Q: My mother-in-law has been prescribed Stator ez 10 (atorvastatin). However, the strip mentions Manufactured by: Madras Pharmaceuticals and Marketed by Nicholas Piramal. What does this indicate? We normally see the reputation of the manufacturer and not the marketing company. Can you explain the real situation? Same is the case with Covance AT (Marketed by Ranbaxy) and manufactured by Emcure.

A:In order to cut costs and maximise profits, some drug companies get their popular brands manufactured by small scale manufactures with unknown control on quality. This is unethical, though legal. Unfortunately the government is doing nothing to stop such practices. It is because of this reason that we usually give the following advice: General statement on selection of brands: There are scores, sometimes hundreds, of brands of the same medicine. Against about 300 pharmaceutical manufacturers in western countries like Britain, there are over 20,000 producers in India that market more than 40,000 brands. Most manufacturers do not have quality testing laboratories. Hence, selection of brands is important. Many companies give incentives to prescribers to patronise their products. Patients should check the reputation of manufacturers before consuming medicines. It is also not a good idea to prescribe or consume combination products. Please see the statement below: Fixed-Dose Combinations (FDCs): Medicines are discovered individually and are supposed to be taken separately. A huge number of irrational, illegal combinations of drugs are being sold in India; quite a few without mandatory approval of the Drugs Controller General, India (DCGI). Except in a few cases (such as TB medicines), it is always better to take medicines separately so that dosage can be adjusted and side effects monitored. Stator EZ is a combination product that contains atorvastatin and ezetimibe. Ezetimibe should be used only as adjunct to diet in primary high cholesterol levels only when patients do not respond to atorvastatin alone. If at all it is co-administered with atorvastatin, then it is necessary to monitor liver function tests periodically. Its side effects include: increase in abnormal liver tests, muscle pain, muscle injury (Rhabdomyolysis), which can be fatal, liver damage, bleeding tendency, headache, nausea, abdominal pain, diarrhoea, joint pain, fatigue, cough, swelling of face, rash, inflammation of pancreas etc. However, atorvastatin can be given separately (such as Atorva 10mg) manufactured and marketed by Cadila.