Why did my doctor change the prescription?
Q: I am 62 years old, heart patient. Underwent a stent insertion 2 years back. I am on following medicines - Tab. Clopigel A 75, Tab. Monotrate 20 mg twice, Tab. Atorva 20, Tab. Amlopress AT, Tab. Pantocid 40 mg daily, Tab. Flavidon MR 35 twice a day, Tab. Amaryl 1 mg daily. After my retirement, I consulted a doctor at government hospital. He prescribed all the above medicines, except Pantocid 40. Instead of Pantocid 40 he prescribed ranitidine hydrochloride 150 daily. Please advise me if the change is good for me or I should again request my doctor to change it to Pantocid.
A:It is not clear as to why Pantocid 40 was prescribed in the first place. It suppresses the production of acid in the stomach (normal quantity of acid is required to digest food; only excess production causes trouble and acidity) and is indicated in the treatment of duodenal and gastric ulcer, reflux disease, Zollinger-Ellison Syndrome and gastro-intestinal lesions that do not respond to ranitidine. Since ranitidine was not even tried, your doctor is right in choosing the initial treatment. Ranitidine is sold under various trade names such as Consec, R-Loc etc. While ranitidine is under drug price control, medicines like Pantocid are outside the government price control mechanism; hence aggressively promoted by drug companies. The cost of ranitidine 150mg is about 50 paise per tablet while Pantocid 40 is retailed at Rs. 6 per tablet. I am a little concerned about the use of Amlopres AT (amlodipine + atenolol) in patients of diabetes. Recently, there has been lot of research on the side effects of atenolol. It is now established that atenolol carries unacceptable risk of either precipitating diabetes or making it worse. In view of these findings, the British National Institute of Clinical Excellence (NICE) has pushed atenolol to 4th position even in normal non-diabetic persons i.e. to be used only when other medicines have failed. Amaryl contains an anti-diabetic medicine called glimepiride and is sold at Rs. 55.76 per 10 tablets (plus local taxes). The same medicine under the trade name of Euglim (by Cadila Healthcare - one of India’s top 10 companies) is sold for Rs. 9.87 per 10 tablets. While prescribing medicines that are to be used for life time, more attention needs to be paid to the cost of competing brands. After the insertion of stent, it is necessary to take clopidogrel for a minimum of 3 and maximum of 6 months and aspirin 75-80mg daily for life. You are taking both medicines even after 27 months since Clopigerl A contains both the medicines. Polypharmacy (using large number of drugs) not only causes more side effects but more drug interactions, particularly in the elderly. There is not much experience with Flavedon (trimetzidine) since it is not approved for use in many advanced countries like USA, UK, Australia etc. Hence it is not possible to comment on its long-term efficacy and safety. Atorva is fine, since it is indicated in all cases of angioplasty.