Prevalence of fixed dose drug combinations in nepal: A preliminary study

Background: Though fixed dose combinations (FDCs), offer certain advantages in terms of patient compliance, their use is highly debatable. Studies from Nepal have documented a high prevalence of prescribing FDCs. However, there are no extensive studies on FDCs. Hence, we aimed to study the registration status, availability and utilization pattern of FDCs in the Western region of Nepal. Methods And Findings: Primary, secondary and tertiary healthcare centers (one each) and ten retail pharmacies were randomly selected. Initially, the registration status of 50 FDCs in the national drug regulatory authority was evaluated. The availability of these 50 FDCs in ten retail pharmacies was studied following which, a total of 25, 50 and 75 prescriptions were collected from primary, secondary and tertiary health care (PHC, SHC, and THC) centers, respectively, from October 18th to December 15th 2008 and were studied. Among the 50 registered FDCs at the Nepal Department of Drug Administration, only 5 were listed in either the Nepalese National Formulary (NNF), the Essential Drug list of Nepal, or the WHO model list of Essential medicines (15th Edition). Four FDCs which were not registered in the national drug regulatory authority were found in the market. We found that seventy seven percent of FDCs were prescribed in PHC as 'antimicrobials'. Twenty nine and 35 percent of FDCs prescribed in SHC and THC respectively were for respiratory diseases. We found that 68% and 73% of the total FDCs prescribed in secondary and tertiary health care centers were in the range of 'less than NRs 100 (US$1.33)'. Conclusions: Although some FDCs are not registered in the national drug regulatory authority of Nepal, they are still available in the market. Large proportions of FDCs are widely utilized in different health care settings of Nepal. A study on the availability, utilization pattern and rationality of FDCs in different cities and health care centers of Nepal are urgently needed.