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CONTENTS

About this book 3


Foreword to earlier version 5
Preface to earlier version 6
Acknowledgments 6
How to use this book 8
Index of Drug Profiles 11

Section 1

Chapter 1: About Drugs in General 15


1. Drug Forms and Administration 6
2. Evaluation of Drug Profiles 19
Annexure 1 Some Common Drug Categories and How they Work 47
Annexure 2 Poisoning and its Treatment 87

Chapter 2: Essential Drugs 92


1. Why We Need Only Essential Drugs? 93
2. Why an Essential Medicines List? 96
3. Generic/Brand Names, Innovator Products and Generics 101
4. Implementation of Essential Drugs Idea in Two States of India 112
Annexure 1 Criteria for Withdrawal of Irrational and Hazardous Drugs: the Bangladesh Example 115
Annexure 2 Access to Medicines: How India Stands Globally? 117
Annexure 3 Country Specific Approaches to Updating Essential Drugs and Formulary Lists 119
Annexure 4 Right Brands; Wrong Medicines Dietary Salt Dispensed in Place of Epilepsy Drug 120

Chapter 3: Rationality of Drugs 122


1. What is Rational Therapy? 123
2. Causes of Irrationality 129
3. Combination Drugs: When Drug Combinations are Rational 139
4. Vitamins and Tonics
5. Hazardous Drugs 143
Annexure 1 Why Some Leading Drugs in the Indian Market should not be sold - but are still sold 154
Annexure 2 Dubious FDCs Being Marketed in India … not Approved by DCGI and hence Illegal 160
Annexure 3 List of Drugs Prohibited for Manufacture and Sale through Gazette Notifications 162
Annexure 4 Identification of Harmful, Irrational and Useless Analgesics 165
Annexure 5 Irrational Combinations of Paracetamol 167
Annexure 6 Rofecoxib, Heart Attacks and the FDA: Testimony of David J. Graham 169

Chapter 4: Marketing of Drugs 178


1. Pharma Scenario in India 178
2. Marketing of Top 300 Drugs in India: A Brief Analysis 181
3. Marketing of Drugs and the Abandoning of Quality and Ethics 188
4. Manipulating Quality 192
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5. Prevalence of Spurious Drugs 194
Annexure 1 Landmark Incidents in the Unethical Marketing of Drugs 201

Chapter 5: Drug Promotion, Clinical Trials and Conflicts of Interest 208


1. "Forms of Entanglement" 208
2. Clinical Trials, Research Publications and Conflicts of Interest 217
3. Conflicts of Interest and Codes of Marketing 231
Annexure 1 What are Clinical Trials? 235
Annexure 2 Conflict of Interest: My Journey 239
Annexure 3 WHO Ethical Criteria and IFPMA Code of Pharmaceutical Marketing Practices 241

Chapter 6: Patents, Trade and Availability of Medicines 247


1. Free Trade, WTO/TRIPS and the Pharma Industry 248
2. India, Patents and TRIPS 258
3. Possible Impacts 271
4. What is to be done? 279
Annexure 1 TRIPS in WTO: Is it Logical? 284
Annexure 2 Openness Promotes Growth? 285
Annexure 3 For Free Trade in Ideas 285
Annexure 4 Unfairness of Free Trade: WTO, a Neutral Arbiter? 287
Annexure 5 Some of the Useful Recommendations in the CIPIH Report 290

Chapter 7: Pricing and Availability of Drugs 299


1. Need for Price Control 299
2. Health and Political Context of Price Control 311
3. Some Positive Initiatives and Reports 318
4. How much do Drug Formulations Actually Cost and can Cost 324
Annexure 1 Pricing and Price Control of Drugs and Pharmaceuticals 326

Chapter 8: Women and Medicines 333


1. Medicines and Women's Health 333
2. Misuse of Drugs and its Effects on Women 337
3. Contraceptive Drugs and Women 341
4. Hormonal Replacement Therapy (HRT) 347
5. Other Concerns 348

Chapter 9: What is to be done? 356

Section 2 Profiles of 50 Drugs 363


Section 3 Short Profiles of 107 Drugs 505
Section 4 583
Primary and Secondary Information Sources on Drugs & Related Health Issues 583
Glossary 593 About LOCOST 597 About All-India Drug Action Network 598
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Index of Drug Profiles

Page No. Page No.


Activated Charcoal 507 Coaltar 522
Albendazole 507 Co-trimoxazole 396
Allopurinol 508 Codeine Phosphate 399
Aluminium Hydroxide & Magnesium 508 Cyclosporin 522
Aluminium Hydroxide 365 Dapsone 401
Aminophylline 509 Dexamethasone 523
Amitriptyline 510 Diazepam 403
Amoxycillin 367 Diclofenac Sodium 524
Amphotericin - B 510 Diethyl Carbamazine 524
Ampicillin 369 Digoxin 407
Aspirin 372 Diloxanide Furoate 525
Atenolol 511 Diphenhydramine 410
Atropine 374 Domperidone 525
Beclomethasone 512 Doxycycline 526
Benzanthine Benzyl Penicillin 513 Ephedrine 413
Benzoic Acid and Salicyclic Acid 377 Epinephrine 527
Benzophenones 513 Ergocalciferol (Vit. D2) 529
Benzyl Benzoate 378 Ergometrine 530
Benzyl Penicillin 514 Ergotamine 416
Betamethasone 379 Erythromycin 419
Bisacodyl 383 Ethambutol 422
Calamine Lotion 387 Ethionamide/Propionamide 530
Calcium Lactate 514 Ethosuximide 531
Carbamazepine 515 Ferrous Sulphate 424
Cephalexin 516 Flucytosine 531
Chloramphenicol 517 Folic Acid 427
Chlorhexidene 388 Frusemide (Furosemide) 430
Chloroquine Phosphate 389 Furazolidone 532
Chlorpheniramine Maleate 393 Gentamicin 532
Chlorpromazine 518 Gentian Violet 433
Cimetidine 519 Glibenclamide 434
Clofazimine 520
Clonidine 520 Glucose 533
Clotrimazole 521 Glyceryl Trinitrate 437
Cloxacillin 521 Griseofulvin 534

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Index of Drug Profiles

Page No. Page No.


Haloperidol 535 Nitrous Oxide 555
Hydralazine 535 Norethisterone 556
Hydrochlorthiazide 536 Nystatin 557
Hydrocortisone 537 Oral Contraceptives/Birth
Ibuprofen 440 Control Pills 465
Imipramine 537 ORS (Oral Rehydration Salts) 471
Indomethacin 538 Paracetamol 475
Insulin 444 Pethidine 558
Iodine 539 Phenobarbitone 558
Ipecacuanha 540 Phenoxymethyl Penicillin 559
Iron Dextran 540 Phenytoin 560
Isoniazid 450 Pilocarpine 561
Isoniazid+Thiacetazone (INH) 541 Piperazine Citrate 561
Isosorbide Dinitrate 542 Podophyllin 562
Potassium Chloride 563
Ketoconazole 543 Praziquantel 564
Levamisole 543 Prednisolone 564
Levodopa + Carbidopa 545 Primaquine 565
Levothyroxine 546 Procain Benzyl Penicillin 565
Lindane Procainamide 566
(Gamma Benzene Hexachloride) 547 Promethazine 476
Lithium Carbonate 547 Propranolol 479
Loperamide 452 Pyrantel Pamoate 566
Mannitol 548 Pyrazinamide 567
Mebendazole 455 Pyridoxine (Vit. B6) 567
Mefloquine 549 Pyrimethamine & Sulfadoxine 483
Methyldopa 457 Quinidine 568
Methylene Blue 549 Quinine 485
Metoclopramide 551 Ranitidine 487
Metronidazole 460 Reserpine 490
Miconazole 463 Riboflavin (Vit. B2) 569
Morphine 551 Rifampicin 493
Neomycin 552 Rifampicin + INH + Pyrazinamide 570
Niclosamide 553 Salbutamol 496
Nifedipine 553 Silver Nitrate 571
Nitrofurantoin (NFT) 554 Silver Sulfadiazine 571
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Index of Drug Profiles

Page No. Page No.


Sodium Bicarbonate 572 Thiamine 577
Sodium Chloride 573 Trihexyl Phenidyl 577
Sodium Chloride + Dextrose (Glucose) 573 Valproic Acid 578
Sodium Thiosulphate 574 Verapamil Hydrochloride 579
Streptokinase (Enzyme) 574 Vinblastine 579
Sulfacetamide 575 Vincristine 580
Sulfadimidine 575 Vitamin A 500
Tamoxifen 576 Warfarin (mainly as Warfarin Sodium) 580
Tetracaine 576 Zinc Oxide 581
Tetracycline 498

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