Karnataka government has accepted an essential drug list recommend by the State Pharmacy Council. In a major initiative by the State government, all government hospitals and the 2,565 primary health centers have to put into use the essential drug list with immediate effect.

Although the recommendations for the essential drug list was made by the Karnataka Pharmacy Council, a major initiative was taken in this regard by the members of an NGO of medical specialists, Drug Action Forum (DAF), Karnataka.

"The implementation of the essential drug list in government medical centers is one of the first steps towards rationalization of drug use. In fact Karnataka is one among the few states along with Delhi, Rajasthan, Haryana and Tamil Nadu to accept essential drug list", Dr. Prakash C Rao, vice president, DAF, Karnataka told pharmabiz.com

"The situation is dangerous and a major cause for concern as combination drugs are mostly a shotgun therapy where in the event of a side effect it would be difficult to pin point which drug is the cause of the reaction. Often ingredients in the combination drug are not recalled by the doctors. There have been several representations made by DAF, Karnataka against the sale of non-essential drugs to the Drugs Controller General of India and former drugs controller Anand Rajashekar on various occasions," informed Dr. Prakash Rao.

The main reasons for increased sales of non-essential drugs are attributed to the nexus between pharmaceutical companies and medical practitioners, poor vigilance of the state drugs control departments and lack of initiative by the government, points out DAF Karnataka.

The World Health Organization (WHO) recommends most of the drugs should be single ingredients except for a few combinations like Trimethoprim +Sulphamethoxazole (Septram or Bactrim). But the reality is that most of the available combinations like EMFLAN Plus which contains Ibuprofen 400mg and Paracetomol 325 mg (both pain killers) are useless and cannot double the effect of pain relief. Such combinations only add to the cost of therapy and increases the side effects, pointed out Dr. Prakash Rao.

Any doctor would be in a better position to combine two different drugs to the patient. Hence available combination drugs now available in the market are useless. Doctors prescribe combination drugs because of aggressive promotion by the pharma sector. There is low therapeutic awareness among doctors who are at the mercy of the drug companies for the details of the drugs and their efficacy, he averred.

DAF Karantaka has a list of some of the harmful combination drugs which include Baxin, Cifran CT (Antibiotics), Atecard D Pressolar (Anti Hypertensive), Corbutyl, Micropyrine, Cofenac, Esgipyrine and Combiflam (Analegesics), Dipsalic, Betnovate N, Zole F and Quadriderm (Dermatology), Spasmindon, Meftal Spas and Colimax (Antispasmodics), Trinicalm Plus, Sedyl, Hexidol and Vesperex (Anti psychiatric), Asmapox, Asmatone, Grilinctus BM, Cadiphyllate Elixer, Sedonal, Tedral (Anti respiratory), Digene Gel, Moticare MPS, Logascid and Helibact (Anti Ulcer).

Dr. Prakash Rao also brought forth the issue of anemia in pregnant women where the most popular drug in single ingredient form is ferrous sulphate and folic acid. However, numerous expensive and ineffective ferrous salts, formulations of iron polymaltose and carbonyl iron are marketed.

Despite the British Pharmacopeia excluding hemoglobin as a drug for human use world wide, in India, it is sold under brand names: Globiron, Hemfast and Heppforte. Hemoglobin in combination of vitamins, minerals and proteins: (Fesovit, Heamup, Vitcofol, Iberol, RB Tone, Cherry capsules, Ultiron, Calron, Hepaboglobin, Dumasules, Hb-Rich, Lysrix, Hifi Softules, Anaemidex, Autrin and Tonoferon are also ineffective, according to DAF.

DAF, Karnataka warn doctors and patients to exercise restraint over the use of anti cold remedies such as Action 500, Contact CC, Coldguard, Colscold, Coldarin, Escold, Rinostat, Coldoff, Decolgin, Vicks Vaporub, Febrex Plus, Deletus, Colgin Plus, EF Cold, Cinaryl, Actifed, Coldact, Cosavil and Dristran because these contain caffeine and Quinine which cause side effects.

To control the situation, DAF, Karnataka recommends a multi-pronged approach in association with the drugs control department, medical practitioners and consumers where regular and frequent education and awareness programmes are organized in every district. It calls for a strict vigilance by the state drugs control department on the sale of drugs and to increase the number of Adverse Drug Reaction cells in the country. Another suggestion is to include Rational Drug Use as a subject in medical colleges to educate doctors on the dangerous reactions of non-essential drugs.