International Journal of Basic & Clinical Pharmacology
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Evaluating blood pressure variability in hypertensive patients with comorbidities: a prospective observational study using 24-hour ambulatory blood pressure monitoring
Get PDFBackground: Blood pressure variability (BPV) is an independent predictor of cardiovascular risk, particularly in patients with hypertension and diabetes. This study aimed to evaluate BPV in hypertensive patients with comorbidities using ambulatory blood pressure monitoring (ABPM) and assess the influence of gender and antihypertensive therapy.
Methods: This prospective observational study included 58 patients (aged 26–85 years) undergoing 24-hour ABPM in Mumbai, India. BPV was assessed using the standard deviation of 24-hour systolic blood pressure (SD 24-h SBP). Patients were categorized based on hypertension and diabetes status, gender, and antihypertensive therapy (monotherapy, dual, or triple therapy). Statistical comparisons were made using t-tests and chi-square tests, with significance set at p<0.05.
Results: Patients with diabetes exhibited significantly higher BPV than those without diabetes (p<0.05). Gender differences were observed, with females showing greater BPV than males. Among hypertensive patients, those on triple therapy had higher BPV than those on dual therapy, indicating greater difficulty in achieving BP control. Despite antihypertensive and adjunct therapies, BPV remained elevated in some patients, particularly those with diabetes and those requiring multiple antihypertensive agents.
Conclusions: BPV is significantly elevated in patients with diabetes and those on intensive antihypertensive regimens, highlighting the challenges in BP management. The observed gender differences suggest potential influences of hormonal and vascular factors. These findings underscore the need for personalized treatment strategies to improve BP control and reduce cardiovascular risk in high-risk populations
Pharmacological, behavioral, and sociocultural dimensions of GLP-1 and dual incretin therapies in Saudi Arabia: clinical evidence, misuse patterns, and policy priorities
Get PDFGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies, including semaglutide and tirzepatide, have reshaped the management of obesity and type 2 diabetes. Their rapid uptake in Saudi Arabia has created both opportunities and challenges, notably the rise in cosmetic-driven use, socioeconomic disparities, and emerging regulatory concerns. This narrative review synthesizes clinical, mechanistic, sociocultural, and policy-related evidence on GLP-1 and dual incretin therapies in Saudi Arabia, with a particular focus on real-world use patterns, misuse, and implications for Vision 2030 health goals. Evidence was drawn from randomized clinical trials, observational studies, national reports, and Gulf-region literature published between 2016 and 2025. Key thematic areas include pharmacologic mechanisms, efficacy, safety, public behaviour, affordability, off-label misuse, and policy gaps. Tirzepatide demonstrates superior glycemic and weight-loss outcomes compared to semaglutide, largely due to its dual GLP-1/GIP activity and enhanced neurobehavioral effects on appetite regulation. Semaglutide, however, retains proven cardiovascular benefits, while similar outcomes for tirzepatide await results from the ongoing SURPASS-CVOT trial. In Saudi Arabia, off-label and cosmetic use of these agents has proliferated, fueled by social media influence, inequitable access, and unregulated parallel markets. High drug costs and limited insurance coverage continue to restrict access for clinically indicated patients. Clinical audits and qualitative studies further reveal significant misuse among non-obese individuals, contributing to medication shortages and threatening equitable distribution. While GLP-1 and dual incretin therapies hold transformative potential for metabolic health, their misuse, affordability barriers, and sociocultural pressures must be addressed. National strategies involving pricing regulation, controlled prescribing policies, public awareness campaigns, and enhanced pharmacovigilance are urgently needed to optimize clinical impact and safeguard public health
Assessment of predisposing factors and prescribing pattern in coronary artery disease patients at a tertiary care hospital of Southern Rajasthan
Get PDFBackground: Coronary artery disease (CAD) is the leading cause of mortality globally. The risk factors for the development of cardiovascular disease include lifestyle changes, diabetes mellitus, hypertension, smoking, hyperlipidemia, obesity and psychosocial stress. Drug regime plays an important role in declining the untimely deaths and enhances the quality of life. Few studies have been done on the prescribing patterns of CAD; hence the main objective of the study was to scrutinize various risk factors and therapy patterns for CAD patients.
Methods: A non-interventional prospective study was conducted among 120 patients, to assess the risk factors and prescribing pattern in CAD patients. Information regarding patients was recorded in data collection form. Data was statistically analyzed using IBM statistical package for the social sciences (SPSS) software.
Results: Majority of the patients were male (77.5%). Most of the patients (59.20%) were in age range of 50-69 years. Most common co-morbidities found were hypertension and diabetes. Body mass index (BMI), tobacco chewing, smoking were major risk factors. Majorly prescribed drugs were antiplatelets, anticoagulants, statins, antibiotics, nitrates, antihypertensive, PPI’s and analgesics. Average number of drugs encountered per prescription was 8.70. While number of encounters with a drug indicated in CAD was 5.66. Number of drugs prescribed with an injection and generic name were 4 and 1 respectively. As per DDD calculation, Heparin was consumed in highest amount.
Conclusions: Polypharmacy was practiced. Generic prescribing was low. Major risk factors included BMI, tobacco chewing, smoking, diabetes and hypertension. Findings of this study can be used to develop a framework for ongoing prescription assessment in a healthcare setting
An insight to kidney dialysis treatment
Get PDFThe kidneys are a pair of crucial organs that perform multiple functions in maintaining the cleanliness and chemical balance of blood. The two most common causes of kidney damage are high blood pressure and diabetes. The national kidney foundation recommends three simple tests: a blood pressure check, a spot check for protein or albumin in the urine, and calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Ridding the blood of waste and extra water is done through the procedure of dialysis. It is basically used in patients with renal failure to create an artificial substitute for the lost kidney function. End-stage renal disease (ESRD) is a condition other referred to as ESRD, referring to complete or almost complete, irreversible kidney failure. If treatment is not received, uremia can cause a coma, seizures, and death. Patients may require dialysis or a kidney transplant if both kidneys fail completely
Cost variation analysis of anti-epileptic drugs available in the Indian market
Get PDFBackground: Epilepsy is a chronic, noncommunicable disease of the brain affecting 50 million people worldwide. Out-of-pocket expenditure (OOPE) remains a major burden for Indian households, leading to poor adherence in epilepsy treatment. Many patients discontinue therapy due to high costs, worsening disease outcomes. This study aimed to analyse price variations among different brands of anti-epileptic drugs (AEDs) available in India.
Methods: The prices in Indian rupees for all AEDs of same strength manufactured by different pharmaceutical companies in the Indian market were obtained from Current Index of Medical Specialities (CIMS) 3rd update 2024, Indian drug review (IDR) 2024 issue and National Pharmaceutical Pricing Authority (NPPA)-Pharma Sahi Daam. The cost ratio was calculated by dividing the price of the costliest brand by the price of the least costly brand. The percentage cost variation was determined by subtracting the minimum cost from the maximum cost, dividing it by the minimum cost and multiplying by 100.
Results: Analysis of 1708 brands of 23 single AEDs and 112 brands of fixed dose combinations (FDCs) in India revealed wide cost variations. Clonazepam showed highest percentage cost variation and cost ratio among single drugs, while Oxcarbazepine and Sodium valproate had the lowest percentage cost variation and cost ratio, respectively.
Conclusions: The study highlights significant cost disparities among different brands of AEDs, affecting patients’ OOPEs. Clinicians should therefore consider these price variations to prescribe cost-effective treatments, improving patient compliance and disease outcomes. The findings also emphasize need for regulatory measures to promote equitable and affordable drug pricing
Comparative evaluation of two prophylactic intravenous bolus doses of phenylephrine for prevention of spinal-induced hypotension in elective cesarean sections: a prospective and randomized study
Get PDFBackground: Hypotension is a common and clinically significant complication associated with spinal anesthesia during cesarean section, often persisting despite standard preventive strategies such as fluid preloading and left uterine displacement. Vasopressors like phenylephrine are routinely employed to counteract the hemodynamic instability, yet limited data exist comparing different fixed bolus doses of phenylephrine for prophylaxis against spinal-induced hypotension in obstetric anesthesia. This study aimed to evaluate and compare the efficacy and safety of two intravenous bolus doses of phenylephrine-150 micrograms and 200 micrograms-administered immediately following spinal anesthesia, in preventing maternal hypotension during cesarean delivery.
Methods: A prospective, randomized, double-blind study was conducted at Adichunchanagiri Institute of Medical Sciences, Karnataka, India involving 60 parturients scheduled for elective cesarean section. Group A received 150 µg and group B received 200 µg phenylephrine IV bolus immediately after spinal anesthesia. Hemodynamic parameters, incidence of hypotension and bradycardia, requirement of rescue boluses, and Apgar scores were recorded.Results: The incidence of hypotension was 16.6% in both groups. Group B showed a significantly higher incidence of bradycardia (43.3%) compared to group A (20%, p<0.05). Group A demonstrated better hemodynamic stability with fewer rescue interventions. Neonatal outcomes were similar in both groups.
Conclusions: A 150 µg bolus of phenylephrine is as effective as 200 µg in preventing hypotension following spinal anesthesia in cesarean delivery, with fewer adverse effects. It is recommended as the preferred dose for prophylaxis
Comparison of safety profiles of DPP-4 inhibitors with SGLT-2 inhibitors in type 2 diabetes mellitus: a systematic review
Get PDFIn type 2 diabetes mellitus (T2DM), add-on therapy to metformin is often required. Both sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used, but differ in their safety profiles due to distinct mechanisms of action. This study aimed to systematically review and compare the safety outcomes of SGLT2 versus DPP-4 inhibitors in patients receiving background metformin therapy. A systematic literature search was conducted in PubMed for studies published from 2006 onward. Randomized controlled trials and observational studies evaluating safety outcomes of SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) and DPP-4 inhibitors (sitagliptin, teneligliptin, vildagliptin) as add-on to metformin were included. Data on adverse events (AEs), serious adverse events (SAEs), and drug-related adverse events (DRAEs) were extracted and analyzed. Twenty studies met the inclusion criteria: 8 studies on SGLT2 inhibitors (n=946) and 12 on DPP-4 inhibitors (n=1903). The overall incidence of AEs was higher with DPP-4 inhibitors (66%) compared to SGLT2 inhibitors (34%), while DRAEs were comparable (12% vs. 11%). SGLT2 inhibitors were more often associated with genital and urinary tract infections, whereas DPP-4 inhibitors had higher rates of gastrointestinal disturbances and hypoglycemia. Rare events included dehydration and atrial flutter (SGLT2) and dyspepsia and hypertension (DPP-4). Notably, adverse events varied across individual agents within each class. Both SGLT2 and DPP-4 inhibitors demonstrate acceptable safety as add-on therapy to metformin. Given drug-specific adverse events, individualized therapy based on patient characteristics is essential. Further large-scale safety-focused studies are warranted.
Prospective observational study of blood pressure variation and malnutrition using body composition monitor in hemodialysis patient in tertiary care hospital
Get PDFBackground: Blood pressure (BP) variations and malnutrition are critical concerns in hemodialysis patients, significantly impacting morbidity, mortality and quality of life. Accurate assessments using tools such as the Body Composition Monitor (BCM) can guide effective interventions to improve outcomes. This study aimed to evaluate BP variations and malnutrition in hemodialysis patients using BCM, analysed dialysis-related complications and assess the impact of targeted interventions on patient outcomes.
Methods: A prospective observational study was conducted on 125 hemodialysis patients at a tertiary care hospital. Data on BP variations, nutritional status and complications were collected using BCM and the Medical Outcomes Study Short Form-36 (MOS SF-36) questionnaire. Pharmacological and non-pharmacological interventions were tailored based on findings. Follow-up data assessed changes in body composition and complication rates.
Results: Hypertension was the most prevalent BP variation (63.2%), followed by hypotension (26.4%) and intradialytic hypotension (IDH) (8%). Malnutrition affected 24.8% of patients, primarily older males. During follow-up, patients with normal indices of lean tissue (28 to 54), fat tissue (28 to 54) and BMI (28 to 54) increased significantly. The most common dialysis-related complications were cramps (43.2%), itching (28%) and edema (20.8%). Targeted interventions, including nutritional supplementation and BCM-guided fluid management, reduced complications and improved nutritional and hemodynamic parameters.
Conclusions: The study highlights the high prevalence of hypertension and malnutrition among hemodialysis patients and underscores the utility of BCM in optimizing patient management. BCM-guided interventions were associated with improved nutritional status and reduced complications, emphasizing the need for individualized care strategies. Further multicenter studies are recommended to validate these findings and expand their applicability
A prospective study on identification, assessment, and spontaneous reporting of adverse drug reactions at a tertiary care hospital
Get PDFBackground: Adverse drug reactions (ADRs) significantly contribute to global morbidity and mortality. Voluntary ADR reporting is crucial for the Pharmacovigilance Programme of India (PvPi), which identifies and quantifies medication risks. This study monitors ADRs from various departments of a tertiary care hospital, assessing them for causality, preventability, and severity before reporting to the Indian Pharmacopoeia Commission (IPC).
Methods: This prospective study was conducted over six months at a tertiary care hospital, which is an approved ADR Monitoring Centre (AMC). Data was collected by PharmD students, who assessed each ADR for causality, severity, and preventability using the World Health Organization (WHO) scale, Hartwig’s severity scale, and Schumock and Thornton scales. Descriptive statistics were used for analysis.
Results: A total of 358 suspected ADRs were evaluated. Most reactions (87.98%) were classified as "moderate" in severity, with 45.53% considered not preventable. The majority of ADRs were categorized as probable (84.07%), with Class J drugs (Anti-infectives) being the most associated (29.89%). Most reports came from General Medicine (53.35%), and the primary affected organ systems were metabolic and nutritional (21%).
Conclusions: Most ADRs in this study were caused by antimicrobials, highlighting the need for careful prescribing and patient monitoring. Type A ADRs were often underreported, with healthcare professionals focusing primarily on Type B and H reactions. This study emphasizes the importance of voluntary ADR reporting and the vital role of clinical pharmacists in assessing and documenting these reactions
Prescription pattern of topical corticosteroids in dermatology department in a tertiary care hospital
Get PDFBackground: Topical steroids are sometimes combined with other active ingredients including antibacterial agents, antifungal agents and calcipotriol. The study of prescription pattern measures the performance of health care providers in several key dimensions related to the appropriate use of drugs. The objectives of the study were to study the prescription pattern of topical corticosteroids in terms of indications, its potency, average number of topical corticosteroids per patient and in fixed dose combinations.
Methods: Data of patients prescribed with topical corticosteroids in dermatology department OPD were collected. Data included age, gender, clinical diagnosis, topical & systemic corticosteroids prescribed and their dosing schedule
Results: Out of 500 cases, 229 were males and 271 were females. Mean age of patients was 40.60±19.789 years. Most common dermatological condition for topical corticosteroid prescription was dermatitis (43.8%). 45. 9% of prescribed corticosteroids were moderate potent agents. Average number of topical corticosteroids per prescription was 1.04. Most commonly prescribed topical corticosteroids were betamethasone dipropionate. Most common dosage form was cream. Most common fixed dose combination was with gentamicin. Among 103 fixed dose combinations 42.7% were combined with moderately potent steroids. 72% drugs were prescribed in generic name. 4% of prescription had strength of steroids mentioned. 80% of prescription stated site of application and in 76% cases frequency of drug application was mentioned. Duration of treatment was mentioned in 86.4% of cases.
Conclusions: Study demonstrates variability of topical corticosteroid utilization in various dermatological conditions