Rational use of drugs

Modern health care system is unimaginable without the availability of essential drugs as medicines are one of the weapons to fight against diseases. With the increase in use of medication, increase incidents of misuse are prevailing in the form of overuse of Antibiotics, by using needless expensive drugs and self-medication etc.

What is Rational Use of drugs?

Rational use means that patients are receiving correct drug that is suitable for their clinical needs i.e. appropriate drug suitable for the patient, appropriate dosage with proper administration for an adequate period of time and at an appropriate cost. Consumers’ perspective may be different for rational use of drugs as consumer will consider economic and cultural status. So to understand the actual meaning of rational use, both viewpoints should be considered.

Reasons for irrational use of drugs

Lack of communication between patient and health care professionals, improper training to medical graduates, insufficient laboratory resources and diagnostic facilities, imbalance between the accessibility to potent drugs, free availability of fake and expired drugs in the market, improper examination of patient, incomplete documented medical history, lack of access to the most needed drugs are the factors which contribute to irrational use of drugs. Shortage of essential drugs occurs due to inappropriate drug selection, storage and non-adherence by patient.

Determinants of Irrational Use of Drugs

Types of irrational use of drugs

1. Self-Prescription

Self-medication is apparently extensive and widespread all over world. Intensified resistance of pathogens is main problem related to self-medication which cause serious health problems such as adverse drug reactions and sustained suffering. Antimicrobial resistance is a major problem globally especially in developing countries where antibiotics are frequently used without any prescription. The medication given by a doctor to relieve pain may not always sufficient to provide ease either because patient has developed tolerance or the pain is too extreme and as a result of these patients may give themselves additional doses of medications. Commonly abused are stimulants. The most eminent stimulant based drugs that are abused are Dimethylphenidate, Detroamphetamines and amphetamine sulfate. Medications that are used to fight against anxiety are often abused as well.

Potential risks related with self-medication:

• Failure to find proper medical advice
• Improper choice of therapy
• Incorrect medication that cause adverse effects
• Incorrect or excessive dosage
• Risk of developing addiction and dependence
• Incorrect route of administration

Drugs used for self-medication include:

2. Excessive Use of injections and antibiotics

Pakistan has one of the highest rate of using excessive injections and overuse of antibiotics. Antibiotic resistance is because of irrational use of antibiotic and is one of the major causes for the development of antibiotic resistance. Resistance to bacteria can occur impulsively through mutation. Antibiotics are globally used as growth supplements in livestock.  Antibiotics are used in animals, primarily to prevent infection and to promote growth. Treating livestock with antimicrobials is said to improve the overall health of the animals, producing larger yields and a higher-quality product. The antibiotics used in livestock are indirectly ingested by humans when they consume food. Antibiotic use in food-producing animals kills or suppresses susceptible bacteria, allowing antibiotic-resistant bacteria to flourish. Unsafe injection practices are equally widespread. The WHO defines rational and proper prescribing as prescription of injections in less than 15% of cases, and anything above 15% is considered improper injection.

In Pakistan, it has been reported that people’s beliefs that injections work more quickly than other mediation and they urge clinicians to prescribe injections. Moreover, there could be financial gains that motivate health care professionals to prescribe injections in place of oral medications, as an additional fee is charged by prescribing injections. Other reasons behind consumers ‘preference for injections include an enhanced belief in their power to heal.

3. Food-Drug and Drug-Drug Interactions

Food-Drug interaction includes the effect of medicine on nutritional status. Certain foods and specific nutrients in foods, if ingested combined with some drugs, may affect the therapeutic efficacy, bioavailability, pharmacodynamics and pharmacokinetics of the medications. For example, Iron absorption from supplements reduces to half when taken with food. Calcium is used in dairy products or fortified foods and when Tetracycline and Ciprofloxacin is given concomitantly, insoluble complexes are formed.

Drug-drug interactions (DDIs) are one of the commonest causes of medication error. Drug-drug interactions occur when a drug interferes with another drug. This can cause unexpected side effects or can alter the way one or both of the drugs act in the body. The drugs involved can be over-the-counter medicines, prescription medications, and even herbal products and vitamins.

Pharmacodynamic effects are the base of the use of reversal agents. Best example of this in veterinary medicine includes naloxone and opioid. Changes in drug absorption can occur following pharmaceutical interaction in the small intestine or stomach.

The good example of this is tetracycline chelation that can be occurring by calcium containing solutions in the stomach by such as a milk diet in newborns. . Drugs when combined with vehicles containing cations, strong chelating capability can be stopped. Fluoroquinolones can be inactivated in solutions with calcium (such as lactated Ringer’s solution) or iron (lixotinic).

4. Unsafe Use of Drugs during pregnancy

Adverse events of drugs during pregnancy result in direct drug toxicity, teratogenicity, fetal growth retardation, and carcinogenesis. For example, Sulfonamides can cause brain damage and jaundice in the fetus. Warfarin can cause birth defects and risk of bleeding problem is newborns and mothers.

5. Polypharmacy

The number of drugs per case or per prescription describes the pattern of polypharmacy, where more than one drug is prescribed (often unnecessarily) for a disease or condition

Actions to Promote Rational Use of Medicines

• standard treatment guidelines
• Patient education regarding potential side effects, regular medication, the importance of being actively involved in their own care.
• Check for expiry date, drug name, indications and dose
• Training of doctors and paramedical staff
• Supervisory visits
• Group lectures, seminars and workshops
• Addressing the underlying causes of the prescribing problems: false perceptions and poor knowledge
• Aspects of pharmaceutical management such as procurement, distribution and selection
• Cost information

 This article is collectively authored by Yasra Syed, Pharm-D 8^th Semester, University of Agriculture, Faisalabad and dr. Kanwal Rehman, Assistant Professor (PhD Pharmacology), Institute of Pharmacy, Physiology and Pharmacology