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Chapter 3: Rationality of Drugs    
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Annexure 3

Identification of Harmful, Irrational and Useless Analgesics

Analgesics are the most widely used OTC medicines and the market is flooded with lots of analgesics available in single as well as combination forms. All of these available products are not useful, and hence it is very important for the consumer to identify the harmful, irrational and useful analgesics and choose the right product for his/her condition.

The following information will give a brief account of the analgesics which should not be used as they offer no special benefits over the rational analgesic product.

I   Analgesics that are harmful

a) Analgin (Dipyrone) and its combinations

The use of Analgin and its combinations can cause severe blood disorders, the appearance of which is sudden and unpredictable. The risk of such serious adverse effects of analgin and the availability of other safer and equally effective analgesics (e.g., aspirin, paracetamol) do not justify the use of analgin. It has been banned in many countries all over the world. Examples of brand products of Analgin (single and combination) are listed below:

Brand Content Manufacturer
Novalgin Analgin Hoechst

Baralgan

Analgin +Pitofene + Fenpivenium broncide Hoechst
Analgin Analgin IDPL
Ultragin Analgin + Paracetamol + Caffeine Wyeth

Baralgan has been since banned by an order of the Supreme Court of India.

b) Oxyphenbutazone and Phenylbutazone

The use of oxyphenbutazone and phenylbutazone as anti-inflammatory drugs is restricted to only hospital treatment of severe conditions like ankylosing spondylitis.

They cause serious adverse effects such as peptic ulcer, blood disorders, kidney and liver problems, and hence their use for minor inflammatory ailments is not recommended. They have been banned in many countries all over the world and safer alternatives such as aspirin, paracetamol and ibuprofen are being recommended. Examples of brand products of oxyphenbutazone and phenylbutazone (single and combination) are:

Brand Content Manufacturer
Actimol Phenylbutazone + Paracetamol Pharmed
Algesin Phenylbutazone + Lidocaine Alembic
Zolandin Phenylbutazone S.G. Pharma
Zolandin Alka. Phenylbutazone + Dried Alum.Hydrox. gel S.G. Pharma + Mg. Trisilicate
Phenabid Oxyphenbutazone IDPL
Reparil Oxyphenbutazone F.D.C.
Butadex

Oxyphenbutazone + Chloroquine Phos.

Cadila
Flumar P Oxyphenbutazone + Paracetamol Indoco
Tromalgio Oxyphenbutazone + Analgin La Pharma

II Irrational Analgesic Combinations

a) Analgesics plus Caffeine: This combination unnecessarily increases the cost of the product. Beside caffeine has got no analgesic or anti-inflammatory effect and it may itself induce headache in excess doses or on sudden stopping of the medicine. Examples of marketed products are:

Brand Contents Manufacturer
Micropyrin

Aspirin + Caffeine

Nicholas
Zimalgin Analgin + Paracetamol + Caffeine Rallis

b) Analgesics plus Metoclopramide: In these products metoclopramide is claimed to help produce a more rapid effect by facilitating the absorption of analgesics. However, this is not true. Moreover, metoclopramide causes serious adverse effects like drowsiness, fatigue, etc. Hence this combination is useless, irrational and expensive. Examples of marketed products are:

Brand Contents Manufacturer
Motopar

Paracetamol + Meclopramide

CFL Pharma
Paramet Paracetamol + Meclopramide Wallace

c) Analgesics plus Sedatives: This combination can cause excessive sedation (sleeping effect) which can be dangerous. Hence it is an irrational and expensive combination. Examples of marketed products are:

Brand Contents Manufacturer
Pomagin Analgin + Diazepam Alkem
Walagesic

Dextropropoxyphene + Paracetamol + Diazepam

Wallace
Proxyron Dextropropoxyphene + Paracetamol Wockhardt

III Useless Analgesics

a) Enzymes and Chymotrypsin as Anti-inflammatory Agents: Although available in the market, the use of chymotrypsin and other enzymes in the treatment of swelling and pain has not been proven adequately. Examples of marketed products are:

Brand Contents Manufacturer
Alfapsin

Alpha Chymotrypsin with 1ml Sodium

Ranbaxy
Chloride Injection (for use in cataract Surgery)  

Source: C. Satyamala, Nirmala Sundaram and Nalini Bhanot:
Taking Sides : The Choices before the Health Worker, Anitra, Madras, 1986

     
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