Posology of Antidiabetic Drugs and Insulins: A Review of Standard Textbooks

Objectives: The aim of this bibliographic review is to assess whether standard pharmacology, endocrinology and diabetology textbooks adequately mention the details regarding timings of administration, frequency and dose of various oral and injectable antidiabetic drugs. Material and methods: Four standard textbooks of pharmacology, two of diabetology and three of endocrinology were assessed for the published information regarding dose, timing and frequency of antidiabetic drugs. Results: Various omissions and contraindications were found in the coverage of glucose-lowering drugs in standard textbooks. Proper timing and frequency of administration of sulfonylureas, thiazolidinediones, SGLT2 inhibitors, GLP receptor agonists and DPP-4 inhibitors have been omitted in majority of the textbooks. Conclusions: This article stresses upon the need of a uniform source of information for providing adequate and standardized knowledge regarding timing, frequency and dose of antidiabetic drugs

DEVELOPMENT AND VALIDATION OF NOVEL SPECTROPHOTOMETRIC METHODS FOR SIMULTANEOUS ESTIMATION OF PIOGLITAZONE AND METFORMIN IN BULK AND FIXED DOSAGE FORMS BY AREA UNDER CURVE AND DUAL WAVELENGTH MODE

Objective: Two simple, accurate and reproducible spectrophotometric methods have been developed and validated for simultaneous estimation of metformin (MET) and pioglitazone (PIO) in bulk and tablet dosage forms. Methods: (1) Area under curve method (Area calculation): The proposed area under the curve method involves measurement of area at selected wavelength ranges. Two wavelength ranges were selected 228-238 nm and 265-275 nm for estimation of MET and PIO respectively. (2) Dual wavelength method: In the dual-wavelength method, two wavelengths were selected for each drug in a way so that the difference in absorbance is zero for another drug. PIO shows equal absorbance at 235 and 266 nm, where the difference in absorbance was measured for determination of MET. Similarly, the difference in absorbance at 216 and 241.5 nm was measured for determination of MET. Results: Linearity range for MET and PIO is 2-10 μg/ml and 10-50 μg/ml at respective selected wavelengths. Accuracy and precision studies were carried out, and results were satisfactory. The proposed methods have been validated as per ICH guidelines and successfully applied to the estimation of MET and PIO in their combined tablet dosage form. Conclusion: The developed methods are simple, precise, rugged and economical. The utility of the methods has been demonstrated by analysis of commercially available formulations. Keywords: Metformin, Pioglitazone, Area under curve method, Dual wavelength metho

Assessment of prescription writing practices in a government tertiary care hospital in Haryana by using WHO prescribing indicators

Background: Writing a prescription is a combination of science and art. Good quality prescriptions are a sign of prescriber’s expertise. World Health Organization has defined certain parameters to promote rational drug use in all countries. This study was designed to assess the prescription writing practices in a government tertiary care hospital in Haryana by using WHO prescribing indicators.Methods: A total of 2155 prescriptions were evaluated. Each prescription was evaluated for average number of drugs prescribed per patient per encounter, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed and percentage of medicines from Essential drug list prescribed. These indicators help us to check polypharmacy, practice of prescribing drugs by brand names, antibiotic overuse, preference of injectables and non-adherence to Essential drug list.Results: The average number of drugs prescribed per patient per encounter was calculated to be 3.25±0.24. The percentage of medicines prescribed by generic names was 35.89%. Percentage of encounters with an antibiotic prescribed was 48.21 % and with an injection prescribed was 1.85%. The percentage of medicines form NLEM was 76.36%.Conclusions: The values of WHO prescribing indicators obtained from this study show that there are some areas where the prescribers need to improve their prescribing practices

DIFFERENCE SPECTROPHOTOMETRIC METHOD FOR SIMULTANEOUS ESTIMATION OF MOXIFLOXACIN AND CEFIXIME TRIHYDRATE IN BULK AND COMBINED DOSAGE FORM

Objective: To develop rapid, accurate, reproducible, validated and economical difference spectroscopy method for the simultaneous determination of moxifloxacin (MFN) and cefixime (CEF) in tablet dosage forms.Methods: The method comprised the measurement of the absorbance of a solution of the tablet extract in 0.1 M NaOH relative to that of an equimolar solution in 0.1 M HC1 at 254 nm for MFN and 292 nm for CEF. The presence of identical isosbestic points for pure drug solutions and tablet extracts indicated the non-interference of excipients in the absorption at these wavelengths.Results: The method was found to be linear over the concentration range of 10-50 μg/ml for CEF and 4-20 μg/ml for MFN. Accuracy was found to be in the range of 99.91-101.18%. Relative standard deviation for precision and intermediate precision was found to be less than 2%. The developed method was successfully applied for the simultaneous estimation of Moxifloxacin and Cefixime in tablet formulation. The results obtained from the validation experiments prove that the developed method is suitable for routine analysis.Conclusion: This method is simple, selective, linear, precise, and accurate and sensitive hence can be successfully employed for the routine quality control of dosage forms containing both the drugs in pharmaceutical industries.Â

COMPARISON OF SAFETY OF LATANOPROST WITH PRESERVATIVE BENZALKONIUM CHLORIDE (BAK) VERSUS BAK-FREE TRAVOPROST IN PRIMARY OPEN-ANGLE GLAUCOMA

Objective: The objective of this study was to compare the safety of BAK-preserved latanoprost versus travoprost BAK-free ophthalmic solution in the primary open-angle glaucoma (POAG). Methods: Prospective, open-labeled, and randomized comparative study conducted in tertiary care hospital. Forty patients were enrolled and divided into 20 patients in each group: Group A topical latanoprost (0.005%) with BAK and Group B topical BAK-free travoprost (0.004%). Safety assessment was done by following parameters – Schrimer test (ST), tear break-up time (TBUT), and ocular surface disease index (OSDI). Results: ST and TBUT were calculated at baseline, 1 month, 2 months, 3 months, and 4 months and OSDI scores were calculated at baseline, 2 months and 4 months. Group A and B were compared using ST, TBUT, and OSDI scores. Group B showed statistically significant results (p<0.05). Conclusion: Topical BAK-free travoprost is more tolerable than BAK-preserved latanoprostin POAG

New corona virus: is just a tip of iceberg?

The world is again experiencing a global viral epidemic of zoonotic origin. As of March 30, 785807 confirmed cases of coronavirus disease 2019 (COVID-19) and 37820 deaths had been reported in more than 120 countries. Strenuous efforts are being made by various countries of the world to halt transmission through shutting down transport, quarantining entire cities and enforcing the use of face masks. International flights have been cancelled and affected cruise ships quarantined. As in all outbreaks, there is an urgent need to develop effective diagnostics, therapeutics and vaccines. Several experimental diagnostic platforms are already in use in China and elsewhere. The whole-genome sequence of SARS-CoV-2 has been obtained and shared widely. Several potential treatments have been proposed, however, no antiviral treatment has been approved for the novel coronavirus, and despite two outbreaks of novel coronaviruses in the past two decades, vaccine development is still in its infancy

A COMPREHENSIVE ANALYSIS OF DRUG PRESCRIBING PRACTICES OF DOCTORS AND COMPLETENESS OF PRESCRIPTION IN A GOVERNMENT MEDICAL COLLEGE IN NORTHERN INDIA

Objective: This study was designed to analyze the drug prescribing practices of doctors and completeness of prescriptions in a government medical college in Northern India. Methods: A total of 2155 prescriptions were evaluated for adequacy of information related to prescribed drugs and completeness of information related to patients and doctors. Results: The weight of the patient was written only in 1.90% prescriptions. The diagnosis was not written on 43.85% prescriptions. A total number of drugs prescribed in all the prescriptions was 6998. The average number of drugs per prescription was found to be 3.25±0.24. Out of these, 64.10% were prescribed by brand names. About 69.14% of drugs were prescribed in the form of tablets. Route of administration was not found to be mentioned for 86.08% drugs. For 53.90% drugs, dose was not mentioned. The name of the prescribing doctor was mentioned in 1.95% prescriptions only. Conclusion: The study revealed that many prescriptions lacked crucial components of information pertaining to the drugs prescribed and the prescribing doctor. There is a vast scope for improvement by the prescribers

Fixed drug eruptions: causing drugs, pattern of distribution and causality assessment in a leading tertiary care hospital

Background: It is bitter truth that there is no drug in this world which is without an adverse drug reaction (ADR). After the clinical trials when the drug comes in market or when it is taken by variety of population then actual reality of the drug comes out about its efficacy and adverse drug reactions. Fixed drug eruption is also one such type of ADR in which a specific type of lesions occurs over the skin after the drug is taken.Methods: We have conducted a clinical, observational study, in BPS Government Medical College, Khanpur Kalan, Sonepat, Haryana, India over a period of eight months. In that period we have found 159 patients having adverse drug reactions. Patients of both genders, under all age group were included in the study.Results: Out of 159 adverse drug reactions reports 69 (43.39%) were cutaneous adverse drug reaction report, 45 (28.30%) cases were of fixed drug eruption (FDE). Out of these 45 cases seen, there were 4 males (8.88%) and 41 females (91.11%). Flouroquinolone antibiotics like ciprofloxacin, ofloxacin and norofloxacin were the most common drugs causing fixed drug eruption followed by nitroimadazole antibiotic like metronidazole, tinidazole and NSAIDS like diclofenac, paracetamol and meftal spas in our study. FDE are more common in upper limbs extremities followed by lower limb extremities than face and trunk. Causality assessment was done with the help of WHO UMC scale and we found that association was possible in all the cases.Conclusions: Fixed drug eruptions are one of the major types of adverse drug reactions and should be assessed and reported

LORNOXICAM: A REVIEW OF ITS THERAPEUTIC POTENTIAL IN DIFFERENT CLINICAL STUDIES

Lornoxicam is a member of the oxicam group of nonsteroidal antiinflammatory drugs (NSAIDs), producing analgesic and antipyretic effects  through the non-selective inhibition of cyclo-oxygenase-1 and -2. Besides its inhibitory effect on COX1 and COX-2 peripheral receptors, is also increases endogenous dinorphin and beta-endorphin levels promoting central analgesic and anti-inflammatory effects. Recently, lornoxicam has been introduced in Indian market in oral, intravenous and intramuscular formulations.  Lornoxicam is completely absorbed after oral administration, reaching peak plasma concentrations of 280 mg/L within 2.5 hours after a 4 mg dose.  After intramuscular injection maximum plasma concentrations are achieved after approximately 20-25 minutes. Lornoxicam is extensively metabolished in liver by cytochrome P4502DC9 to inactive metabolite 5’-hydroxy-lornoxicam. The mean elimination half life is 3 to 4 hours. There is plenty of literature available on the effect of lornoxicam on chronic and acute pain management. These preliminary finding require confirmation in further comparative studies. Key words:- lornoxicam, analgesic, anti inflammatory drugs

Posology of insulins: A review of standard textbooks and product inserts

Objectives: The study is aimed to assess whether the information contained in standard pharmacology, endocrinology, and diabetology textbooks regarding timings of administration, frequency and dose of various insulins is adequate and also to see whether the information contained in these texts is concordant with product inserts. Materials and Methods: Four standard textbooks of pharmacology, two of diabetology and three of endocrinology were assessed for the published information regarding dose, timing, and frequency of insulin administration. The product inserts of commonly available insulins in India were also studied for the same. Results: Various omissions and disparities could be seen in the coverage of insulins in standard textbooks. Posology information about premixed insulins and basal insulins have been omitted by the majority of the textbooks. Details about dose, frequency and timings of ultra-short acting insulins have also not been covered by all textbooks. Some discrepancies regarding prescribing information was also noted in product inserts, especially in case of newer insulins. Conclusions: Thus, this article stresses upon the need of a uniform source of information for providing adequate and standardized knowledge regarding timing, frequency, and dose of insulins