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Abstract

NARROW THERAPEUTIC INDEX DRUGS - A CRITICAL STUDY ON PRESCRIPTION TRENDS IN SOUTH INDIAN TERTIARY CARE HOSPITAL

*Dr. Ramesh Roshan Yadav, Dr. Yogananda R. and B. Shankar Reddy

ABSTRACT

Background: Drugs with a narrow therapeutic range, which may require drug monitoring both to achieve therapeutic levels and to minimize toxicity Drugs with a narrow therapeutic index (NTI-drugs) are drugs with small differences between their therapeutic and toxic doses, implying that small changes in dosage or interactions with other drugs could cause adverse effects. The outcome of irrational use of medicines includes economic loss, development of adverse drug reactions (ADRs), development of antimicrobial resistance etc. Thus there is a need for drug evaluation which is an important component in monitoring, evaluating and making necessary modifications in the prescribing practices to achieve a rational drug use. Objectives: To evaluate prescription pattern of narrow therapeutic index drugs and to identify drug related problems associated with narrow therapeutic index drugs. Methodology: A Prospectiveobservational study was carried out for a periods of six months at general medicine and psychiatric department of Basaveshwara Medical College Hospital & Research Centre Chitradurga, Karnataka. Data entry was done in Microsoft excel 2007. SPSS version 16 was used to calculate the descriptive statistical parameters. Results: A total of 100 patients age more than 18 years were enrolled for the study among which 34 were females and 66 were males. More number of patients were from middle age group. 31% of patient were overweight and 15% were obese. smoker patient (32%) were more prevalent than others. More number of patient was having DM-II as medical history and Asthma and epilepsy were more frequently diagnosed in the subjects. Amikacin (45.9%) was most commonly prescribed NTI antibiotic. antiepileptic drug Phenytoin was more frequently prescribed followed by valproic Acid. combination of etiofylline and theophylline was the most frequently prescribed drugs among all NTI drugs where as warfarin was more frequently used anticoagulant during the therapy. DRPs associated with the use of NTI Drugs were in the form of drug–drug interaction where significant interaction between (Theophylline- budesonides) were more prevalence (55.8%). Adverse drug reaction was more assesses in possible category(44%) and more than 22 times NTI drugs were used for no specific indication according to WHO Indicator. There were no Evidence of dose individualization in Overweight and Obese subjects. Conclusion: Prescribing by generic name is to be promoted to avoid confusion in understanding prescriptions; this also adheres to WHO standards of rational prescribing. The therapy associated with NTI drugs should be monitored and individualized based on the outcome. This study was carried out inorder to bring awareness in the health care professionals regarding the safe and effective use of NTI drugs.

Keywords: Narrow Therapeutic Index, WHO, EDL, Drug related problems, Adverse drug reaction, drug- drug interaction, Rational drug use.


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