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Rational drug therapy is defined as “administration
of the right drug indicated for the disease, in right
dose through an appropriate route for a right
duration”following are the reasons for irrational use
1,2,3,4,5,6 of drugs:
! Lack of information about drugs
! faulty training of medical graduates
! Absence of role models
! Lack of diagnostic facilities
! Demand from patient – prompt and quick
! Patient load
! Promotional activities of drug companies
! Exaggerated claims by drug companies
! Lack of patient doctor communication
! Ineffective rules and regulations
There are so manyhazards of irrational useof drugs,
7,8,9
some of these hazards are given below:
! Ineffective and unsafe treatment
! Over treatment
! Under treatment
! Prolongation of ailment
! Loss of patient doctor confidence
Following are examples of some common types of
irrational uses:
Type I Drug Type II Drug used for
8
same
! Choice of drug:
! Efficacy of drug
! Safety of drug
! Cost effectiveness
! Mono drug therapy
! Drug combinations (only if essential e.g
chemotherapy of cancerT.B.etc)
! Dose of the drug (optimum doses should be
used)
! Dosage form/route of administration
(parenteral route should only be used when
! required and in emergencies)
! Duration of therapy(not so long and not too
short)
! Patient's compliance
Following are some suggestion for developing
national strategies for promoting rational use of
11,12,13,14 drugs.
! EBM guidelines to be developed
! Essential drug lists / treatment of choice
should be published by MoH.
! Auditing of prescription by drug and
therapeutic comittees of MoH.
! Subject should be taught at UG level at
medical colleges
! Continuing medical education (CME) for
doctors.
! Public education through family physicians /
PMDC/medical institutes.
! Avoidance of perverse financial incentives by
drug marketing companies.
! Appropriate and strict drug regulations by
MoH.
Doctor's participation should be a pre requisite for
changes in behaviour of irrational Prescribing andthe
objectives should be:
! To identify factors which hinder rational drug
therapy
! To foster the concept of essential drugs in
order to reduce the cost of health
caredelivery
! To tailor prescribing to the needs of individual
patients
! They should know the advantages of an
essential drug list, such as cost effectiveness
control, management, purchase, storage and
distribution
! Factor responsible for irrational therapy with
Some general principles for rational prescribing
6,7,8,10
are
! Need for drug therapy
93
JIIMC 2016 Vol. 11, No.3
reference to patients such as his
socioeconomic status, social taboos and
beliefs, simultaneous treatment form
different systems of medicine.
! Prescribing irrational drug combinations &
formulationby physicians.
There is a need to find remedial measures to
overcome irrationality at various levelsthat what is
the reason for the popularity of certain drugs
orcombined products which are irrational &
expensive, & to find out/suggest measures to curb
their unethicalpromotion. Remedial measures
14,15
suggested include:
! Patient education.
! Improvement in diagnostic facilities.
! Making essential drugs readily available at all
times.
! Continued medical educations of physicians/
monitoring and feedback from prescription
data
! Training at undergraduate and graduate level
The public should be educated about the harmful
effects of drugs, especially of self-medication.
Patient education is the responsibility of the
prescriber/members of health team. Patient should
be explained about the drug prescribed, dose, and
duration of therapy, possible side effects,
implications of missing dose/ or discontinuation of
16 therapy. Emphasis is needed on preventive aspects
of health rather than curatives one.
14 Some reasons for use of irrational drugs include:
! Easy availability without prescription
! Ignorance of harmful effects.
! Misleading advertisements.
! Attractive incentives for marketing /
prescribing.
Advertisement for a drug influence young doctor a
lot, some prescribers will look to advertisements for
science on which to base their choice and marketers
will provide it. The most important step in preserving
the profession's integrity is to explain at under
graduate/postgraduatelevels how marketing works.
Doctors themselves can be taught to look at
advertisement critically
Akbar Waheed. (2016) Rational Drug use and Essential Drug Concepts, , Volume-11, Issue-3.
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