Pharmabiz
 

Optimization of Drug Therapy

Nitin MahurkarWednesday, February 12, 2003, 08:00 Hrs  [IST]

The thrust area in clinical management of a complication is to provide a drug therapy that is safer and produces least toxicities. The allopathic system of medicine is based on scientific data gathered from animal experiments and their extension to humans by preclinical and clinical trials. The dosage of drugs is generally rationalized unit dose preparations. Most of the allopathic medicines, apart from their beneficial effects unfortunately produce a wide range of adverse effects, side effects, untoward effects, toxicities and allergies. Today, the efforts are towards management of therapies which are more safe and carry lesser risk of toxicities by adopting new techniques like, therapeutic drug monitoring (TDM), individualization of drug therapy (IDT), multi drug therapy (MDT) or by fortification of medicines etc. On the other hand 'Ayurveda' adopts a unique way of treating patients by taking into consideration the seasonal influences (Ritu charya), administration wit multiple ingredients of plants etc. The system has been mainly evolved with the experience and the knowledge transferred by forefathers wherein, various other factors like severity of disease, dietary influences, patient profile are also taken into consideration. Thus ayurveda attempts at optimization and individualization of drug therapy. The above concepts are new to allopathic system, hence these concepts of ayurveda can be tried, tested and if feasible adopted in allopathy also for optimization of drug therapy (ODT). This article is a first step in assimilating some data and beginning a new line of thinking in this direction. The whole concept is extension of ayurvedic principles to allopathic system necessitating a brief introduction of ayurvedic principles of therapy. The ayurveda considers the body as comprising of 3 important constituents i.e. 'vata', 'pitta' and 'kafa' which can be equated to their nearest English terms as, 'air', 'bile/acidity' and 'phlegm'. Any imbalance in them is considered as a causative factor for particular diseases. The different seasons of the year contribute to their balance/imbalance. Ex. Pitta is prominent in 'sharat-ritu' (Sep-Oct) hence, hyperacidity symptoms have to be treated with potent antacids like, H2 - blockers during this season than the hyperacidity symptoms of other seasons, which can be cured b mild antacids. Similarly 'vata' and 'kafa' disorders are treated with their potent medicines in their respective seasons. In ayurveda, the seasons of a year are divided into 6 phases as, Vasanth, Grishma, Varsha, Sharat, Hemanth and Shishir Ritu. These can be corresponded approximately as starting with March till February, two months for each phase respectively. The environmental and seasonal influences as per the literature are as follows; Vasanth ritu (Mar-Apr) - 'Kafa' dominance (likely to suffer from phlegm/respiratory disorders or its aggravation) Varsha ritu (Jul - Aug) 'Vata' dominance (likely to suffer from Inflammatory disorders or its aggravation) Sharat ritu (Sep-Oct) - "Pitta" dominance (likely to suffer from Gl-disorders, hyperacidity etc. or its aggravation) The intensities of these principles vary during other seasons. Generally potent medicines are prescribed when a person complains of complications in respective phases (hyperacidity in Sept-Oct) and with mild medicines during non-dominant phases. They are called as natural and unnatural occurrences in ayurveda ('prakruta' and 'aprakruta'). Similarly the ayurveda divides the energy levels of the body as 'balahina and balavriddhi' phases i.e. descending energy levels and ascending energy levels. Jan-Jun as descending energy levels and Jul-Dec as ascending energy levels due mainly to supportive environmental factors prevailing. The ayurvedic system further recommends the type of diet to be consumed or not to be consumed during respective seasons, which act as synergistic co-factors in preventing the diseases or curing them more effectively. Ex. Milk, Ghee (clarified butter) are recommended during pitta seasons as, it reduces hyperacidity. Bitter principled substances can be safely consumed during vasanth ritu (Mar - Apr) such as bitter gourd, neem flowers, its tender leaves etc. ON the other hand bitter substances are considered as harmful and cause inflammatory diseases or 'vata' dosha if consumed during the dominant season of vata (Jul-Aug) All these concepts are very well inculcated in ayurveda and all the traditional ayurvedic practitioners believe in this type of treatment and practice the same. The concept of fortifying ayurvedic medicines with agents called 'Yoha vahi' is in practice since ages. 'Yoha vahi' is an agent that potentiates the effect of any medicine when given along with it. Recently cow urine components have been patented for fortifying the effect of medicines thereby reducing their dosage, untoward effects. These concepts are not explored in allopathic system. This can begin a new line of thinking in allopathy. Table 1 shows some of thought provoking examples that can be adopted to make a beginning in this direction and many more drugs can be added to this list and explored by oneself. These concepts can help in, 1) Minimizing the dosage of drugs 2) Getting optimum benefits of drugs with minimum toxicities thereby prevent unnecessary drugging (ODT) 3) Opening a new avenue in therapy of allopathy 4) Individualizing the medical treatment mainly by changing dietary habits 5) Reducing the cost of treatment Click here to view Table Information References: 1) Prabhakar Balaji Ogale, Chikitsa prabhakar, 2nd edn., Chitrashala printers, (Pune, India), 1931. 2) Vaidya Shailesh Nadkarni, Ritu Shrunkhala, Vaidya Mitra, Shree Dhootpapeshwar Ltd. (Panvel India), 2000. --- The author is Asst. Professor (Pharmacology), HKE's College of Pharmacy, Gulbarga

 
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