Background: Adverse Drug Reactions (ADRs) are one of the underestimated causes of morbidity and mortality. Monitoring of these ADRs is at the core of any pharmacovigilance program. ADR monitoring suffers from lack of reporting from health care personnels. Unless we know the current knowledge, attitude and practices of the budding doctors it’s difficult to design corrective measures to improve reporting. The present study was designed to assess the knowledge, attitude and practices of pharmacovigilance and ADR reporting among undergraduate and postgraduate medical students.Methods: This was a questionnaire-based, observational study. The questionnaire had six questions each pertaining to knowledge, attitude and practices of pharmacovigilance and ADR reporting. Factors discouraging ADR reporting were also studied. Descriptive statistics were carried out and one-way ANOVA was applied to find the statistical difference between the groups.Results: A total of 288 subjects were approached for the study of which 229 agreed to participate. It was observed that the knowledge of the participants regarding ADR reporting and pharmacovigilance was satisfactory. 68% of respondents felt that educational programmes have a positive effect on ADR reporting. 15% of respondents admitted of having reported an ADR. The mean scores of knowledge, attitude and practices of ADR reporting were considerably higher in postgraduates as compared to undergraduates (p-value <0.05).Conclusions: The study concluded that participants of study were aware of the importance of ADR reporting but it did not reflect in their practices. There is a need to create awareness and to educate these future physicians about Pharmacovigilance.
Background: The present prospective, open labelled study was designed to evaluate the efficacy and tolerability of escitalopram, selective serotonin reuptake inhibitors (SSRI) in comparison with milnacipran, dual serotonin and noradrenaline reuptake inhibitors (SNRI) in the treatment of major depressive disorder.Methods: Outpatients (N=120) with an ongoing/newly diagnosed ICD-10 major depressive episode and having a minimum score of 8 on the 21-item Hamilton Depression Rating Scale (HDRS) were assigned to escitalopram, 10–20 mg/day (54 patients) and milnacipran 50-100mg (66 patients), for an 8 week treatment period with follow up at 2nd, 4th and 8th week. The parameters for efficacy were improvement (decrease in HDRS scores at 8 weeks from baseline values), response (decrease of ≥50% in the HDRS scores) and remission (HDRS score of ≤7). Tolerability was assessed by comparing the frequency of adverse effects and drop out rate due to the same at the end of 2nd, 4th and 8th week in both the groups.Results: Improvement, Response rate and Remission rates at the end of eight weeks were 71.11%, 83.33% and58.33% for escitalopram and 59.35%, 34.14% and75.6% for milnacipran respectively. Adverse experiences were reported by 14% of patients in escitalopram group and 79.2% patients in milnacipran group at 8 weeks. Additionally, there were significantly lesser dropouts due to adverse events in escitalopram (3.70%) than in milnacipran group (30%).Conclusions: Escitalopram, the Senantiomer of citalopram, is a safe and effective antidepressant with potentially superior tolerability and comparable efficacy to the dual reuptake inhibitor, Milnacipran.
Background: The intent of this prospective, open labelled study was to determine the relationship between baseline depression symptom severity and treatment efficacy for Escitalopram selective serotonin reuptake inhibitors (SSRI) in comparison with Milnacipran, dual serotonin noradrenaline reuptake inhibitors (SNRI) in the treatment of major depressive disorder. Methods: Outpatients (N=120) of Psychiatry with diagnosed ICD-10 major depressive episode and having score of ≥8 on 21-item Hamilton Depression Rating Scale (HDRS) were further divided according to their severity of depression as defined by 21-HDRS score of ≥23 as very severely depressed, 19-22 as severely depressed, 14-18 as moderately depressed and 8-13 as mildly depressed patients. These patients were assigned to receive escitalopram, 10-20 mg/day (54 patients) and milnacipran 50-100 mg(66 patients), for a 8 week treatment period with follow up at 2nd, 4th & 8th week of initiating the treatment. The patients with various grades of depression in each group were assessed and compared for efficacy in terms of response (decrease of ≥50% in HDRS scores) and remission (HDRS score of ≤7). Results: Escitalopram achieved highest response and remission among very severely depressed patients i.e. 94.18% and 76.40% respectively whereas Milnacipran showed maximum response and remission among patients with severe depression i.e.85.7% and 50% respectively. Escitalopram showed comparable response in mild to moderate grades and greater response in severe grades of depression whereas remission was significantly higher with Escitalopram in all grades of depressed patients relative to Milnacipran. Conclusion: Escitalopram is more efficacious than Milnacipran in all grades of depression.
Hyperlipidemia is a major cause of atherosclerotic coronary and cerebrovascular disorders affecting a large Indian population. The cost of various hypolipidemic drugs that are used for the prevention and treatment of these afflictions largely varies in the Indian pharmaceutical market. Our study aimed to evaluate the cost variation of different brands of hypolipidemic drugs and to compare the branded prices with their corresponding generic and ceiling prices. The costs of various drugs were procured from the latest issue of the “Drug Today” from October to November 2020 edition which is a directory of all the drugs available in India published quarterly every year by Lorina Publications (India) Inc. Cost ratio, percent cost variation, and daily defined dose (DDD) were calculated. We also compared the branded prices of drugs with their generic and ceiling prices available on the official website.A total of 9 single hypolipidemic drugs and 9 fixed-dose combinations (FDC) showed a wide per cent cost variation. The highest percentage of cost variation was atorvastatin 80 mg (3284%) whereas fenofibrate showed the lowest percent cost variation (0.91%). The cost ratio was also found higher in 2 from 6 drugs. Among FDCs, atorvastatin 10mg + ezetimibe 10 mg (484%) showed a higher cost variation and rosuvastatin 20 mg + fenofibrate 160mg (0.6%) showed a minimum variation. The maximum cost variation from branded prices compared to generic prices was found in simvastatin 20 mg (544%) and atorvastatin 10 mg (155%). In summary, our study showed a wide variation in the cost of hypolipidemic drugs available in the Indian market which provides an insight to the prescriber, gives drug price control authorities to minimize the financial burden on the patient, and improves their compliance
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