Manipal University

Rathnakar U.P. Kasturba Medical College, Mangalore.

M.S.Kotian, Kasturba Medical College, Mangalore

K.Mukund. Mangalore Heart Scan Foundation. Mangalore

Increasing incidence of disease
with age
Multiple diseases in elderly
Important
Nutritional problems
Expense of drugs in
[Entirely dependent on children] elderly
No health insurance
Polypharmacy and drug
interactions
Compliance
Auditing prescriptions →Drug utilization
studies
Monitors, evaluates and if necessary,
suggests modifications in prescribing
practices
Provides feedbacks to prescribers and
creates an awareness about the
irrational use of drugs.
70,000 formulations available in India
WHO lists only about 350 preparations
in essential drug list
This study was undertaken to
Determine the utilization of drugs
in elderly patients
For Cardiovascular diseases
And important co-morbid
condition - Diabetes mellitus (DM)
Also to estimate the cost of
medications in these patients.
Study design
 A longitudinal
Retrospective design was
employed
To analyze the prescriptions of all
the geriatric patients
Attending an exclusive cardiac
clinic in Mangalore, during 2007
Computerized demographic and clinical data
were accessed
All the prescriptions for the year 2007
stored in the computer were analyzed.
Aged 65 years or more - considered as
belonging to geriatric age group.
Number of drugs prescribed in every
prescription was considered to calculate
the incidence of polypharmacy.
Cost calculated using ‘Drug today ready
reckoner of current medical formulations’
and the website www.mims.com.
No. of Pts
Age And Sex Profile
[n=212]

63
52
34

27

13
5
9
9

Age in Years
 Others
DM HTN
[26.41%] [55.2%]

COPD

MI/Angina
[63.2%]
 Incidence of Polypharmacy
No. Of Age
Drugs per Total
65-69 70-74 75-79 >80
Prescription n=212(%)
n=86(%) n=90(%) n=22(%) n=14(%)

1 4(4.6) 4(4.4) 0(0) 0(-) 8(3.7)

2 9(10.4) 10(11. 1(4.5) 1(7.1) 21(9.9)
3 14(16. 1)
13(14. 2(9.0) 2(14.2) 31(14.
4 3)
20(23. 4)
19(22. 6)
3(13.5) 4(28.4) 46(21.
5 2)
21(24. 1)
20(22. 6)
7(31.5) 4(28.4) 52(24.
6 4)
8(8.3) 2)
11(12. 5)
4(18) 1(7.1) 24(11.
7 6(6.9) 2)
7(7.7) 2(9) 32)
1(7.1) 16(7.4)
8 2(2.3) 5(5.5) 1(4.5) 0(-) 8(3.7)
9 1(1.1) 1(1.1) 2(9) 1(7.1) 5(2.3)
10 1(1.1) 0(-) 0(-) 0(-) 1(6.4)
Χ62 = 4.69, p=0.584
 Drugs prescribed for diseases of CVS
Drugs No.of Percentag
prescriptions e
n=212
Antiplatelets* 155 73.1
Beta blockers 117 55.1
Nitrates 115 55.24
Statins* 87 41.03
Diuretics 73 3.43
Ca++ channel 65 36.66
ARB
blocker 44 20.75
ACE-I 34 16.03
* Accounted for 25% 0f the cost
 PRESCRIPTION ANALYSIS
Details of prescription Numbers
Number of prescriptions 212
Total number of drugs prescribed 962
No. of drugs from essential drug list 436
(WHO
Averageor no.
India)
of drugs per prescription 4.5
Number of fixed dose combinations 128
Fixed dose combinations in the WHO 0
approved list

[0.4
9] [0.40]

INR [0.14]
21.64 INR
17.53 INR
6.03
 Fixed dose combinations
No.Of Percentage
Combinations Prescriptions (n=212)
Atenolol+Hydrochlorthia 1 0.47
Atenolol+Nefedipine
zide 1 0.47
Atenolol+Amlodipine 16 7.52
Enalapril+Hydrochloroth 8 3.77
iazide
Losartan+Hydrochloroth 21 9.90
iazide
Telmisartan+Hydrochlor 2 0.94
Clonidine+Hydrochloroth
othiazide 3 1.41
iazide
Amiloride+Hdrochlorothi 7 3.30
azide
Amiloride+Furosamide 2 0.94
Clopidogrel+Aspirin 50 23.58
Isosorbide-5- 1 0.47
Mononitrate+Aspirin
Atorvastatin+Niacin 1 0.47
Atorvastatin+Ezetimibe 3 1.41
Glibenclamide+Metformi 6 2.83
n
Glipizide+Metformin 6 2.83
Polypharmacy of more than 1 drug was
seen in 96% of the prescriptions where as
142 (67%) prescriptions had 4 drugs or
more
Among 962 drugs prescribed nearly half
(436) were not from the WHO approved
essential drug list
Antiplatelets (155) were the most often
prescribed drug
Antiplatelets were prescribed for 155
(73%) patients, more than the prevalence
of cases of IHDs (134) [Primary
prevention]
For cardiovascular diseases money
spent/ prescription /day was INR
17.53 (0.40 USD)
For DM ,INR 6.03 (0.14 USD)
Clopidogrel- Aspirin combination and
Atorvastatin accounted for more
than 25% of the cost of medications
in prescriptions for diseases of CVS.
 Most of the geriatric patients were
prescribed more than 2 drugs -
as nearly 70% of the patients were
suffering from 2 or more diseases.
Increasing age was not related to
increase in the number of drugs per
prescription
Higher prevalence of use of clopidogrel
–aspirin combinations (23.60%) and
statins (41.03%) added substantially to
the cost of medications (18.73%).
Most important aspect of polypharmacy-drug
interactions-could not be studied because of
the retrospective nature of study design.
Defined daily dose (DDD) if calculated allows
drug utilization data to be compared more
realistically
Detailed interview of the treating physician on
the day prescription is issued, may provide
reasons for the use of drugs not found in the
essential drug list
True financial burden of drug costs can be
evaluated from the patient’s perspective only
when the economic status of the patient is
known
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Dr.U.P.Rathnakar. MD.DIH.PGDHM
Asst.Prof.Department of Pharmacology,
Kasturba Medical College. Manipal University.
INDIA
Mr. M.S.Kotian, Asst.Prof.Dept.Of Community
Medicine, Kasturba Medical College, Manipal
university.
INDIA
Dr.K.Mukund.MD.DM.Interventional cardiologist.
Mangalore Heart Foundation. Mangalore.
INDIA
CONTACT:rathnakar26@yahoo.com