Current Prescribing Trends and Rationality of Fixed Dose Combinations in a South Indian Multi Specialty Hospital: An Observational study

Fixed dose drug combinations (FDCs) are defined by the World Health Organization (WHO) as a combination of two or more active ingredients in a fixed ratio of doses and in a single dosage form. Drugs from different pharmacological groups with complementary mechanism of action should be combined in FDCs. When they are combined in a single formulation, the safety, efficacy and bioavailability profiles of the established drugs change, and hence, FDCs are treated as new drugs (Rayasam S P [et al.], 2013). Physicians prescribe a number of FDCs today in which majority of them are irrational. FDCs are widely accepted when it offers justifiable advantages over the products with single active pharmaceutical ingredients (API) (Prajapati K [et al.], 2016). Advantages of FDCs include better efficacy, reduced adverse drug reaction (ADR), provide broader spectrum of antibacterial activity, reduced complications, ease of administration and reduced polypharmacy. The use of combination drugs with fixed dose helps exhibit its effects with fewer pills or dose, thus improving the patient compliance. It may also reduce the cost and offer the poor patient’s a lower overall health care cost. The drugs in combination may provide a synergistic or an additive effect. The therapy with FDCs reduce the polypharmacy or pill burden, which in turn can improve patient compliance. However, the rationality and justification of their uses always raises doubt and it can lead to controversial usage of drugs. Most commonly, the clinicians obtain information from the medical representatives apart from obtaining the information through peer group, resources like MIMS, CIMS, and continuing medical education programs. Insufficient or often biased information can lead to inappropriateness in the use of drugs. Strengthening of the regulatory guidelines, provision of continued updated unbiased information about the drug products and their safety should help in minimizing the inappropriate and irrational use of drugs. Awareness and education about irrational FDCs, FDCs containing banned or controversial ingredients will help develop rational prescribing practices among prescribers. Rational combination of drugs to formulate FDCs and the appropriate use of FDCs can definitely improve adherence to the therapy, safety, and reduce the cost of therapy. However, efforts to increase awareness regarding the correct use of FDCs should be a constant objective for the pharmacists