FarmavitaR+

MARKET RESEARCH OF DRUGS USED IN ATOPIC RHINITIS IN INDIA

The present paper enumerates the pathophysiological conditions of atopic rhinitis and emphasis was made to gather the information about the drugs and to reveal the present status in the market. During the course of present survey of the drugs used in atopic rhinitis, it was found that cetrizine and levocetrizine (antihistamines-II generation), are widely used in Indore locality.

MARKET RESEARCH OF DRUGS USED IN ATOPIC RHINITIS IN INDORE LOCALITY OF MADHYA PRADESH INDIA 

Singh Prachi ¹, Dwivedi Sumeet², Shrivastava Satyaendra³ and Dubey Raghvendra²

1, Smriti College of Pharmaceutical Education, Indore, Madhya Pradesh-India

2, Chordia Institute of Pharmacy, Indore, Madhya Pradesh-India

3, Dr. Shri RMS Institute of Science and Technology, Bhanpura, Madhya Pradesh-India

 

ABSTRACT

Atopic rhinitis is a common TYPE-I hypersensitivity reaction related disease and is estimated to affect as many as 30% of the population on regular basis. The disease is generally caused by common allergens found commonly around us like food, pollen, dander and insect venoms. People often do not pay proper attention to it considering it as common cold and cough and in the long run of time it becomes hazardous. Adversely effects the patient's quality of life, including disturbed sleep and impaired function at work and school is adding to the burden of the health care system. The present paper enumerates the pathophysiological conditions of atopic rhinitis and emphasis was made to gather the information about the drugs and to reveal the present status in the market. During the course of present survey of the drugs used in atopic rhinitis, it was found that cetrizine and levocetrizine (antihistamines-II generation), are widely used in Indore locality.

* Corresponding Author

            E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it , This e-mail address is being protected from spambots. You need JavaScript enabled to view it

            Mob. No. 09302105107, 09893478497{mospagebreak}

 

INTRODUCTION

 Atopic rhinitis is an inflammation of mucous membrane lining nose, usually associated with nasal discharge. It occurs in the parts of body not in direct contact with the allergen. And is defined by the presence of elevated levels of total and allergen-specific IgE in the serum of patient, leading to positive skin-prick tests in common allergens. It is basically divided into two main categories: -

Allergic rhinitis- It is caused by allergy and allergic skin test results found positive. It is further divided into two categories, which is as follows: -

1) Seasonal rhinitis: - it is better known as "Hay fever"

This type is mainly associated with times of year when various pollens are common and occur due to outdoor allergen.

      Trigger agents: -    Tree (maple, birch, oak) and grass pollens.

                                    Weed pollens (ragweed)

                                    Mold (fungus) spores

      Peak months: - Spring time and early summer (March to June)

      Manifestation: - 1) Intensive nasal and eye itching with explosive sneezing.

                                2) Watery eyes and nose.

                                3) Itchy palate.

                                4) Ears with profusive post-nasal drip.

         5) Seasonal puffiness of eyes and eyelids with associated nasal membrane swelling.              

2) Perrinial rhinitis: - It is often called "Permanent cold" and occurs throughout the year and results largely from indoor allergens.

Trigger agents: - House-dust mite droppings.

                           Cat and dog dandruff.

                           Horse hair.

                            Cockroach droppings.

                            Hamster or rabbit urine result.

Peak months: - Occurs all year round.

Manifestation: - 1) Constant nasal blockage.

                          2) Snoring at night.

                          3) Watery postnasal discharge.

                          4) Loss of taste and smell sensation.

                          5) Sneezing only on waking in the morning.

                          6) Also glue ear and chronic sinusitis with polyps.

Non-Allergic Rhinitis: - It is not very well known also triggered by allergy, symptoms are almost same as with allergic rhinitis. But it gives negative allergy skin test. It is further divided into following eight types as follows: -

1) Vasomotor/ Idiopathic/Non-allergic perennial rhinitis: -

Characterstics: - 1) Nasal congestion and drip.

                          2) Occurs when exposed to temperature and humidity changes.

                          3) May occur with exposure to smoke, odours and emotional upsets.

                          4) Allergic skin test is negative.

 2) Non allergic rhinitis with eosinophilia syndrome (NARES): -

       Characterstics:- 1) Persistent sneezing paroxysms.

                               2) Profuse watery runny nose.

                               3) Nasal pruritis.

                               4) Occasional loss of smell.

                               5) Generally not known or found less in population.

3) Occupational rhinitis: -

Characterstics: - 1) Reaction to airborne substances in the work place(eg. lab animal     antigen, wood dust and chemicals)

                                 2) Suspected in individual with nasal symptoms when on work and improve when away from workplace.

4) Food induced rhinitis: -

Characterstics: -1) Producing respiratory symptoms usually found with skin(Eczema) and gastro-intestinal allergy.

                         2) Hot and spicy foods, alcohol may be a reason.

5) Infectious rhinitis: -

Characterstics: -1) This can occur as cold and may continue for longer than a week.

  2) Some people may develop an acute or chronic bacterial sinus infection.

   3) Increased amount of colored and thickened nasal discharge and nasal congestion.

6) Rhinitis medicamentosa: -

Characterstics: - 1) It is seen in the case of long-term use of decongestant nasal sprays or recreational use of cocaine.

                         2) Symptoms are nasal congestion and postnasal drip.

 

7) Mechanical obstruction:-

Characterstics: -1) Often seen with a deviated septum or enlarged adenoids.

                         2) Symptoms include nasal obstruction which may be one sided.

8) Hormonal rhinitis: -

Characterstics: - 1) This is often seen with changes in the hormones.

                          2) Often occurs during pregnancy, puberty, menses or hypothyroidism.{mospagebreak}

OCCURENCE

1. FREQUENCY

 Cumulative prevalence rate is at 15% in men and 14% in women..

 2.RACE

Atopic rhinitis is found in persons of all races. Prevalence of atopic rhinitis seems to vary among different populations and cultures, which may be due to genetic differences, geographic factors or environmental differences or other population based factors.

3. SEX

In childhood, atopic rhinitis is more common in boys than in girls, but in adulthood, the prevalence is approximately equal between men and women.

4. AGE OF ONSET 

Common in childhood,adolescence and early adult years, which mean age of onset 8-11 years, but atopic rhinitis may occur in persons of any age. In 80% of cases,atopic rhinitis develops by the age of 20 years. The prevalence of atopic rhinitis has been reported to be as high as 40% in children, subsequently decreasing with age. In the geriatric population, rhinitis is less commonly allergic in nature.

EPIDEMOLOGY

Peak month (related congregation in confined space)

Temperature climate: - September to March.

Tropics: - Rainy season.

Annual incidence: -

Children: - 6-8 URI'/Season (higher in day care).

Adults: - 2-4 URI's/Season.

Course: -

1) Incubation: - 48-72 hr (may be as long as 7 days).

2) Viral shedding: -

a) Peaks with symptoms.

b) Persists as long as 2-3 weeks.

c) Symptoms peak by days 3-5.

                         d) Transmission: -

                        1) Aerosol transmission predominates.

                        2) Hand to hand to nose (and eye) transmission is common.

                                    a) Hands are virally contaminated 60% of time.

                                    b) Hand washing with viricidal is effective.

                        3) Fomite transmission (eg. Toys) is inconsistent.{mospagebreak}

PATHOPHYSIOLOGY

Pathophysiology of this disease consists of two steps: -

Acute/Early phase response

Late phase response

COMPLICATION OF ALLERGIC RHINITIS/ATOPIC RHINITIS

Otitis media with effusion.

Infective sinusitis.

Facial development retardation.

Impaired quality of life.

STUDY AREA

 The present market research of atopic rhinitis drugs was carried out in 10 different chemists (Bombay medicose, Rohit chemist, Rohan chemist, Anand medicose, Jagdamba medicose, Bombay hospital pharmacy, Bhandari chemist, Laxhmi medical hall, Chaitanya medicose, Bapat hospital pharmacy) and doctors (Dr.Sheetal Sethi, Dr, B.B.Gupta, Dr. R.S Rathore, Dr. Vipin Acharya and Dr. Meenakshi Agrawal) located in different areas of Indore, study sites were selected considering the number of patients and of drugs used in atopic rhinitis by the chemists and the doctors as per plan suggested by Benjamin, 2003; Khan et. al. 2007.

METHODOLOGY

Different study sites (10 chemists and 5 doctors cabin), scattered over different areas of Indore locality (Bombay medicose, Rohit chemist, Rohan chemist, Anand medicose, Jagdamba medicose, Bombay hospital pharmacy, Bhandari chemist, Laxhmi medical hall, Chaitanya medicose, Bapat hospital pharmacy and Dr.Sheetal Sethi, Dr, B.B.Gupta, Dr. R.S Rathore, Dr. Vipin Acharya, Dr. Meenakshi Agrawal) were selected on the basis of number of patient, prescription, sale of drugs and presence of allergens. The knowledge about the use of drugs was obtained both by doctors and chemists. During the course of present market research, all the study sites were visited after carefully planned trip in the months of April-2007 to September-2007. Data regarding the use of the drugs were collected as per plan suggested (Kelvin, 1992;Shrivastava et. al. 2007)

OBSERVATION

Medication: - Basically by three means atopic rhinitis can be cured or prevented.

1.Environmental control measures and allergens avoidance.

2.Pharmacological management.

3.Immunotherapy.

Table: 1 Pharmacological management is the preferred means of treatment and it includes various categories of drugs: -

S.No	Category of drug	Drugs used
1.	Oral Antihistamines (Ist generation)	Chlorpheniramine Clemastine Dexchlorpheniramine Hydroxyzine Benadryl
2.	Oral Antihistamines (IInd generation)	Cetrizine Fexofenadine Desloratidine Mizolastine Levocetrizine Loratidine(used as OTC drug)
3.	Topical nasal coricosteroids	Beclomethasone dipropionate Budesonide Flunisolide Fluticasone Triamcinolone Mometasone
4.	Topical decongestant	Oxymetazoline Xylometazoilne Phenylephrine
5.	Oral decongestant	Pseudophedrine
6.	OTC nasal spray	Cromolyn nasal spray
7.	Other prescription nasal sprays	A nasal anti-histamine: -Azelastine A nasal anti-cholinergic: - Nasal ipratropium bromide
8.	Leukotrine antagonists	Zafirlukast (Accolate)   Montelukast (Singulair)

{mospagebreak}

Table: 2 Drugs used in various chemist's shop in different localities of Indore region: - 

S.No.	Name of chemist	Location	Drugs used	Max.drug sale
1.	Bombay medicose	Opp. Bombay hospital,Ring Road	1) Cetrizine 2) Levocetrizine 3) Beclomethasone 4) Fluitcasone 5) Xylometazoline 6) Montelukast	Cetrizine,Levocetrizine
2.	Rohit chemist	Near Curewell hospital,Jangirwala Chowraha	1) Benadryl 2) Cetrizine 3) Levocetrizine 4) Loratidine 5)Beclomethasone dipropionate 6) Budesonide 7) Fluticasone 8) Mometasone 9) Oxymetazoline	Cetrizine,Levocetrizine, Mometazone
3.	Rohan chemist	Sch.no.54, Near Bhandari hospital,Opp. Meghdoot garden	1) Cetrizine 2) Levocetrizine 3) Beclomethasone dipropionate 4) Budesonide 5) Fexofenadine 6) Mometasone 7) Fluticasone 8)Xylometazoline 9) Triamcinolone 10) Azelastine	Cetrizine,Levocetrizine, Beclomethasone dipropionate, Xylometazoline
4.	Anand medicose	Sch.no.74, Near Ashish nursing home	1) Clemastine 2) Benadryl 3) Fexofenadine 4) Levocetrizine 5) Triamcinolone 6) Budesonide 7) Oxymetazoline 8)Azelastine 9) Montelukast	Levocetrizine,Triamcinolone, Benadryl
5.	Jagdamba medicose	547,Rajendra nagar	1)Cetrizine 2) Levocetrizine 3) Beclomethasone diprpionate 4) Mometasone 5) Xylometazoline 6) Fluticasone 7) Montelukast	Cetrizine,levocetrizine, Xylometazoline
6.	Bombay hospital pharmacy	Bombay hospital,Ring road.	1) Levocetrizie 2) Budesonide 3) Fluticasone 4) Triamcinolne 5) Xylometazoline 6) Montelukast	Levocetrizine ,Triamcinolone, Xylometazoline
7.	Bhandari Chemist	Bhandari Hospital, Sch.no.54, Opp. Meghdoot garden	1) Cetrizine 2) Levocetrizine 3) Mometasone 4) Xylometazoline 5) Beclomethasone dipropionate	Cetrizine,Levocetrizine, Mometasone
8.	Laxhmi Medical hall	24,Jawahar Marg	1) Cetrizine 2) Levocetrizine 3) Beclomethasone dipropionate 4) Xylometazoline 5)Triamcinolone 6) Budesonide 7) Loratidine	Cetrizine,Levocetrizine, Loratidine
9.	Bapat pharmacy	Bapat Hospital,Sukhliya Chowraha	1) Cetrizine 2) Levocetrizine 3) Loratidine 4) Cromolyn nasal spray 5) Oxymetazoline 6) Triamcionlone	Cetrizine,Levocetrizine, Oxymetazoline
10.	Chaitanya medicose	56,Sukhliya, Near Nahar Hospital	1) Cetrizine 2 )Levocetrizine 3) Loratidine 4) Beclomethasone dipropionate 5) Budesonide 6) Fluticasone 7) Mometasone 8)Oxymetazoline	Cetrizine,Levocetrizine, Beclomethasone dipropionate, Oxymetazoline

  {mospagebreak}

Table: 3 Drugs that are generally prescribed by the doctors in the different localities of Indore region: -

S.No.	Name of doctor	Location	Drugs prescribed	Frequently prescribed drugs
1.	Dr.R.S.Rathore	Suyash hospital,A.B. Road	1) Cetrizine 2) Levocetrizine 3) Loratidine 4) Triamcinolone 5) Cromolyn nasal spray	Levocetrizine, Triamcinolone
2.	Dr.Sunil Acharya	84,Anurag nagar,B/H Shalimar Township	1) Cetrizine 2) Levocetrizine 3) Loratidine 4) Triamcinolone 5) Budesonide 6) Zafirlukast 7) Montelukast	Cetrizine,levocetrizine, Triamcinolone
3.	Dr.B.B.Gupta	32-33, Near Bapat Hospital,Sukhliya	1) Cetrizine 2) Levocetrizine 3) Triamcionlone 4)Xylometazoline 5) Budesonide	Cetrizine,Levocetrizine, Budesonide
4.	Dr.Sheetal Sethi	14,Chaturvedi Mansion,A.B.Road	1) Cetrizine 2) Levocetrizine 3) Budesonide 4) Triamcinolone 5) Montelukast 6)Xylometazoline	Cetrizine,Levocetrizine, Xylometazoline
5.	Dr.Meenakshi Agrawal	Bombay Hospital,Ring Road	1) Levocetrizine 2) Budesonide 3) Triamcinolone 4)Xylometazoline	Levocetrizine,Triamcinolone

  {mospagebreak}

RESULT AND DISCUSSION

Atopic rhinitis is a common disease and is a manifestation of TYPE-I hypersensitivity reaction marked by an inflammation of mucous membrane lining nose, usually associated with nasal discharge. Drugs used in A.R are Oral antihistamines (Ist generation){Chloramphenicol, Clemastine} having sedating effect and cardiotoxic effect on long run use, Nasal corticosteroids(Beclomethasone,Triamcinolone) may cause local nasal irritation and nose bleeds, Decongestant(Oxymetazoline,Xylometazoline) may exacerbate B.P problems,dry mucus membrane,cause urine retention and trigger glaucoma.In the present market research, carried out in chemists-Bombay medicose, Rohit chemist, Rohan chemist, Anand medicose, Jagdamba medicose, Bombay hospital pharmacy, Bhandari chemist, Laxhmi medical hall, Chaitanya medicose, Bapat hospital pharmacy and doctors- Dr.Sheetal Sethi, Dr, B.B.Gupta, Dr.R.S Rathore, Dr. Sunil Acharya and Dr. Meenakshi Agrawal,it has been revealed that there are several drugs which are used in Atopic Rhinitis viz. Cetrizine, Levocetrizine, Beclomethasone dipropionate, Triamcinolone, Montelukast, Loratidine, Budesonide, xylometazoline and Oxymetazoline,which were either prescribed by the doctors or they were normally sold on the counter. Thus the above finding indicates that antihistaminic drugs; Cetrizine and Levocetrizine (given in Table 2 and 3) are more efficacious with minimum drug-drug interaction, adverse drug reaction and toxic effect. So, it is expected that in future, it may lead over other drugs used in Atopic rhinitis and proven to be an intensive choice for the human health benefits. But drugs like Montelukast and Zafirlukast are also better option but they are not used much in the Indore region.

ACKNOWLEDGEMENT

 The authors are thankful to the doctors, pharmacist and chemist for their valuable support and suggestion about the present market research of the drugs used in atopic rhinitis.

REFERENCES

1. Kevin Farmer C, Ashol Sumblirk- Unclaimed prescription: an over looked opportunity. Am. Phar. 1992:10-55.
2. Shrivastava, S.; Dwivedi, S.; Kapoor, S.; Dubey, D,; and Sonaniya, R. Surveillance of some recent proton pump inhibitors. Farmavita.Net., 2007.
3. Khan, Parvez; Dwivedi, Sumeet; Pandey, Deepak and Shrivastava, Satyaendra. Marketed protein and polypeptide: An Overview. Pharmainfo.net, Aug-16-2007.
4. Benjamin DM. Reducing medication errors and increasing patient safety: case studies in Clinical Pharmacology: J. Clin. Pharmacology, July 2003: 43(7):768-83.