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Diphenoxylate
unsafe, yet promoted
Doctors
and pharmacists should address the hazardous effects to patients
and regularize the usage of the drug based on therapeutic principles,
say A N Nagappa & S Asif Ansari
Pharmaceutical
companies many a time indulge in unethical promotion and marketing
of potentially hazardous drug in spite of the awareness of danger.
All though stringent laws and regulations exist, there is a systematic
evasion of these laws. There are many instances where a pharmaceutical
company is accused of detailing the product highlighting its benefits
and hiding its adverse reactions, hence with intent to maximize
sales.
The
pharmaceutical companies’ objectives should not be only profit
but also concern for the health of people. We find various categories
of drugs which are abused by prescribers, pharmacists and patients.
The manufacturer and also the regulators are not paying much attention
to control such practices. There are reports of using non staining
iodine ointment as a psycho-stimulant drug by college students.
There
are many abuses of tranquilizers, anitbiotics, vitamins, cough syrups
etc. The Diphenhydramine hydrochloride syrup is used by college
students for psychedelic effects, codeine phosphate syrup as euphoriants.
These drugs and formulations are sold in open market under various
schemes to boost their sales. What will happen to the students and
public who are addicted to these preparations?
A
case study of Diphenoxylate Hydrochloride will highlight the callous
attitude of the manufactures, regulatory agencies, prescribers,
pharmacists etc, towards the patient and the public. The patient
or public being not well-versed with intricacies of drug effect,
will usually rely on prescribers and pharmacists and ask for remedies
which will relive him of the symptoms and discomfort.
It
becomes the responsibility of the prescribers, pharmacists to safeguard
the health of patient or public. This is because there is no transparency
and least accountability by the prescribers or pharmacists who are
found to indulge in prescribing and dispensing medicines without
giving proper reason for the usage.
The
pharmaceutical companies under competitions and market forces are
found to indulge in fierce competitive practices. There are instances
of lucrative offers to the prescriber in sales campaigns. Moreover
the pharmacists are also offered huge bonus offers like ‘‘sell
one and get one free offer,’’ ultimately prescriber and
pharmacists priority gets changed from patient care to product sales.
Diphenoxylate Hydrochoride is a drug which is recommended for specific
kinds of diarrhoea like viral diarrhoea, its paediatric use is banned
as this drug is found to cause central nervous system toxicity.
Hence it is useless to administer this drug in infectious diarrhoea
of bacterial origin, because it gives the opportunity for toxins
and bacteria to remain in intestinal tract for long time. The toxins
destroy the lining of the intestinal tract leading to further loss
of water and electrolytes. However in children, it should not be
used. Even in older children there are problems. Diphenoxylate causes
accidental poisoning in toddlers. Signs of dehydration are also
masked by it causing fatal toxic reactions.
Moreover,
Diphenoxylate Hydrochloride with atropine sulphate is not on WHO’s
essential drug list. In spite of all these regulation and restrictions,
lomotil and lomofen are freely marketed in the drug stores as effective
remedy.
Conclusion
Drug
safety is one of the high priorities having a bearing on the health
of people. Many diseases get aggravated due to over-indulgence of
drugs.
There
is a need for all concerned to address these issues and regularize
the usage of the drugs based on therapeutic principles. A patient’s
health is more important than a company’s sales. This must
be understood, practiced by government, manufacturers, prescribers
and pharmacists.
The
writers are with pharmacy group, Birla Institute of Technology and
Science, Pilani, Rajasthan
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