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Indian Journal of Pharmacology, Vol. 38, No. 3, May-June, 2006, pp. 169-170 Editorial Irrational drug combinations: Need to sensitize undergraduates Gautam CS, Aditya S Department of Pharmacology, GMCH, Chandigarh - 160 032 Code Number: ph06041 Prescribing fixed dose drug combinations has become the "in thing" in medical practice. Using the excuse of better patient compliance, many doctors, both in private as well as government prescribe irrational fixed dose drug combinations. Quite a few infectious diseases are becoming resistant to treatment with a single drug. With the escalating cost of drugs, there is poor drug compliance, which further magnifies the problem, both for the prescriber as well the patient. Manufacturers of drugs having quickly tuned in to the potential golden egg, are marketing fixed dose drug formulations for various diseases. Even though use of combinations of drugs is common practice, the selection of optimal dose and optimal combination has remained largely a matter of trial and error. The basis of many fixed dose drug combinations being taught to the undergraduate medical students and also being prescribed popularly, appears to be irrational to pharmacologists. CIMS lists more than 100 irrational combinations which are not approved in any developed country but are being marketed in India. This fact has to be taught to undergraduate medical students in their formative years of learning so that once they address medical ailments like malaria, tuberculosis, AIDS, hypertension, etc. they should be more logical in selecting appropriate drug combinations and should not be swayed by marketing tricks and false claims made by the pharmaceutical industry. The pharmacological basis of combining each ingredient in the formulation should be taught. Selection of P drugs, rational drug use, use of rational drug combinations and ethical laboratory practices should be inculcated in the student′s curriculum during their clinical training. Fourteenth WHO model list of essential medicines (March 2005) contains only 18 approved drug combinations, whereas in India, there are innumerable examples of irrational drug combinations, which are easily available and can be bought without necessarily giving a prescription. [Table - 1] This issue has to be urgently addressed by us, pharmacologists, as the magnitude of the problem is increasing. What needs to be done?
Unless we encourage our students to think rationally and independently this menace will continue to grow. We cannot complacently offload all blame onto the industry and government regulators; the onus of responsibility lies heavily on the shoulders of academicians too[3]. References
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