Rational use of otc medication

Rational use of otc medication

1. RATIONAL USE OF OTC MEDICATION Submitted To : Dr. KANCHAN VOHRA Assistant Professor Submitted By : Mohd . Rafi Bhat Department of pharmaceutical science & Drug Research

2. RATIONAL USE OF OTC MEDICATION OTC MEDICATION:-Over the counter medication is also known as OTC or nonprescription medicine .All these terms refer to medicine that you can buy without a prescription. They are safe and effective when you follow the directions on the label and as directed by your healthcare.

3. EXAMPLE OF OTC DRUGS Topical anti-bacterial, anti-fungal OTC drugs :- Bacitracin,Clotrimazole ( vaginal,topical use) Miconazole 2% ointment etc. Pain releiver OTC drugs : Acetaminophen,Aspirin,NSAIDs,Ibuprofen,Naproxen etc. Smoking cessation OTC drugs :Nicotine patch Topical Dermatological (skin, scalp) OTC drugs : Capsaicin, Doak tar distillate oil, Hydrocortisone , Permethrin , Pyrethrin , Zinc oxide ointment.

4. . Diabetes OTC drugs : Insulin OTC vials( H umulin 50/50 vial,Humulin N,Humulin R,Novolin 70/30 vial, Novolin R vial etc) Glucose chewable tablet. Digestion OTC Drugs Anti-diarrheal drug :- Loperamide Anti-ulcer drugs :Cimetidine,Famotidine,Ranitidine Nazitidine . Proton pump inhibitors :- Omeprazole Laxatives &Cathartics :- Bisacodyl,Docusate,Glycerine , Psyllium , Sorbitol . Other digestion drugs :- Aluminium hydroxide gel,

5. . Antacid liquid suspension ,Calcium antacid tablets , Simethicone drops etc. OTC Vitamins :- Calciferol , Ergocalciferol drops, Calcium carbonate, Calcium carbonate 600mg+vit. D, Calcium citrate,Ferrous fumerate ,Ferrous gluconate ,Ferrous sulfate, Magnesium oxide, Multivitamins etc. Eye care OTC drugs :-Artificial tears ,Refresh tears, liquigel (15ml or 30ml bottle only), Sodium chloride 5% drops ,ointment , Systane etc. Cough/Cold/allergy OTC drugs Anti –histamine :- Cetrizine tab, Cetrizine -D tab,Cetrizine sol., Diphenhydramine , Loratadine , Loratadine -D, Anti-histamine/Decongestant Combinations :- Brompheniramine - Pseudoephederine elixir. Other drugs :- Nasal spray,Pseudoephedrine

6. What is rational use of drug? Rational use of medicines refers to the correct, proper and appropriate use of medicines. Rational use requires that patients receive the appropriate medicine, in the proper dose, for an adequate period of time and at the lowest cost. & Use of an appropriate ,efficacious, safe and cost effective drug given for the right indication in the right dose and formulation, at right intervals and for the right duration of time.

7. Irrationality Ineffective & unsafe drug treatment. Inappropriate self medication. Worsening or prolonging of illness. Consequences of irrational use of medicine Incorrect use of medicine ocuur in all countries,causing harm to people and wasting resources. Consequences include:- Antimicrobial resistance :-overuse of antibiotics increases antimicrobial resistance and the number of medicines that are no longer effective against infectious disease. l

8. . Adverse drug reactions & medication errors :- harmful reactions to medicine caused by wrong use or allergic reactions to medicine can lead to increased illness, suffering and death. Lost resources :-10-40% of national budget are spent on medicines. out of pocket purchase of medicines can cause severe financial hardship to individuals and their families. if medicines are not prescribed and used properly ,billions of dollars of public and personal funds are wasted.

9. Eroded patient confidence :-exacerbated by the overuse of limited medicine, drugs may be often out of stock or at unaffordable prices and as result erode patient confidence. poor or negative health outcomes due to inappropriate use of medicine may also reduce confidence.

10. Factor contribute to incorrect use of medicines Lack of skills and knowledge Inappropriate unethical promotion of medicines by pharmaceutical companies profit from selling medicine Unrestricted availability of medicines Overworked health personnel Unaffordable medicines

11. What can be done to improve rational use of medicines? WHO advices countries to implement national programes to promote rational use of medicines through policies , structures , information and education. These include:- A national body to coordinate policies on medicine use and monitor their impact Evidence based clinical guidelines for supervision and supporting decisions making about medicines List of essential medicines used for medicine procurement and insurance reimbursement

12. . Drug (medicines) and therapeutics committees in districts and hospitals to monitor and implement interventions to improve the use of medicines; Problem-based training in pharmacotherapy and prescribing in undergraduate curricula; Continuing medical education as a requirement of licensure; Publicly available independent and unbiased information about medicines for health personnel and consumers; Public education about medicine

13. . Elimination of financial incentives that lead to improper prescribing, such as prescribers selling medicines for profit to supplement their income; Regulations to ensure that promotional activities meet ethical criteria; and Adequate funding to ensure availability of medicines and health personnel. The most effective approach to improving medicines use in primary care in developing countries is a combination of education and supervision of health personnel, consumer education, and ensuring an adequate supply of appropriate medicines. Any of these alone have limited impact

14. IRRATIONAL DRUG COMBINATIONS If the combination of drugs is illogical in terms of plasma half-life and pharmacokinetics of the drug, the combination should be termed as irrational drug combination. Large numbers of such irrational drug combinations are available in the market which unnecessarily increase the cost of medication and add to the side effects of the therapy.

15. IRRATIONAL DRUG COMBINATION Ampicillin + Cloxacillin Ampicillin is effective against Gram negative bacilli but Cloxacillin is an Anti-staphylococcal penicillin and not effective against Gram negative bacilli. Mixed Gram negative and Staphylococcal (Gram positive) infection rarely coexists. So, in a patient with a single infection, one of the drugs of the combination would be useless. In addition to the cost of therapy it would add to adverse side effects and resistance of bacteria to the drug. On the other hand the combination would reduce the dose of effective drug to the half and the patient would need longer course of therapy .

16. . Antibacterial + Antiamoebic Combinations: Ciprofloxacin + Metronidazole , Norfloxacin + Tinidazole and Ofloxacin + Ornidazole are such commonly available fixed dose drug combinations. In bacterial diarrhoea only anti-bacterial drug is effective and antiamoebic drug is useless. Similarly, in intestinal amoebiasis only antiamoebic drug is effective while antibacterial drug is useless. Amoebiasis and bacterial diarrhoea rarely coexist. The therapy should be based on the diagnosis to reduce the cost of treatment since in a given case, only one drug of the combination would be effective and the other one would be useless.

17. . NSAIDs Combinations Nimesulide , diclofenec , ibuprofen and Paracetamol are some non-steroidal anti-inflammatory drugs (NSAIDs). There is no justification in combining one NSAID ( nimesulide , diclofenec , ibuprofen) with another NSAID ( paracetamol ) having same pharmacological actions. The increased risk of hepatotoxicity has been reported due to the use of combination of nimesulide with paracetamol . There is increased risk of nephrotoxicity with NSAIDs combinations.

18. . H2 Blocker + Domperidone Ranitidine and Famotidine are H2 blockers. H2 blockers reduce gastric acid production in peptic diseases and give symptomatic relief. The combination of these drugs with antiemetic drug ( Domperidone ) is an irrational drug combination as peptic ulcer is not always associated with vomiting. Even in gastro- esophageal reflux disease (GERD), the domperidone is less effective as compared to metoclopramide , so combining H2 blockers with domperidone seems to be an irrational choice.

19. . H2 Blocker (Ranitidine) + Antispasmodic Drug ( Dicyclomine ) The pain of peptic ulcer is due to high level of gastric acid but not due to spasm of smooth muscles and will subside only with reduction in gastric acid in stomach by use of H2 blocker (Ranitidine) or proton pump inhibitor drugs ( Omeprazole , Pantoprazole or Lansoprazole ). So there is no justification in combining H2 blocker (Ranitidine) with antispasmodic drug ( Dicyclomine )

20. . Mucolytic Agent + Antibacterial Ambroxol + Ciprofloxacin or Cefadroxil or Roxithromycin . Ambroxol is a mucolytic agent used to liquefy thick respiratory secretions. There is no justification in combining mucolytic agent with antibacterial, as thick secretions in respiratory tract are always not due to respiratory infections. Also the antibacterial therapy always does not require an associated dose of mucolytic agent.

21. . Metformin + Glimepiride + Pioglitazone Metformin is indicated drug in obese type -2 diabetes mellitus whereas Sulfonylurea ( Glimepiride ) is indicated drug in non-obese type-2 diabetes mellitus. As per pharmacological principle, other drug should be added only when monotherapy fails. Metformin ( biguanide ) is to be administered after meal whereas Glimepiride (sulfonylurea) drug is to be administered before meal, therefore even when both the drugs are required, it would be better to administer them separately. Pioglitazone is indicated in suspected cases of insulin resistance. So, the combination of all these drugs in one formulation is an irrational drug combination.

22. . Codeine+NSAID ( paracetamol ) This combination is used to treat severe pain or to inhibit pain perception but these combinations can cause excessive sedation which can be dangerous. Needs further examination. Multi vitamin preparations Multivitamin combination is considered to be irrational. Excessive use may leads to several side effects.

23. . Expectorant+central cough suppressants antihistaminics + bronchodilator+mucolytic agent Bromhexine Hydrochloride 8 mg + Terbutaline sulphate 2.5 mg + Guaiphenesin 100 mg + Menthol 5 mg, this combination of expectorants is a costlier way of helping a condition which is often self-resolving. Expectorant given in effective doses are often not tolerated and produce adverse drug reaction.

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