Analysis of the prescription pattern of psychotropics in an outpatient department of a general hospital psychiatry unit.

BACKGROUND: World Health Organization has prescribed drug use indicators for evaluating rational prescribing. Very few studies have been conducted on rational prescriptions for psychotropic drugs; hence, this study was undertaken at a tertiary care center of North India. METHODS: After obtaining approval of the Institutional Ethics Committee, all prescriptions deposited with the dispensary of the psychiatry department of the hospital between 01 October 2017 and 31 December 2017 were included in the study. The prescriptions were analyzed for drug use indicators, namely the average number of drugs per encounter, percentage of prescriptions with generic name, percentage of prescriptions from the essential drug list, percentage of prescriptions with antibiotics, and percentage of prescriptions with an injection. In addition, the prescriptions were analyzed for patterns of psychotropics prescribed. RESULTS: A total of 3770 prescriptions were analyzed. On an average, 2.35 medicines were prescribed per prescription. Injectable comprised 2.39% of prescriptions and fixed drug combinations were 0.16% of the total. Of all prescriptions, 91.3% were by generic name, while 55.02% of prescriptions were from the essential drug list. Polypharmacy constituted 4.53% of prescriptions. Risperidone, escitalopram, sodium valproate, and clonazepam were the most commonly prescribed drugs. CONCLUSION: While we fared well with respect to the percentage of prescriptions with injections and those with an antibiotic, we have not been able to achieve the prescribed standards in prescription with generic names, number of drugs per prescription, and prescriptions from the essential drug list. The study emphasizes that there is scope for improvement.

Drug update - Baloxavir marboxil: Latest entrant into the arena of pharmacotherapy of influenza.

Influenza is a frequent cause of clinically significant human disease, with seasonal epidemics and occasional pandemics. Uncomplicated influenza in healthy individuals is managed symptomatically. Vaccination against influenza plays a vital role in the control of infection in humans. The currently available antivirals include adamantanes, neuraminidase inhibitors, and ribavirin. Baloxavir marboxil, the prodrug of baloxavir, is the latest addition to the family of anti-influenza drugs, and it received US-FDA approval on October 24, 2018. Baloxavir acts through a novel mechanism of inhibiting Cap-dependent endonuclease (CEN), the vital step in the transcription of viral RNA, and prevents further spread of the virus.

An observational study to assess the possibility of patient participation in implementing pharmacovigilance in a busy tertiary care hospital.

BACKGROUND: Adverse drug reactions are an important cause of morbidity and mortality worldwide. Monitoring adverse drug reaction is the primary function of Pharmacovigilance Programme of India (PvPI). The national program at the inception allowed only physicians, nurses, and pharmacists to report adverse drug reactions but has recently permitted even the consumers or patients to report. The knowledge, attitude, and practice of patients toward such a program have not been studied, and hence, the present study was conducted to assess the same. METHODS: A questionnaire was prepared based on the review of literature and was filled up by the interviewer based on inputs from patients attending various outpatient departments and dispensary of a tertiary care center after obtaining informed consent. Descriptive statistical analysis was carried out, and the results are expressed in terms of means and proportions for continuous and categorical data, respectively. RESULTS: Majority of the patients were male (58.3%) and were using smart phones (63.9%). Most of the participants (91.6%) felt reporting adverse drug reaction is important, but only 37.7% thought of reporting the same. A very low percentage of participants (10%) were aware about the PvPI and the helpline number. CONCLUSION: The Indian health consumer is highly unaware about the existence of the PvPI and various tools available to report adverse drug reactions. It is the need of the hour to create awareness of the same by using the positive attitude toward the program.

A prospective study to assess the medication adherence pattern among hypertensives and to evaluate the use of cellular phone text messaging as a tool to improve adherence to medications in a tertiary health-care center.

AIM: The aim of the study was to assess improvement in adherence to medications using mobile phone text messaging (short message services [SMSs] and social media). OBJECTIVES: The objective was to assess the pattern of adherence to medication in hypertensives and to assess the improvement in adherence pattern to antihypertensive medications using mobile phone text messaging as a tool. METHODOLOGY: After obtaining informed consent, the study participants' blood pressure was recorded, and their adherence to medications was graded as high, medium, and low using the Medication Adherence Questionnaire. Then, messages in the form of either SMSs or WhatsApp were sent regularly (once every 3 days) reminding them of the importance of regular medicine intake. After 2 months of follow-up, again blood pressure was recorded and adherence graded. Data were tabulated and statistically analyzed. RESULTS: Majority of study participants in who were initially placed in medium to low grading of adherence (65.2%) moved toward high adherence (88.4%) at follow-up after receiving messages for 2 months. A statistically significant decrease was noted in systolic (8.3 mmHg,P < 0.001) and diastolic blood pressure (2.4 mmHg,P < 0.002) at the end of follow-up. CONCLUSION: Nonadherence to medication is a global phenomenon to be tackled at the earliest. Our study clearly brings out the importance of improving adherence by regular reminders as messages. Hence, there is a wide scope to avail means to improve the adherence pattern and maximize the health benefits.

Neuroleptic malignant syndrome in an adolescent receiving olanzapine-lithium combination therapy.

A 16-year-old boy developed fever, generalized rigidity, leukocytosis, and increased serum transaminase and creatine kinase levels while receiving treatment with olanzapine and lithium. When both drugs were discontinued, his fever and rigidity subsided and biochemical irregularities spontaneously returned to normal, without any complications. Classic neuroleptic malignant syndrome (NMS) was diagnosed. Concomitant administration of lithium with olanzapine may place patients at risk for NMS. Clinicians need to be aware of this rare but potentially fatal side effect in patients of all ages, and especially in adolescents receiving both drugs.