Combo drugs pushing up treatment costs

When 36-year-old banker Ravikiran Mehta was down with fever and pain last month, he was prescribed Sumoflam by his family physician, which cost Rs 53 for a strip of 10 tablets. Later, upon consulting a doctor friend, he got to know that for the kind of fever he had, all he needed was paracetamol, which was available at Rs 10 for 10 tablets.

Sumoflam is a combination of not one but three medicines, of which paracetamol is for fever and pain, while nimesulide and serratiopeptidase are for pain.

There are several other irrational fixed dose combinations (FDCs) in the market.

Estimates peg the FDC market at Rs 10,000-15,000 crore, which is over 40% of the domestic market for pharmaceuticals in India.
Several combinations don’t have any medical logic, says S Chatterjee, senior consultant, internal medicine, Indraprastha Apollo Hospital, New Delhi.

Popular combinations include ibuprofen and paracetamol (see Table A), both of which are for pain and fever. Then there are losartan, amlodipine, atenolol, all three of which are for blood pressure.

There is also a combination of a drug for infections called ornidazole, used mainly by the poultry industry, in combination with an antibiotic called ofloxacin.

Then there is nausea drug domperidone, in combination with acidity drug rabeprazole.

Healthcare experts feel that by combining two medicines targeting the same ailment, drugmakers are only making patients spend more. Individually, the medicines are available at a fraction of the price.

“There is also no logic behind combining medicines for vomiting with those for acidity, other than extracting more money from patients,” says Chandra M Gulhati, editor of Monthly Index of Medical Specialties.

Like in Ravikiran’s case, the patient may need only one medicine, buts ends up taking a combination having two targeting the same ailment, leading to unnecessary medication and costs. Some FDCs also have two drugs producing side effects on the same organ.  For example, both paracetamol and nimesulide have a toxic effect on the liver.

ENT surgeon and co-convenor of All India Drug Action Network, Gopal Dabade, rues the lack of a system for flow of unbiased medicine information to doctors once they leave the medical college. “Doctors’ only source of information, especially in private practice, is from drug companies, which needless to say is biased. Hence, if medical representatives promote an FDC, at times doctors start prescribing it to patients.”