1. The issue of different doses of drug (e.g.,
dextromethorphan, paracetamol) in formulations from different
companies has been raised in past [2-4].
2. Phenylephrine is not available as single salt
for oral consumption, but is available in majority of cases in
combination with Chlorpheniramine maleate, cetrizine or
levocetrizine. The combination of phenylephrine with other molecules
manufactured by different pharmaceutical companies have different
quantities of different ingredients. Interchange of brands may
result in up to 100% lower or higher dose of drug that may be
ineffective in one case or very high dose resulting in toxicity in
other case. Doctors usually know the composition of the brand of
drugs they prescribe, and it may be difficult to write names and
quantity of all the ingredients needed for a particular patient, and
would not be possible for the pharmacist to identify the required
products.
3. Dicyclomine is not recommended for children
below six months of age. For infantile colic in children below six
months of age, Simethicon, Dil oil and Fennel oil are often
prescribed. Some manufacturers market products containing
dicyclomine in addition to the other ingredients meant for use in
children aged <6 months; clinicians may face difficulty in
prescribing these drugs.
4. Saccharomyces boulardii is recommended
for antibiotic-associated diarrhea, and recommended dose is 5
billion spores once or twice a day. There are few preparations of
S. boulardii with 5 billion spores in each dose. If the doctors
are not permitted to prescribe S. boulardii as a brand
preparation, they will have to write probiotic S. boulardii,
5 billion spores once or twice a day. As on date, no generic
preparation has 5 billion spores of S. boulardii. Pharmacist
can hand over any probiotic or pre-probiotic combination that has
few million spores of S. boulardii, which may be 1/50th to
1/100th of the required quantity.
Such problems can occur with many other formulations,
and are more likely to occur with formulations meant for children. The
authorities should not only ensure the quality of drugs but also see
that all similar drugs in the market are of uniform and rational
formulations to avoid any mishap. These problems cannot be solved
overnight. Till these issues are taken care of, the doctors should not
be forced to prescribe only generic drugs.