International Journal of Basic & Clinical Pharmacology
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Global trends in using digital technology and smart inhalers in asthma management, problems, challenges and future directions
Full text linkAsthma management is increasingly patient-centred and tailored to individual needs. Medication non-adherence and a shortage of skilled personnel continue to pose challenges in asthma care. Digital health solutions and smart inhalers have shown promise in addressing these issues; however, they have not been assessed by meta-analysis. This systematic review and meta-analysis assess the effectiveness of using digital technology and smart inhalers in asthma care, exploring challenges and future directions in depth. We followed the preferred reporting items for systematic reviews and meta-analyses. The selected outcomes, compliance with asthma management and the level of asthma control were assessed separately. The results were displayed using a Forest plot and tables. Our data demonstrate significant effectiveness in achieving compliance and asthma control with digital health and smart inhaler interventions compared with controls. The pooled odds ratio for compliance was 2.64 (95% CI: 1.49-4.68); digital health and smart inhaler interventions have been shown to improve compliance significantly. However, its use is significantly limited, and differences are observed. Factors affecting these are further discussed with possible solutions. Based on the controlled trials, digital health and smart inhalers can revolutionize asthma care. To overcome current challenges, close collaboration between healthcare and technology teams is necessary, with implementation targeted to select groups and cost-effective. Although the initial investment is substantial, the long-term cost-effectiveness of digital applications in asthma care is likely to be favourable
Prescription pattern of antibiotics in hospital discharge summaries of a tertiary care hospital in India: a cross-sectional study
Full text linkBackground: Particularly in poor and developing nations, antibiotics have a remarkable role in extending life. Inappropriate antibiotic prescribing methods are implicated by a number of factors, including a lack of communication between the doctor, pharmacist, and patients, peer pressure and patient demands, diagnostic uncertainty, and inadequate expertise among clinicians. Aim of this study was to observe pattern of antibiotic prescribing in discharge summaries of admitted patients.
Methods: A cross sectional IPD based study was carried out in a tertiary care hospital of north India for a period of 3 months.500 discharges were collected and data regarding antibiotic prescribing was analysed in the form of Name, and route of the antibiotic prescribed, usage of multiple antibiotics, usage of prophylactic antibiotic, prescribing of antibiotics according to access watch and reserve. The recorded data was then compiled in spreadsheet (Microsoft Excel) and then exported to data editor of SPSS Version 29.0 and R software.
Results: Total 500 discharge summaries were analysed. A total of 468 (93.6%) antibiotics were prescribed. Females were prescribed a high number of antibiotics compared with males. Antibiotics were prescribed most commonly to patients of >60 years of age. Out of 468 antibiotics (101) antibiotics were from ACCESS group 314 from WATCH group and 53 from RESERVE. Percentage of drugs prescribed by generic name was 1.6%.58.4% of prescriptions had a single antibiotic, and 16.6% of the population have received multiple antibiotics.
Conclusions: Out of 500 prescriptions analysed 468 prescriptions had antibiotics prescribed which constituted a percentage of about 93.6% exceeding the WHO limit of 30% suggestive of irrational antibiotic prescribing. WATCH group of antibiotics constituted the highest number according to AWaRe which is a concern since these antibiotics have higher resistance potential and includes highest priority agents among antibiotics. Awareness among the physicians must be boosted up in this regard. Strict implementation of the use of standard treatment guidelines and Adherence to AWaRe prevents inappropriate prescribing. To combat antibiotic resistance such studies should be continued and proper auditing after every 3 months should be implemented
Retrospective assessment of adverse drug reactions linked to first-line antituberculosis drugs at a tertiary healthcare facility in Northern India
Full text linkBackground: Tuberculosis (TB) continues to pose a major health challenge in India, where the burden remains among the highest globally. First-line anti-tubercular therapy (ATT), though effective, often leads to adverse drug reactions (ADRs) that may interfere with patient adherence and overall treatment success. This study aimed to assess the pattern and severity of ADRs associated with ATT in a real-world clinical setting.
Methods: This retrospective review analyzed 102 reports of adverse drug reactions (ADRs) submitted to the Pharmacovigilance Programme of India (PvPI). Data were obtained from the ADR Monitoring Centre at Motilal Nehru Medical College, Prayagraj. Although the data were collected between 2015 and 2018, the analysis was performed in 2025 to derive retrospective insights into ADR trends. Given the consistency of the standard ATT regimen over the years, the findings remain clinically relevant. The study evaluated types of ADRs, severity using the modified Hartwig and Siegel scale, and causality using WHO-UMC criteria. Statistical analysis was performed using SPSS version 25.
Results: Drug-induced hepatitis was the most frequently observed ADR (58.8%), followed by gastrointestinal symptoms (22.5%) and skin-related reactions (8.8%). Most ADRs occurred in male patients (63.7%) and during the intensive phase of ATT (73.5%). A significant correlation was noted between the type of ADR and the treatment phase (chi-square =56.29; p<0.001).
Conclusions: ADRs with first-line ATT are not uncommon, with liver toxicity being especially prevalent during the initial months of treatment. Strengthening ADR monitoring and early intervention can help improve treatment adherence and patient safety
Cost variation analysis of commonly used oral antidiabetic drugs available in the Indian pharmaceutical market: a cross-sectional study
Full text linkBackground: Type 2 diabetes mellitus (DM) is a chronic, progressive metabolic disease that can lead to both microvascular and macrovascular problems. OHAs, or oral hypoglycemic agents, are crucial for controlling elevated blood glucose levels and treatment adherence. The cost of medications affects both patient adherence and sensible prescribing. In India, the same antidiabetic drugs are sold under several different brands at wildly disparate costs. Financial burden may result from prescribing pricey brands, particularly for long-term illnesses like diabetes mellitus. Aim was to enumerate the price of commonly used oral antidiabetic drugs in India and study the cost variation of oral antidiabetic drugs.
Methods: Data from CIMS April-June 2024 on 17 antidiabetic drugs (various strengths) were analysed. Maximum and minimum prices (per 10 tablets) were recorded. Cost differences, cost ratios, and cost variation percentages were calculated using MS Excel 2021, with data represented in tables and charts.
Results: Overall, the maximum and minimum cost variation among individual drugs were linagliptin 5 mg (586.67%) and glibenclamide 5 mg (39.80%) respectively. Among FDC’s the minimum cost variation was glibenclamide + metformin (5+500 mg SR tablet; 4.77%) and maximum cost variation was of glimepiride + metformin (1+500 mg SR tablet; 1246.47%).
Conclusions: The prices of the numerous brands of oral anti-diabetics that are sold in the Indian market vary greatly. Physicians need to be aware of these differences and prescribe medications appropriately, taking the patient’s financial situation into account and also to encourage treatment compliance
An overview of intranasal drug delivery systems for Alzheimer’s disease
Full text linkAlzheimer’s disease is a neurodegenerative condition with severe consequences interfering with patient quality of life. It is a chronic and irreversible cognitive brain condition in which memory and thinking capacities are severely impaired to the point of preventing the completion of daily activities, because of physical and cognitive limitations. The standard treatment is administered orally; however, it has significant disadvantages, including poor bioavailability, rapid metabolism, restricted uptake into the brain and severe side effects. The intranasal route has been proposed as a promising alternative to deliver drugs and improve the Alzheimer's disease treatment. Still, there is not a clear alternative delivery system available in the market with advantageous bioavailability and safety. The aim of this review is to perform an overview on the strategies for intranasal drug delivery in Alzheimer’s disease management. The advantages and disadvantages of this delivery route and the delivery systems developed so far are discussed. A special focus is given on the use of permeation enhancers, the types of intranasal drug delivery devices, as well as possible toxicity concerns.
Influence of educational status on compliance and psychological outcomes of injectable contraceptive use among postpartum mothers
Full text linkBackground: Injectable depot Medroxyprogesterone acetate (DMPA) is a progestogen-only contraceptive widely used in the postpartum period. Despite its efficacy, there is limited regional data on compliance patterns and psychological impacts associated with its use among postpartum women in Eastern India. The objectives were to assess the clinical and biochemical adverse drug reactions of DMPA, analyze compliance levels in relation to educational status and evaluate psychological outcomes using the CES-D depression scale in postpartum mothers.
Methods: This cross-sectional observational study included 107 postpartum women attending the Antara Clinic under the Department of Community Medicine, Medical College, Kolkata. Inclusion criteria were women aged 18–45 years who received at least one DMPA injection within the past year. Compliance was determined through DMPA card review. Depression was evaluated using the CES-D scale and lipid profiles were analyzed.
Results: The mean age of participants was 27.14±4.28 years. Of the total, 50% had received their first injection, 36% the second, and 15% three or more. ADRs were reported in 91% of participants, predominantly menstrual abnormalities (64%), weight gain (40%), and headache (10%). Amenorrhea was more common among ≥3 injection recipients (43%). Compliance was observed in 56% of participants and was significantly associated with educational status; 83% of those with secondary or higher education showed good compliance (p<0.001; OR=18.5). Discontinuation was most commonly due to irregular spotting (30%). Depression scores (CES-D≥16) were significantly higher in those receiving ≥3 injections (81%) (p=0.001; OR=7.616).
Conclusion: The study highlights a significant association between educational status and compliance with DMPA use. Pre-treatment counselling, especially for women with lower educational levels, is crucial to improving adherence and managing adverse outcomes
Evaluation of prescription patterns using World Health Organization prescribing indicators in outpatient department at a tertiary care hospital in Central India
Full text linkBackground: Rational prescribing entails administration of safe, efficacious, and cost-effective medications. Adherence to standards in medical treatment can enhance quality of life in developing countries. One approach to promote rational use is the evaluation of drug utilization patterns in healthcare facilities. Objective of the study was to evaluate prescribing practices in outpatient department (OPD) of a tertiary care hospital using World Health Organization (WHO) standards.
Methods: Total 2000 randomly selected OPD prescriptions from patients of all ages and genders were collected from 1/09/2024 to 28/02/2025 and analysed for WHO standards and completeness of prescription. Institutional Ethics Committee approval was obtained vide reference no 93/31/08/2024.
Results: Among 6235 prescribed drugs in 2000 prescriptions, the average number of medicines was (3.1±1.49). Adherence to National List of Essential Medicine (NLEM) was high (90.67%), while generic prescribing was suboptimal (52.09%). Antimicrobial use was more (32.8%), injectable use was low (5.32%), brand names were used in 47.9%, and fixed drug combinations (FDCs) in 32.57%. The most frequently prescribed drugs were pantoprazole (54.57%), Diclofenac (38.5%), and Amoxycillin (28.7%). Prescriptions completeness in demographic information (90.67%), diagnosis (48.8%), legible handwriting (59.2%), capital letters (6.8%), abbreviations (100%), vernacular instructions (78.6%), and signature, designation, registration number, and qualification (36.9%).
Conclusions: Prescribing practices deviated from WHO standards, with incomplete documentation of patient-related information. The study identified inappropriate prescribing, including polypharmacy (3.1±1.49), limited generic drug use (52.09%), and high use of NLEM drugs (90.67%). Prescription completeness was low (52.09%). These practices could result in adverse health outcomes and higher costs, indicating the need for continuous education of healthcare professionals.
Effect of digoxin on corrected QT interval in geriatric inpatients: a prospective observational study
Full text linkBackground: QT interval prolongation is a recognized surrogate marker for torsades de pointes risk. Digoxin, a cardiac glycoside used for atrial fibrillation and heart failure, is not typically associated with torsades but may shorten QTc, particularly in toxicity. Whether therapeutic digoxin shortens QTc in elderly inpatients remains unclear. Objective was to evaluate the effect of digoxin on QTc interval in geriatric inpatients at therapeutic plasma concentrations.
Methods: We performed a prospective observational study over six months (November 2012-February 2013) in 201 geriatric inpatients. QT intervals were measured ≥15 days after digoxin initiation and corrected using Bazett’s (QTcB) and Fridericia’s (QTcF) formulas. Patients on amiodarone, donepezil, salbutamol, or venlafaxine were excluded. Covariates included demographics, comorbidities (hypertension, heart failure, diabetes, renal disease, atrial fibrillation/flutter, COPD), and clinical presentation. High QTc was defined as >460 ms in women and >450 ms in men.
Results: Twenty-three patients received digoxin (mean dose 151±88 µg/day; mean plasma level 1.2±0.4 ng/ml) and 152 served as controls. Digoxin patients had lower QTcB (427.7±33.5 ms versus 447.1±56.2 ms; p=0.1166) and QTcF (408.4±36.1 ms versus 423.2±48.5 ms; p=0.1642). High QTc prevalence was lower in the digoxin group for QTcB (13.0% versus 28.9%, p=0.082) and QTcF (8.7% versus 23.0%, p=0.162), though differences were not statistically significant. Baseline characteristics were otherwise similar between groups.
Conclusions: In elderly inpatients, digoxin therapy was associated with a non-significant trend toward QTc shortening and lower prevalence of high QTc. These findings do not support initiating digoxin solely to reduce QTc but suggest a potential ancillary benefit in patients already indicated for the drug. Larger studies at higher therapeutic plasma levels are warranted
Addressing cardio-metabolic risks in type 2 diabetes: evidence-based insights on efpeglenatide
Full text linkType 2 diabetes (T2D) is a chronic metabolic disorder linked to significant complications, including cardiovascular disease (CVD) and chronic kidney disease (CKD). Efpeglenatide, a long-acting glucagon-like peptide-1 receptor agonist (GLP-1 RA), has emerged as a promising therapy for addressing glycemic control, weight management, and cardio metabolic risks. A systematic review of randomized controlled trials (RCTs) was conducted using PRISMA guidelines. Searches in PubMed, Google Scholar, and Science Direct identified studies on efpeglenatide impact on T2D outcomes. Data on efficacy, safety, dose-response, and combination with sodium-glucose cotransporter-2 (SGLT2) inhibitors were extracted and analyzed. Out of 843 studies screened, 10 were included. The AMPLITUDE-O trial showed a 27% reduction in major adverse cardiovascular events (MACEs) (hazard ratio [HR]: 0.73, p=0.007) and significant renal benefits (HR: 0.68, p<0.001). Phase 2 trials demonstrated HbA1c reductions (0.6%-1.2%) and weight loss (up to 7.5%). Gastrointestinal side effects were common but mild to moderate, with no major safety concerns. Sub-analyses indicated that combining efpeglenatide with SGLT2 inhibitors did not diminish its efficacy, suggesting potential synergy in reducing cardio metabolic risks. Efpeglenatide demonstrates robust efficacy in glycemic control, weight loss, and reducing cardiovascular and renal risks, with a tolerable safety profile. Its long-acting properties and compatibility with SGLT2 inhibitors support its use in comprehensive, individualized T2D management. Further research is warranted to refine dosing strategies and evaluate long-term outcomes in diverse patient populations
A rare disease gets a breakthrough: Ctexli approved for cerebrotendinous xanthomatosis
Full text linkCerebrotendinous xanthomatosis (CTX) is a rare, autosomal recessive lipid storage disorder caused by mutations in the CYP27A1 gene, leading to sterol 27-hydroxylase deficiency and cholestanol accumulation. Ctexli’s features range from infantile diarrhea to adult-onset neurodegeneration. Early diagnosis and treatment with chenodeoxycholic acid (CDCA) can significantly improve outcomes. Recently, the FDA approved Ctexli (chenodiol), a synthetic form of CDCA, as the first standardized treatment for CTX. Clinical trials demonstrated its efficacy in reducing plasma cholestanol and urinary bile alcohols. Ctexli’s approval represents a significant advancement, enabling more consistent therapy and highlighting the importance of early intervention in managing CTX