Ban effect: Diabetic drug intake to rise to 15 drugs in Hyderabad
Hyderabad: Thanks to the recent ban on fixed dose combinations, diabetes patients will now have to opt for new dual combination drugs or single dose drugs, increasing their pill burden from seven to 15 drugs.
Endocrinologists, diabetologists and general physicians say that 85 per cent of the banned combination drugs were regularly used by diabetics who will be adversely affected. Senior consultant physician Dr Shiva Raju said,
“The major problem is the increased pill burden, which will increase the cost of the medicines. This will be the first comparison made by patients. If earlier their medicines cost Rs 3,000 per month, it is likely to double.”
At the same time, the huge “pill burden” brings up the question of compliance levels. Senior general physician Dr Rahul Aggarwal said, “Compliance levels are a cause of concern among diabetic patients. Given the range of medicines they take, they will have to remember to take them at the right time. FDCs (fixed dose combinations) helped to do away with these problems to some extent as the combinations ensured that the drugs were present in the body and would act.
But now, patients and their family members will require proper counseling. This means that the general physician has to put in extra time and explain to the patients the importance of these single doses and why FDCs are not being given.” But a section of endocrinologists say that there were too many irrational combinations in the market.
Dr V. Sri Nagesh, consultant endocrinologist, said, “In diabetics the drugs have to act to control the blood sugar levels. But certain combinations like Metformin + Glimepiride + Methylcobalamin did not work properly. Glimepride is to be taken before meals while Voglibose is to be taken after meals. So in combination drugs like Voglibose + Metformin + Chromium Picolinate, the efficacy of the drugs was a cause of concern.” Experts say that the rationality of combination drugs had been a cause of concern from the time they started mixing more than two to three molecules.
A senior doctor on condition of anonymity said, “To treat multiple diseases like diabetes, hypertension and renal issues combination drugs were being loosely prescribed without understanding whether it really helped the diabetic.” The problem now is that patients have got used to combination drugs and they are going to take time to adjust to the new drug regime.
