JIIMC September 2016.cdr


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EDITORIAL

Rational Drug use and Essential Drug Concepts
Akbar Waheed

-------------------------------------------------
Correspondence:
Prof. Akbar Waheed
HOD Pharmacology
Islamic International Medical College
Riphah International University, Islamabad
E-mail: akbar.waheed@riphah.edu.pk 

Received: Sept 18, 2016; Accepted: Sept 20, 2016

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



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JIIMC 2016 Vol. 11, No.3  

r e f e r e n c e  t o  p a t i e n t s  s u c h  a s  h i s  
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.
! Att ra c t i ve  i n c e nt i ve s  fo r  m a r ke t i n g  /  

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 
4,5

advertisement critically.

Conclusion:
The profession needs to be alert not subverted.
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