WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka

Background Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation. Methods This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines. Results Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively. Conclusions The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations.

Safety of Herbal Medicines in Children

Herbal medicine is used by individuals of all ages, including children. Herbal medicine includes herbs, herbal materials and preparations, and finished herbal products. Herbal medicine or herbal products’ use for all ages have increased in recent years. Based on the data of the World Health Organization, almost 80% of the population in developing countries trust herbal medicines to meet their health needs. Herbal medicines use unconsciously as though these products are harmless. The use of herbal products in children is a concern because little information is available concerning the benefits and risks of these products in the pediatric population. This creates a serious problem in the treatment of children, and reveals a serious and under-recognized hazard in clinical care. The safety of most herbal medicinal products is absent since lack of suitable quality controls and not available of appropriate patient information. Owing to the possibility of serious health complications arising from the use of herbal products, it is mandatory to understand their use in the general population in order for appropriate measures to be put into place.

Sustainable medicines use in clinical practice - a clinical pharmacological view on ecopharmacostewardship

Climate change continues to pose a dangerous threat to human health. However, not only is health impacted by this crisis, healthcare itself adds to the problem, through significant contributions to green house gas emissions. In the UK, the National Health Service (NHS) is responsible for an estimated 4% of the overall national carbon footprint. Medicines account for a quarter of this and whilst they are vital in in health now, through sustainable use they can also positively influence the environmental health of the future. In this review, we explore how clinical pharmacologists and other health care professionals can practice sustainable medicines use or eco-pharmaco-stewardship. We will discuss current and near future environmental practices within the NHS, which we suspect will resonate with other health systems. We will suggest approaches for championing eco-pharmaco-stewardship in drug manufacturing, clinical practices and patient use, to achieve a more a sustainable healthcare system.

Herbal Medicines use in Pregnancy in Northern Cyprus

Objective: To identify the herbal medicinal products used in pregnancy in community pharmacies, the approach of pharmacists in Northern Cyprus and to compare the availability of the most commonly mentioned medicinal plants in accessible databases, in Northern Cyprus. Design: Questionnaire was designed and administered to 263 community pharmacists in Northern Cyprus and gathered the data on herbal medicinal products they had and recommended to pregnant women. Databases such as ScienceDirect, PubMed, OpenAcces Journals were searched through the Near East University Grand Library’s Online Resources for keywords relating to the ‘herbal medicine’, ‘pregnancy’ ‘pregnant women’, ‘herbal products’. Descriptive statistics was used with IBM® Statistical product and service solutions software platform. Location/Setting: Northern Cyprus Outcome Measures: Herbal medicinal products used and recommended in pregnancy by community pharmacists in Northern Cyprus were identified. It has also been determined which of the most used plants in the world are grown in Northern Cyprus. Results: The most recommended herbal pharmaceutical forms were herbal lozenges (n = 76, 31%), then herbal form of teas (n = 60, 24%), herbal oils (n = 57, 23%), herbal capsules (n = 36, 14%), other pharmaceutical forms (n=20, 8%). Within the limitation of our literature search, totally 650 medicinal plants (single or formula) used in pregnancy were determined. Out of these 74 were mostly used worldwide, and it was discovered that 56 species out of these plants are grown or cultivated; 18 of the compiled species were imported species some of the genera have species growing naturally growing in Cyprus. Conclusion: Pregnant women in Cyprus also follow their counterparts in other countries in developing interest in herbal medicines. The number of herbal medicines in the pharmacies owned by Turkish Cypriots is small. Interestingly, the result of this study showed that the pharmacists that were mainly Turkish Cypriots were found not to be selling herbal medicinal products to pregnant women without doctor’s prescriptions. This study recommends that the herbal medicines use in pregnancy should be the ones that have undergone in-depth evidence-based scientific researches with clinically proven efficacy that are known not only to the healthcare professionals such as medical doctors, midwives but also the pharmacists and the general public.

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

Cancer patients are identified as fragile patients who are often immunodepressed and subject to secondary diseases. The Ada cohort comprises cancer survivors aged 15–39 years at diagnosis included in 34 Italian cancer registries. This study aimed to analyze the possible excess of non-cancer medicines use on the basis of the medicine database of the Ada cohort. Records of medicines present in the pharmaceutical flows collected by eight Lombardy cancer registries and used by patients with any type of cancer were extracted for the year 2012. Medicine consumption data were processed to assign a defined daily dose value and to evaluate the consumption of medicines belonging to different groups of the ATC (Anatomical Therapeutic Chemical) classification. The values were compared with values in the Lombardy population. Medicine consumption related to 8150 patients was analyzed, for a total of 632,675 records. ATC groups A and C for females and group N for both sexes showed significant increases. Group J for males and group M for females showed intermediate increases, and group H for both sexes showed smaller increases. This method allowed the identification of excess medicine use to reduce cancer therapy side effects and primary disease sequelae in this group of patients.