Rational Drug Prescribing and Essential Medicine

Rational Drug Prescribing

Rational Drug Prescribing involves the process of prescribing the right drugs according to patients' requirements. The prescription should be rational, contain the appropriate dose required by the patient, and be given at the right time for an equitable duration. It should be properly documented to avoid legal issues. 

For example, 

• If a patient has a fever, paracetamol is prescribed. Any other prescription may cause serious effects.
• A teratogenic drug should not be prescribed to a pregnant lady. 
• If an adult man of about 40 years of age comes with a fever, 50 mg of paracetamol will not suffice. He should be given a dose according to an adult man, that is 500 to 650 mg. Similarly, a child of approximately 20 kg should not be given such a high dose. Therefore, appropriate dosage is important.
• Sleeping tablets should be taken at night-time and not during the day.
• If the treatment is positive, a person suffering from tuberculosis should be treated for at least six months. Similarly, an antibiotic should be taken for a minimum of five days.
• Whatever medicine is prescribed, it should be written properly. It should depict the right time and duration of consumption. The number of tablets to be taken before or after food intake should also be mentioned clearly.

P-Drug

P-drug is also known as a preferred or personalized drug. If a person suffers from typhoid caused by Salmonella typhi, he/she can be treated in one of the following ways: 

• Ceftriaxone (given intravenously- IV) 
• Cefixime (given orally) 
• Ciprofloxacin (given orally)

Therefore, drug prescription changes depending upon the patient. 

Parameters OF P-Drugs              

The following are the parameters that decide the selection of the drug.

1. Efficacy – A drug with maximum efficacy is preferred. Cefixime has maximum efficacy.
2. Safety – Whether the drug to be prescribed has an adverse effect or not is also considered. Ciprofloxacin is avoided in the case of children and pregnant women because it can cause cartilage damage.
3. Affordability—The patient's financial capacity is also considered when prescribing a drug. Costly drugs can be avoided if a supplement is present.
4. Suitability – Is the drug suitable for the patient is also important.

Essential Medicine

Essential medicines are the medicines that take care of priority health care needs. 

• CASE 1 - Patient asks for body-building drugs.
• CASE 2 - The patient is suffering from androgenic alopecia. 
• CASE 3 - The patient is suffering from tuberculosis.
• CASE 4 - The patient is suffering from hypertension. 

Among all these cases, the patients suffering from tuberculosis and hypertension are considered as priority health care needs. Every country must have affordable medicines for infectious diseases such as TB, HIV, malaria, and typhoid and non-communicable diseases such as diabetes or hypertension etc. These are called essential medicines.

Every country has its own prior healthcare medicines at a rate affordable for its citizens. World Health Organisation (WHO) has prepared a list of essential medicines. Every country has a different disease pattern.  For example – anti-snake venom essential medicine is rendered useless in a country that does not have snakes. Therefore, every country prepares its list of essential medicines, known as the National List of Essential Medicines.

According to the National List of Essential Medicines of India for the year 2022, there are 384 essential medicines classified into 27 therapeutic categories. Different therapeutic categories, such as anesthesia, vitamins and minerals, anti-infectives, drugs for the heart, etc., are classified into distinct categories.

The above table depicts the National List of Essential Medicines, India (2022). It records the medicine's name, the level of healthcare (where it should be available), and the form and strength of the medicine.

For example, Diclofenac should be available in primary, secondary, and tertiary health care centers in 20 mg tablet form and 25 mg/ml injection form. Fentanyl should be available only in secondary and tertiary health care centers. Most of the time, primary health care centers do not require certain medicines, such as anesthetics. 

Frequently Asked Questions:

Q: What is a P drug?

Answer: P-drug is also known as a preferred or personalized drug.

Q: What is an Essential Drug?

Answer: Essential medicines are the medicines that take care of priority health care needs.

Q: What is Rational drug prescribing?

Answer: Rational Drug Prescribing involves the process of prescribing the right drugs according to patients' requirements.

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