc Med Bras. 2012;58:442-6.

Baiardini I, Guerra L, Pasquali M, Bonadonna P, Pasalaqua G, Canonica GW. Quality of life in patients with adverse reactions to drugs: preliminary results from a new questionnaire. J Allergy Clin Immunol. 2004;113(2):s70.

Rayasam SP, Dudhgaonkar SS, Dakhale GN, Hire RC, Deshmukh PS, Gaikwad NN. The irrational fixed dose combinations in the Indian drug market: an evaluation of prescribing pattern using WHO guidelines. Int J Basic Clin Pharmacol. 2013;2:452-7.

Devi M, Sriram S, Rajalingam B, Anthraper AR, Varghese RS, Phani VA. Evaluation of the rationality of fixed dose combinations of cardiovascular drugs in a multispecialty tertiary care hospital in Coimbatore, Tamilnadu, India. Hygeia J D Med. 2012;4(1):51-8.

19th WHO Model List of Essential Medicines, 2015. Available at http://www.who.int/medicines/publications/pharmacopoeia. Accessed 24 November 2014.

National list of essential medicines of India, 2015. Available at http://www.cdsco.nic.in. Accessed 1 March 2016.

Betalactum antibiotics. In: Tripathi KD eds. Essentials of Medical Pharmacology. 7th ed. New Delhi, Jaypee Brothers Medical Publishers (P) LTD; 2013:716-732.

Dhaneria SP. Rational and irrational drug combinations. Drug Bulletin. 2010;35(2):1-15.

Hiller A, Silvanto M, Savolainen S, Tarkkila P. Paracetatamol and diclofenac alone and in combination for analgesia after elective tonsillectomy. Acta Anaesthesiol Scand. 2004;48(9):1185-9.

Amitava S. Indian market’s fixation with fixed dose combinations. Rational Drug Bulletin. 2002;12:1.

Sreedhar D, Subramanian G, Udupa N. Combination drugs: are they rational? Curr Sci. 2006;91:406.

Rational use of medicines. Good pharmacy practice - I.P.A. - C.D.S.C.O. - W.H.O. India country office. Available at http://www.whoindia.org/LinkFiles/ GPP Rational Use of Medicines.pdf. Accessed 3 August 2010.

Rathod RT, Misra D. FDC of montelukast with levocetirizine: focus on bilayer technology. J Ind Med Ass. 2009;107(8):562-4.

Stanon T, Reid JL. Fixed dose combination therapy in the treatment of hypertension. Journal of Human Hypertension. 2002;16:75-8.

Goeng BK, Jeong KK, Sul P, Jai JJ, Hyung SY, Sang HK, et al. Effect of atorvastatin and clopidogrel co-administration after coronary stenting in Korean patients with stable angina. Korean Cardiology J. 2011;41:28-33.

Antiadrenergic drugs. In: Tripathi KD eds. Essentials of Medical Pharmacology. 7th ed. New Delhi, Jaypee Brothers Medical Publishers (P) LTD; 2013:143-4.

Anastasios M, Maria S, Dimitris PP. Resistant hypertension workup and approach to treatment. International Journal of Hypertension. 2011;2011:598694.

Cardiac glycosides and drug for heart failure. In: Tripathi KD eds. Essentials of Medical Pharmacology. 7th ed. New Delhi, Jaypee Brothers Medical Publishers (P) LTD; 2013:522-3.

Moshfegh K, Redondo M, Julmy F, Wuillemin WA, Gebauer MU, Haeberli A, et al. Antiplatelet effects of clopidogrel compared with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol. 2000;36(3):699-705.

Donohue JF. Combination therapy for chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society. 2005;2:272-81.