Primarily the relationship between medical professionals and pharmaceutical industry is based on the common goal of providing help to the people during illness, and to maintain good health. Patients take a drug prescribed by a doctor because they have full faith in the treating doctor knowing that a doctor would abide by the cardinal principle of medical profession. A doctor prescribes a drug believing that any drug that has been licensed must be safe and approved. Is it a misplaced trust? [1]. The most important point is that drug formulations should be appropriate regarding ingredient(s) and the quantity of ingredients. Unfortunately, many drug formulations do not fulfill criteria to be labeled as appropriate formulations:

Substandard drugs: In case the quantity of any ingredient happens to be less than 90% of the quantity mentioned, it is called substandard drug.

Spurious drugs: In case the ingredient(s) quantity is zero percent it is called spurious drug.

Irrational formations: Clavulanic Acid is approved in combination with Amoxicillin, and Sulbactum for combination with Cefoperozone. Presently many antibiotics in combination with Clavulanic Acid or Sublactum are available in the market. These formulations add tremendously to the cost of therapy without providing any additional benefit to the patients.

Combination of antagonistic ingredients: Iron and zinc have many similar absorption and transport mechanisms, and may therefore compete for absorption [2,3]. Iron may interfere with absorption of Zinc, when ingested together.

Combination of ingredients having different administration schedules: Many cough and cold formulations have Cetirizine or Levocetirizine, which are to be administered once in 24 hours. Other ingredients in cold or cough formulations are recommended 3 to 4 times in 24 hours.

Potentially harmful combinations: Paracetamol, Ibuprofen and Mefenamic acid are marketed as antipyretics. Ibuprofen and mefenamic acid may have significant side effects [4]. The combination of these drugs with paracetamol does not offer any advantage, but increases the chances of adverse effects.

Different quantities of ingredients: Cough syrups of different brands have different quantity of dextromethorphan per 5 mL of liquid (e.g. 5 mg, 10 mg and 15 mg). Some doctors may not be aware of this fact, which can result in inappropriate dosage of dextromethorphan [4]. There are many formulations meant for providing relief during cough/cold, which have combinations of different ingredients in variable quantities.

It seems that in a race for ‘one-upmanship’ the pharmaceutical industry has turned blind eye to the science of pharmacy and safety of people. Doctors should have full information about the drug formulations which they prescribe so as to give right medicine in right dose.

1. Paul Y. Need for safe and doctor friendly drug formulations. Pharma Times. 2013; 45:31- 2.

2. Sandstrom B. Micronutrient interactions: Effect on absorption and bioavailability. British J Nutr. 2001;85: 5181-5.

3. Solomons NW, Ruz M. Zinc and iron interaction: concepts and perspectives in developing world. Nutri Res. 1997;17:177- 85.

4. Grosser T, Smyth E, Fitzgerald GA. Anti-inflammatory Antipyretic and Analgesic Agents: Pharmacotherapy of Gout. In: Goodman and Gillman Pharmacological Basis of Therapeutics, New York: Brunton LL, Chabner BA, Knollman BC. Eds. 12th ed: McGraw Hill; 2011.p.982-7.