Tamiflu over the counter? The jury is out

Cases of resistance to Tamiflu have come to light in China, Singapore, Japan, Canada, Hong Kong, Denmark and the US, going by recent data from the World Health Organisation (WHO).

On their part, British drug regulators have recorded over 600 reactions to oseltamivir (generic name of Tamiflu), which include psychiatric/ skin/ gastrointestinal disorders, and also liver failure in patients.

Given such threats, healthcare experts feel, a restricted sale of the drug through authorised hospitals is the best option available to the government.

Oseltamivir is among the few treatment mechanisms available for swine flu at present, as the vaccines are still being tested and will require a few months to be out in the market.

In a pill-popping country such as India, where people have a tendency to self-medicate, there are high chances of consumers irrationally consuming the medication if it is made available in chemist shops.

Dr Pratit Samdani, associate professor of medicine, JJ Group of Hospitals, and member of medTitans, an association of leading doctors, agrees. “Retail sale of the drug would lead to more abuse than use, as every household would stock and consume it out of panic,” he says.

“Retail sale can lead to random consumption of the drug by people who show the symptoms. This can lead to the virus developing resistance to the drug,” says CM Gulhati, editor of Monthly Index of Medical Specialties, a reference journal for medical practitioners, and a member of the government’s advisory panel for swine flu.

Resistance is a phenomenon wherein a virus can defend itself against the medication.
Retail sale can lead to people who can afford the medication buying it as a precaution and hoarding it, thereby depriving the needy poor, cautions Gulhati.

It can also lead to black marketing of oseltamivir, says Krishnakant Dhebri, convenor, action &public relations, General Practitioners’ Association, Greater Bombay. “Black marketing is currently seen with the masks, which are being sold at twice their actual prices as there is a demand. Same can happen with the medicine,” he says.

What’s more, a doctor’s prescription actually does not hold much merit in India, where almost every drug is available freely over the counter (OTC).

“So even if oseltamivir was to be made available at the chemist as a prescription-only product, there are chances of it being sold and purchased as an OTC product,” says FD Dastur, director, (quality), PD Hinduja Hospital.

On the other hand, oseltamivir is known for causing side effects such as vomiting, nausea, diarrhoea, abdominal pain, rash, psychiatric disorders, as also liver failure. “Thus it is to be used judiciously and given only to those who are in the purview of medical judgment and under supervision,” says Dhebri.

However, the manufacturers of oseltamivir feel the drug should be made available in the open market. “India is among the few countries where oseltamivir is not sold through the chemists, which, if permitted, could widen the reach and availability,” says an official of a domestic drugmaker manufacturing the generic version of Tamiflu.