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| Dangerous medicines | | Beware of harmful side-effects | |
by Sanjeev Singh Bariana
Medicines and drug combinations that have been banned globally for their potential for harmful side-effects continue to be available in the Indian market. The long list of such drugs include medicines like analgin (brand names include Novalgin), nimesulide (Nise, Nimulid), cizapride (Ciza) droperidol (Droperol), phenylpropanolamine (included in combination medicines such as D-Cold and Vicks Action 500) and piperazine, besides several others.
All these drugs, some of them popular, non-prescription, medicines, are banned in most Western countries. Analgin, a painkiller, has been linked to bone marrow depression. Cisapride is used for acidity, but has been known to cause irregular heartbeat, as is droperidol, an anti-depressant. Nimesulide is effective against fever and pain, but has been associated with liver failure. And phenylpropanolamine (PPA), a decongestant used in several cough and cold medicines, has been linked to incidents of stroke.
The Government of India has issued more than 70 notifications banning different medicines and medicine combinations. Etoxic, an environmental group based in India, has listed a number of drugs that have been banned in the European Union and USA, but continue to be sold in India. The ‘Banned and Bannable Drugs’ published by the Voluntary Health Association of India, has listed all the “questionable drugs” in the Indian markets.
The issue came up for a detailed discussion at a workshop relating to healthcare in Chamarajanagar district of Karanatka, recently. The workshop was organised by the Communication for Development and Learning (CDL), an awareness group.
Speakers pointed out a lack of government initiative in spreading awareness among people. They stressed the health hazards related to such “questionable medicines and combinations”.
A paper titled ‘Cashing in on a brand name’ by Vijay Thawani and K.J.Gharpure, has pointed out that “consumers in the Third World get third rate treatment from the pharmaceutical industry, who sell them junk in the name of medicine. The companies have adopted a new technique of marketing new formations under old brand names without informing consumers. These companies exploit people’s faith in brand names. They also hide behind antiquated laws which do not ban the launch of new formulations using old brand names”.
The paper points out that “Disprin is known for its aspirin content (acetyl salicylic acid with calcium carbonate and citric acid).The company launched ‘Disprin plus’ with much fanfare. However, the new ‘Plus’ is actually minus the aspirin”.
Dr H Sudarshan, a Padma Shri awardee who has done pioneering work in tribal care, said that as per the drug laws, when two or more drugs are sought to be combined, the resultant product is required to registered with the Drugs Controller General, New Delhi. The state governments do not have the power to approve any new combinations. In actual practice a number of drugs banned in one state are available in other.
Quoting from the ‘Banned and Bannable Drugs’ by the Voluntary Health Association of India, certain drug combinations with questionable rationality were pointed out. These included Atorvastatin and Amlodipine; Mosapride and Pantoprazole; Tamsulosin and Finasteride; Domperidone and Omeprazole; and Glibenclamide, Metformin and Rosigitazone (widely used in diabetic treatment).
Dr N.S. Prashanth, coordinator Health and Biodiversity of the Karuna Trust engaged in healthcare in rural areas in Karnataka said: “certain fixed dose combinations of nimesulide continue to be marketed without due approval of the concerned authorities. These include nimesulide combined with paracetamol (Acilid Plus, Dolomide, Artifen, Nimuzen plus), and nimesulide with dicyclomine (Nise-spas DS). Certain more questionable/banned combinations, such as combinations of bronchodialotors with antihistamines such as Codoric syrup, Noscof tablets and Protussa syrup are available in the open market.
The workshop pointed out certain other combinations also which have been quoted in a well researched publication on drugs and drug policy by Mira Siva and Wishvas Rane titled “Banned and Bannable drugs – unbiased drug information, essential drugs and rational drug policy” presently in the fifth revised edition, published by the Voluntary Health Association of India (VHAI).
It is worth mentioning that the Government of India has prohibited manufacture, sale and distribution of approximately 70 drug combinations through different notifications. Experts felt that certain categories of the banned drug combinations were available in the open market and implementation of the ban is very poor.
According to Mrs Shangon Dasgupta, director CDL, said that a certain category of questionable drugs including analgin and minor medicines for stomach troubles were available off-the-shelf in common medical shops in different parts of the country. These were not recommended by the doctors and were sold directly by the pharmacists to the unknowing customers.
Ms Bharti of CDL said that awareness groups need to take up the issue in a big way in their respective areas and spread the message among people.
Dr Prashanth said: “firstly, the government notifications banning different drugs were not circulated among the masses. Secondly, there needs to be a wider understanding among the medical fraternity itself on the rational use of drugs and evidence-based practice. The names of the drugs are not easy for a common man to understand. Combination drugs are mostly for the benefit of the pharma companies and are useful only in a few cases. However, most of the drugs sold over the counter are irrational and questionable combinations. We also need to increase awareness among the people on these irrational combinations and banned drugs”.
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