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Year : 2022  |  Volume : 54  |  Issue : 6  |  Page : 407-416

Use of drugs not listed in the National List of Essential Medicines: Findings from a prescription analysis by the Indian Council of Medical Research-Rational Use of Medicines Centres Network in tertiary care hospitals across India

1 Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
2 Indian Council of Medical Research, New Delhi, India
3 Department of Pharmacology, CMC, Vellore, Tamil Nadu, India
4 Department of Pharmacology, VMMC, New Delhi, India
5 Department of Pharmacology and Medical Education, CMC, Ludhiana, Punjab, India
6 Department of Pharmacology, PGIMER, Chandigarh, India
7 Department of Pharmacology & Therapeutics, SGSMC and KEM, Mumbai, Maharashtra, India
8 Department of Pharmacology, IGIMS, Patna, Bihar, India
9 Department of Pharmacology, Medical College, Baroda, Gujarat, India
10 Department of Pharmacology, IPGMER, Kolkata, West Bengal, India
11 Department of Pharmacology, BJMC, Ahmedabad, Gujarat, India
12 Department of Pharmacology, AIIMS, New Delhi, India
13 Department of Pharmacology, JIPMER, Puducherry, India
14 Department of Pharmacology, DMCH, Ludhiana, Punjab, India

Correspondence Address:
Ratinder Jhaj
Department of Pharmacology, All India Institute of Medical Sciences, Bhopal - 462 020, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijp.ijp_878_21

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BACKGROUND: The concept of listing essential medicines can lead to improved supply and access, more rational prescribing, and lower costs of drugs. However, these benefits hinge on the prescription of drugs from an Essential Medicines List (EML). Several studies have highlighted the problem of underutilization of EMLs by prescribers. Therefore, as part of prescription research by the Indian Council of Medical Research-Rational Use of Medicines Centres Network, we evaluated the extent of prescription of drugs not listed in the National List of Essential Medicines (NLEM). MATERIALS AND METHODS: Prescriptions of outpatients from participating centers were included after obtaining verbal/written informed consent as approved by the Ethics Committee, and evaluated for prescription of drugs from the NLEM 2015. RESULTS: Analysis of 4838 prescriptions from 13 tertiary health-care institutes revealed that 2677 (55.33%) prescriptions had at least one non-NLEM drug prescribed. In all, 5215 (31.12%) of the total 16,758 drugs prescribed were not in NLEM. Of these, 2722 (16.24%) were single drugs and 2493 (14.88%) were fixed-dose combinations (FDCs). These comprised 700 different drug products – 346 single drugs and 354 FDCs. The average number of non-NLEM drugs prescribed per prescription was 1.08, while the average number of all drugs prescribed was 3.35 per prescription. It was also found that some of the non-NLEM drugs prescribed had the potential to result in increased cost (for example, levocetirizine), increased adverse effects (dextromethorphan), and less effectiveness (losartan) when compared to their NLEM counterparts. Nonavailability of an essential drug (oral hydroxocobalamin) was another important finding of our study. CONCLUSION: This study highlights the extent and pattern of drugs prescribed from outside the NLEM at the tertiary health-care level and the need for training and enhanced awareness among prescribers for greater utilization of the NLEM.


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