Fixed Drug Combinations

It was about couple of weeks back that the store in-charge at our place informed us that a commonly used medicine - Doxycycline was not available for purchase anywhere. Instead, a Fixed Drug Combination comprising of Doxycycline with Beta-Cyclodextrin was available at almost 3 times the price of simple Doxycycline.

It was unfortunate. Along with Septran, Doxycycline is an antibiotic we regularly use. Contrary to popular thought, they are quite effective in managing bacterial infections at least in remote locations of the country. 

Today, there was this article in the Times of India about an article in The Lancet about India's Drugs Act aiding proliferation of harmful combination drugs. And of recent, me and my colleagues were debating about use of combination drugs in diabetes. To be frank, I'm yet to see even one diabetic patient treated elsewhere who is not on a combination drug. 

I'm glad that this issue has come in print. It seems meaningless to try to educate the pharmaceutical industry and the healthcare community about the vagaries of Fixed Drug Combinations. As I mentioned in one of earlier posts, the major challenge is that most doctors get information from the pharmaceutical representatives. 

I think that the only solution is to educate the public about the issue. 

Couple of other medicines with which we've had this issue is Hydrochlorothiazide, the first line drug for Systemic Hypertension and Butylscopolamine (Buscopan), one of the best drugs for abdominal spasms and cramps. Both very cheap medicines coming under the Drug Price Control. No supplier wanted to stock them as there was no margin. 

The issue is all the more serious for us since the prohibitive costs of medicines accounts for a major proportion of costs in healthcare. One can imagine about how much costs increase with FDCs when combination of doxycycline is 3 times the cost of plain doxycycline. 

One can only hope that the government takes up this issue seriously. 

Well, before I sign off, just a gentle reminder on how rich the pharmaceutical industry has grown. I quote a recent news item - 'India has leapfrogged Russia and the UK to third place with 97 billionaires, 27 more than 2014. Manufacturing and Pharma are the preferred sectors with 23 and 14 billionaires respectively. Combined wealth of the Indian billionaires comes to $266 billion. Mumbai is headquarters to most of the Indian billionaires.'