Essential Drug Use

Mr.
Gaurang Ramani
1
Definition:
The WHO has define essential drugs as “those that satisfy the
healthcare needs of the majority of the population”
WHO in 1975, defined essential drugs as “Those considered to be

of utmost importance and hence basic, indispensable and necessary
for the health needs of the population.
These must be available at all times, in the proper dosage forms, to

all segments of society”. The WHO model list of Essential
Medicines published in 1975. The eleventh revision of this list
appeared in 1999 and includes about 325 drugs. 2
• The Indian Government published its first national Essential
Drug List in 1996, and some state government have also adopted
an EDL. When a drug is in the EDL, it is imperative (require
attention) that all attempts must be made to make it available at

affordable cost. It is believed that only 250 drugs are essential to
treat the majority of the diseases in the country.
Selection of medicines for the national EML
Criteria for selection of EDL
• Quality of the drug
• The pattern of the prevalent diseases
• Treatment facility available
• Safety and efficacy of drugs 3
• Cost of drug and treatment
• Ease of administration
• Storage condition
• Training and experience of available personnel
• Patient acceptability
• Benefit/risk ratio
While the subsequent factors are

• Genetic factors
• Demographic and emergency
• Environmental
• Mortality and morbidity status
• Local manufacturer
4
Guidelines for establishing an EDL include provision of unbiased
scientific information on a drug, which looks at benefit/risk ratios,
and cost of treatment. Generally, fixed-dose combinations should
be encouraged in an EDL, unless there is clear evidence of
therapeutic benefit as in the case of oral contraceptive agents and
co-timoxazole.
The selection of essential drugs is a continuing process, which

should take into account changes in disease prevalence, as well as
new advance in pharmacological and pharmaceutical knowledge.
5
Advantages of EDL
1.Most cost effective, control in management of purchase, storage
and distribution
2.Improve drug use in term of safety and simplified and more
efficient drug information including training to health worker
3.Better possibility to define health care needs and perform
program evaluation
4.Identification and evidence of ADR and drug interactions
5.Stimulation of local drug industries for formulation and product.
6.It helps to protect the end users from financial exploitation and
misuse of scarce resources.
7. Promotes rational drug use messages
8. Assists the development of standards
9. It helps to encourage the use of standard treatment protocols
and rational prescribing policies.
10. Eliminates confusion
11. Provides clear guidelines for decision making
Disadvantages of EDL
1. Creating of monopoly for example favoring a single product
2. Lack of interest for drug innovation
3. Reduced freedom of choice at all level (promotor, prescriber,
customer)
Orphan drug:
An orphan drug is a pharmaceutical agent that has been developed
specifically to treat a rare medical condition, the condition itself
being referred to as an orphan disease.
These are drugs or biological products for
diagnosis/treatment/prevention of a rare disease or condition for
which there is no reasonable expectation that the cost of developing
and marketing it will be from the sales of the drug.
E.g. sodium nitrate
Though these drugs may be lives saving for some patients are
commercially difficult to obtain. 8
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Definition:
RDU is conventionally defined as the use of an appropriate,
efficacious, safe, and cost effective drug given for the right
indication in the right dose and formulation, at right intervals and
for the right duration of time.
The rational use of medicines depends upon
1.Correct diagnosis
2.Correct medicine
3.Appropriate indication
4.Appropriate medicine as regards efficacy, safety, suitability for
the patient and cost
6. Contraindications
7. Correct dispensing, including appropriate information for
patients
8. Patient adherence to treatment
Significance /IMP of RDU

The importance of RDU relates to its impact on the health of
individuals and communities, health care costs and the
environment.
 RDU leads to effective and safe drug treatment

 Reducing ADR
 Fast recovery from disease
Example of Rational prescribing practice
1.Prescribing drugs with proven value
2.Evidence based treatment
3.Prescribe drugs which is necessary to treat condition or disease
4.Prescribe appropriate dose
5.Prescribe cheaper drugs when they available
6.Prescribe oral instead of injectable when they available
Common types of irrational medicine use are:
1.Poly-pharmacy
2.Inappropriate use of antimicrobials, often in inadequate doses, for
non-bacterial infections.
3.Over use of injections where oral formulations would be more
appropriate.
4.Failure to prescribe in accordance with STG.
5.Inappropriate self-medication, often of prescription medicines
only.
Promotion of RDU
It involves wide range of activities such as
1.The adaptation of the essential drug concept
2.Training of health care professionals in rational drug use and the
use of development of evidence based clinical guidelines
3.Unbiased and independent drug information
4.Continuing education of health professionals
5.Provide consumer education
6.Use regulating strategies to promote RDU.
WHO advocates 12 key interventions to promote more rational
use:
1.Establishment of a multidisciplinary national body to coordinate

policies on medicine use
2.Use of clinical guidelines
3.Development and use of national essential medicines list
4.Establishment of drug and therapeutics committees in districts
and hospitals
5.Inclusion of problem-based pharmacotherapy training in
undergraduate curricula
6.Continuing in-service medical education as a licensure
8. Use of independent information on medicines
9. Public education about medicines
10. Avoidance of unnecessary financial incentives
11. Use of appropriate and enforced regulation
12. Sufficient government expenditure to ensure availability of
medicines and staff.
Role of Pharmacist in RDU
1. Drug selection and Procurement

•It should be evidence based and according to EDL
•Procure the most cost effective drug in right quantities
•Select reliable suppliers of high quality products
•Ensure timely delivery
•Achieve the lowest possible total cost

2. Distribution and dispensing of drug
3. Inventory control
•Monitoring drug stock and minimizing out of stock situation
•Use formulary to restrict the number and brands of drugs stocked
will be helpful
•Expired drug should not be stored or dispensed
•All required for the health facility should be kept in stock and
patients should not be turned away due to unavailability of drugs.
4. Drug information and education
•Inform other healthcare professionals regarding introduction of

new drugs, drug policy changes in the hospital, availability of
drugs and drug-related problems.
• Any ARD noticed should be reported to appropriate ADR center
• Appropriate program should be evolved to raise the awareness of
prescribers about ADRs and drug induced illness.
• Pt. should be counseled regarding appropriate drug use and
patient compliance
• Organize educational programs for the public
5. Pharmaceutical care
• Aim of P’ceutical care is to optimize QoL and achieve positive
and cost effective outcomes
• Plan individualized drug therapy in consultation with other
healthcare professionals
• Promote evidence based approach
• Weighing the pros and cons of treatment
• Give information and assistance to carry out the drug therapy
plan
• Monitoring of treatment outcomes and suggestions to modify the
treatment plan
20
Guidelines for rational prescribing
1. Define the patient’s problem (the diagnosis), then specify the

therapeutic objective for this problem in this particular
patient. Much of unnecessary drug use can be avoided if the
therapeutic goal of treatment is clearly defined.
2. Decide whether a drug is needed to achieve your therapeutic

objective. Use drugs only when indicated and when the
potential benefits of drug therapy outweigh the potential
risk.
3. If drug therapy indicated, consider the various treatment
alternatives. Choose a drug of proven efficacy and safety. The
drug must also be suitable for the individual patient, and be
affordable.
4. Choose a dose which is suitable for the individual patient.

Careful dose adjustment is required for children, the elderly,
and patient with renal or hepatic impairment.
5. Avoid using more than one drug of the same chemical class
at the same time
6. Inform the patient. Tell the patient how to take the
medication, how long it will take to work, how long to continue
with treatment and possible side effects, and what to do if these
occur.
7. Monitor the effects of treatment. Has the treatment been

successful? Has sufficient time passed for a response to occur?
Has the patient experienced side effects?
23
8. If treatment has not been effective try to an identify why.
You should reconsider the diagnosis, the therapeutic objective,
the treatment which was chosen, whether the dose was too low,
whether the patient actually used the drug in the way which was
intended, and whether you monitoring is correct.
9. Decide whether the drug should be continued at the present

dose, at a different dose or stopped. Continue treatment only if
the original therapeutic objective is still relevant.

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Mr.

WHO in 1975, defined essential drugs as “Those considered to be

These must be available at all times, in the proper dosage forms, to

attention) that all attempts must be made to make it available at

While the subsequent factors are

The selection of essential drugs is a continuing process, which

The rational use of medicines depends upon

Significance /IMP of RDU

 RDU leads to effective and safe drug treatment

1.Establishment of a multidisciplinary national body to coordinate

1. Drug selection and Procurement

4. Drug information and education

•Inform other healthcare professionals regarding introduction of

1. Define the patient’s problem (the diagnosis), then specify the

2. Decide whether a drug is needed to achieve your therapeutic

4. Choose a dose which is suitable for the individual patient.

7. Monitor the effects of treatment. Has the treatment been

9. Decide whether the drug should be continued at the present

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