Prescribing Pattern of Antidiabetic Drugs in Indore City Hospital

Indian Journal of Pharmaceutical Sciences 637 September October 2008 found in the range 10-50 μg/ml with high correlation coeffi cients for both the drugs. Six replicate readings of drug solution were taken to study the precision of method.% RSD was found to be less than 1.5, indicating reproducibility. For recovery study different volumes of standard solution was added to the fi xed volume of sample solution. The total amount of drug added was determined by proposed method. Results of recovery studies are shown in Table 1.

found in the range 10-50 μg/ml with high correlation coeffi cients for both the drugs.Six replicate readings of drug solution were taken to study the precision of method.%RSD was found to be less than 1.5, indicating reproducibility.For recovery study different volumes of standard solution was added to the fi xed volume of sample solution.The total amount of drug added was determined by proposed method.Results of recovery studies are shown in Table 1.

Key words: Diabetes, inpatient, outpatient, Prescription Auditing
Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood.Insulin produced by the pancreas lowers blood glucose.Absence or insufficient production of insulin causes diabetes.Symptoms of diabetes include increased urine output, thirst and hunger as well as fatigue 1 .Diabetes is diagnosed by blood sugar (glucose) testing.The major complications of diabetes are both acute and chronic.Acute complications include dangerously elevated blood sugar, abnormally low blood sugar due to diabetes medications, chronic is related to diseases of the blood vessels (both small and large), which can damage the eye, kidneys, nerves, and heart 2 .Diabetes treatment depends on the type and severity of the diabetes.The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent).Insulin is vital to patients with type 1 diabetes -they cannot live without a source of exogenous insulin.Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise when these measures fail to control the elevated blood sugars, oral medications are used.If oral medications are still insufficient, insulin medications are considered 3 .Diabetes is among the leading causes of kidney failure, but its frequency varies between populations and is also related to the severity and duration of the disease 4 .
As estimated, 135 million people worldwide have diagnosed diabetes in 1995, and this number is expected to rise to at least 30 million by 2025 5 .Drug utilization studies are powerful exploratory tools to ascertain the role of drugs in society.These studies create a sound sociomedical and health economic basis for healthcare decision making 6 .WHO specifies drug use indicators 7  Patient's data such as the age, name, gender and data on prescribed drugs that include name of drug, dosage form, route of administration, most prescribed drug and so on were recorded on a customized data collection sheet in an approved manner.Each drug was counted only once without considering any change in the regimen.
Out of the 220 prescriptions of antidiabetic drugs studied, 66.36% were for men and 33.64% were for women indicating that men predominated over women (Table 1).Maximum patients with Diabetic Mellitus were of the age group of 51 to 60 years followed by the age group of 41 to 50 years (Table 1).Greater prevalence in this age group may be due to change in life style, lack of exercise and stress.Table 2 indicates that metformin (27%) and glimepiride (22.60%) were the most prescribed drugs.Metformin and glimepiride (20.86%) was prescribed most commonly in combination.Other commonly prescribed drug was pioglitazone (13.91%).Tablet formulation was found as the most commonly prescribed (Table 2) most probably due to the ease of administration.Table 3, shows the description of various category of drugs in different prescriptions.Prescription of oral antidiabetic drugs was found to be maximum (95%).
Several studies showed that a combination of sulphonylurea with metformin has been most widely used 9 .The present study also showed that a combination of sulphonylurea and metformin was most frequently prescribed (20.86%).Metformin does not promote weight gain and has beneficial effects on several cardiovascular risk factors.Accordingly, metformin is reported to be regarded as the fi rst drug of choice for most patients with Type 2 diabetes 10 .
Our study also supported the same conclusion; 50.4% of patients studied received metformin alone and/or in combination with other oral antidiabetic drugs.At present, glibenclamide and glimepiride are the second-generation sulphonylureas most widely used in the United States 11 .In this study among the second-generation sulphonylureas, glimepiride was found to be the most commonly prescribed.Coronary heart disease (CHD) is one of the major causes of death in elderly diabetics 12 .In our study, 35% (Table 3) showed presence of cardiovascular complications other than hypertension and drugs used were nitrates (23.43%) and aspirin (42.18%).
From the data collected, it was observed that among the antidiabetic drug category, drugs were found to be prescribed in following order; metformin>glimepiride> combination of metformin and glimepiride>pioglit azone>miglitol.Among the sulfonylurea category, prescription was found to be maximum for glimepiride followed by glipizide.Among the biguanide category the only drug prescribed was metformin.Among glitazone category the only drug prescribed was pioglitazone.Rectal drug delivery has a number of advantages such as reduced hepatic first pass elimination of high clearance drugs, avoidance of gastric irritation associated with certain drugs in case of nausea, vomiting and when the patient is unconscious.Rectal route of administration is specifi cally useful for infants and children who have diffi culty in swallowing oral medicine.Drug administered in suppository form can produce not only local effect but also systemic therapeutic action 1 .Suppositories can be prepared by using lipophilic bases like cocoa butter or by hydrophilic bases such as PEGs [2][3][4] .These suppositories melt or dissolve in body fl uids and release the drug, but are unstable at higher temperature.Agar has been recently used as base to produce non-disintegrating/ non-dissolving suppositories, which are stable at higher temperature 5,6 .Tramadol hydrochloride is a synthetic opioid analgesic used for moderate to severe pain like labor pain, traumatic pain, postoperative

Saleem,
et al.: Tramadol Rectal SuppositoriesRectal suppositories of tramadol hydrochloride were prepared using different bases and polymers like PEG, cocoa butter, agar and the effect of different additives on in vitro release of tramadol hydrochloride was studied.The agar-based suppositories were non-disintegrating/non-dissolving, whereas PEGs were disintegrating/dissolving and cocoa butter were melting suppositories.All the prepared suppositories were evaluated for various physical parameters like weight variation, drug content and hardness.The PEG and cocoa butter suppositories were evaluated for macromelting range, disintegration and liquefaction time.In vitro release study was performed by USP type I apparatus.The prepared suppositories were within the permissible range of all physical parameters.In vitro drug release was in the order of PEG>Agar>cocoa butter.Addition of PVP, HPMC in agar suppositories retards the release.The mechanism of drug release was diffusion controlled and follows fi rst order kinetics.The results suggested that blends of PEG of low molecular weight (1000) with high molecular weight (4000 and 6000) in different percentage and agar in 10% w/w as base used to formulate rapid release suppositories.The sustained release suppositories can be prepared by addition of PVP, HPMC in agar-based suppositories and by use of cocoa butter as base.Key words: Agar, cocoa butter, in vitro release, liquefaction, macromelting, PEG, tramadol hydrochloride