Q: I have read about a new medication called Xigris, launched in India for sepsis. I have a relative who is admitted to ICU. How good is it and where can I approach for this drug?

A:Xigris is not the name of medicine but a trade name (in US, Australia) of a drug called protein C. It is also sold under the trade name of Ceprotin in England. This product is now produced through recombinant technology (just like human insulin) and is called drotrecogin alfa (activated). In UK protein C is licenced to be used only for drug-induced skin necrosis in patients who are deficient in protein C from birth. In US and Australia, drotrecogin alfa is allowed to be used for severe sepsis associated with acute organ dysfunction in adults only. There should be acute dysfunction in at least two organs with preset parameters. For example cardiovascular dysfunction will mean systolic blood pressure of 90 mm Hg for at least one hour despite appropriate intensive medication. Similarly kidney dysfunction means urine output of less than half ml per kg body wt per hour despite adequate iv infusion. Its efficacy is not adequately proved. In fact the US Federal Drug Administration rules require that no tall claims on efficacy be made and that patients are warned that it may or may not be effective. It is a very expensive product costing Rs. 75,000 in UK for just 5 mg vial. The usual dose is 1.5 mg per hour for a normal adult male. It is to be given for 96 hours. One can calculate the cost. You may be able to get it at a very large chemist shop that imports drugs from countries like USA/UK.