DRUG UTILIZATION AND PRESCRIBING PATTERN OF GLAUCOMA IN A TERTIARY CARE HOSPITAL OF DEHRADUN

Abstract

Glaucoma is a condition in which distinctive changes occur in the optic nerve and visual field. In glaucoma intraocular pressure (IOP) is raised that compresses and damages the optic nerve. As the optic nerve is damaged, it fails to carry the visual information to the brain which induce clinically progressive loss of peripheral visual field and ultimately loss of vision. Aims and Objectives: To Evaluate the drug utilization and prescribing pattern of drugs used for treatment of glaucoma, to analyze current prescribing trends in anti-glaucoma drugs, to perform a drug utilization study, to identify drugs per prescription, category wise identification of drugs prescribed, mono therapy vs combination therapy. Materials and Methods: The present study was a prospective, observational study carried out in 105 patients at Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. Results: Out of total 105 patients, 68 were males (64.76%) and 37 were females (35.24%). The most common age group was 46-60 years. Patients were mostly affected by primary open angle glaucoma (95.23%) then angle closer glaucoma (4.76%). Total 184 drugs were prescribed in the treatment of glaucoma. Average number of drugs per prescription was 1.75. Combination therapy was prescribed in 51.43% patients & most common used combination therapy was combination of Brimonidine+ timolol (81.48%) followed by Bimatoprost+ timolol (18.52%). Monotherapy was used in 48.57% patients in which drug dorzolamide (22.31%) was prescribed mostly which is belongs to the category of carbonic anhydrase inhibitors followed by timolol (19.23%) (βblockers) which was second line choice of drug. Generic drugs were mostly prescribed in 77 patients (73.33%) followed by 28 patients (26.66%) were brand names. Conclusion: The prescription analysis of glaucoma patients concluded that monotherapy with dorzolamide was the first line choice for glaucoma therapy and timolol was found to be the second line choice. Timolol+ brimonidine was the mostly prescribed combination of drug. It also showed that all drugs were prescribed in their generic name instead of brand name. Article Info: Received 10 July 2019; Review Completed 18 Aug 2019; Accepted 23 Aug 2019; Available online 30 Aug 2019 Cite this article as: Reenoo J, Vandana, Drug Utilization and Prescribing Pattern of Glaucoma in a Tertiary Care Hospital of Dehradun, Journal of Drug Delivery and Therapeutics. 2019; 9(4-A):497-504 http://dx.doi.org/10.22270/jddt.v9i4-A.3405 *Address for Correspondence: Vandana, M. Pharm (Pharmacy Practice), Department of Pharmacy Practice, School of Pharmaceutical Sciences, Shri Guru Ram Rai University, Patelnagar, Dehradun-248001, Uttarakhand, India INTRODUCTION Glaucoma is a condition in which distinctive changes occur in the optic nerve and visual field. It is characterized by raised intraocular pressure (IOP) that compresses and damages the optic nerve. As the optic nerve is damaged, it fails to carry the visual information to the brain which cause clinically progressive loss of peripheral visual field and ultimately loss of vision. [1] Glaucoma is not a single disease entity but it’s a group of eye diseases characterized by anatomical features, such as open angle where the anterior chamber angle of the eye remains open and angle closure where anterior chamber angle remains closed. [2] There is so many risk factors to cause glaucoma such as, High intraocular pressure, age more than 60 years, family history of glaucoma, systemic conditions like diabetes, heart disease, high blood pressure and sickle cell anemia, eye condition like near sightedness, and topical administration of steroids for a long time. It is difficult to detect optic nerve damage in early stages of the disease. [3] Treatment of glaucoma depends on the type of disease. It can be treated with eye drops, oral pills, laser, open surgical procedure, or a combination of methods. The whole purpose of treatment is to prevent further loss of vision. This is imperative as loss of vision due to glaucoma is irreversible. Keeping the IOP (intra ocular pressure) under control is the main key factor in preventing the loss of vision from glaucoma. [4] Jauhari et al Journal of Drug Delivery & Therapeutics. 2019; 9(4-A):497-504 ISSN: 2250-1177 [498] CODEN (USA): JDDTAO Drug therapy is an important component of patient care management in health care settings. Many pharmaceutical products are available in the market often having unaffordable cost. Irrational use of drugs and dosage forms result in potential adverse effects to the patients and cause financial burden. To avoid such problems, every member of the healthcare system should practice rational use of drugs. So, drug utilization study is important criteria to avoid the irrationality of drugs. [5] Evaluation of drug utilization pattern is considered powerful means to find out the role of drugs in society as well as to increase the therapeutic efficacy and the cost-effectiveness of therapy in medical practices. In addition, periodic auditing of drug utilization pattern also provides feedback to the prescribers and helps to decrease the occurrence of untoward adverse effects due to the use of medicines. [6] MATERIAL AND METHODS: A prospective study was conducted at a tertiary care hospital in Dehradun, Uttarakhand for a duration of 6 months. After getting approval from the ethics committee of the hospital, subjects were selected based on inclusion & exclusion criteria. Inclusion criteria: \uf0d8 Patients visiting at Outpatient Department of Ophthalmology for the treatment of glaucoma. \uf0d8 Patients with either sex (male and female). \uf0d8 Patients more than 18 years of age. \uf0d8 Patients willing to participate in the study. Exclusion criteria: \uf0d8 Patients not willing to participate in the study. \uf0d8 Patients less than 18 years of age. \uf0d8 Patients who are diagnosed with other ophthalmological condition/ surgery. Signed inform consent was obtained from all participants prior to the study. Data was collected from the patients using self-designed structured data collection form to assess the drug utilization pattern and prescribing pattern of glaucoma medication. Other relevant information on the disease, prevalence, diagnosis, treatment plan was collected. RESULTS: 1. Gender wise distribution of patients Out of 105 glaucoma patients, 64.76% (n=68) were male & 35.24% (n=37) were female as shown in table 1 and figure 1. Table 1: Gender wise distribution of patients Category Number of patients (%) (n=105) Male 68(64.76%) Female 37(35.24%) Figure 1: Gender wise distribution of patients Age wise distribution of patients Out of 105 patients, the maximum patients belong to age group between 46-60 which were 64.76% as shown in table 2 and figure 2. Table 2: Age wise distribution of patients Age (Years) Number of patients (%) (n=105)