What is the most prescribed medication in India, excluding anti-hypertensive (high blood pressure) and anti-diabetic medications?

Most Prescribed Medications in India (Excluding Anti-Hypertensives and Anti-Diabetics)

Based on available evidence, non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed medications in India, excluding anti-hypertensive and anti-diabetic medications.

NSAIDs Prescription Patterns in India

NSAIDs are extensively used across India, with studies showing they are prescribed in approximately 30.83% of all patient encounters 1. Their widespread use spans across various practice settings, from general practitioners to specialists.

Most Commonly Prescribed NSAIDs in India:

1. Paracetamol (Acetaminophen) - Most frequently prescribed NSAID (39.45%) 1
2. Ibuprofen - Among the top choices across different practice categories 2
3. Diclofenac - Widely prescribed, especially by orthopedic surgeons 2
4. Aspirin - Commonly prescribed despite concerns in certain populations 2
5. Piroxicam - Popular among certain specialist groups 2

Prescription Characteristics:

• NSAIDs are prescribed by doctors across all specialties, with individual physicians prescribing between 1-15 NSAID prescriptions daily 2
• Most prescribers limit their NSAID choices to 2-5 preferred agents despite the numerous options available 2
• Fixed-dose combinations (FDCs) of NSAIDs are prescribed by 39-76% of doctors, with orthopedic surgeons being the highest prescribers (76%) 2
• Generic prescribing of NSAIDs is relatively high at 91.15%, though still below WHO ideal standards 1

Reasons for High NSAID Prescription Rates

1. Wide Availability: NSAIDs are easily accessible as over-the-counter medications in India 3

2. Broad Applications: Used for numerous conditions beyond their primary indications:

   • Headaches
   • Arthritis
   • Menstrual cramps
   • Back pain
   • Cancer pain
   • Chronic pain conditions 3
   • Some physicians even use certain NSAIDs for pelvic inflammatory disease, pre-term labor, and patent ductus arteriosus 2

3. Consumption Volume: Approximately 1.6 billion NSAID tablets are consumed annually in India 3

Other Commonly Prescribed Medication Classes

Neuropathic Pain Medications

These are also frequently prescribed, though often at lower doses than internationally recommended:

• Amitriptyline: Commonly initiated at 5-10 mg/day (lower than standard recommendations) 4
• Pregabalin: Typically prescribed at 50-75 mg/day in India 4
• Gabapentin: Usually prescribed at 100-300 mg/day 4

Nutritional Supplements

• Food supplements and tonics constitute a significant portion of prescriptions in India, despite questionable nutritional and pharmacological value 5

Prescription Practices and Concerns

• There are significant variations in NSAID prescribing patterns among different medical specialties 2
• Dosage variations exist both in terms of dose and frequency of administration 2
• Inappropriate prescribing occurs, such as aspirin and ibuprofen for patients with bronchial asthma despite contraindications 2
• Only 49.72% of prescribed NSAIDs are from India's National List of Essential Medicines (2015), falling short of WHO standards 1

Common Adverse Effects of NSAIDs

Most prescribers perceive NSAIDs to cause primarily mild gastrointestinal adverse events, though the actual risk profile is more complex:

• Common side effects include nausea, vomiting, headache, gastritis, abdominal pain, and diarrhea 3
• More serious concerns include renal damage and cardiovascular problems with prolonged use 3
• Diclofenac and ibuprofen have been linked to depression and dementia 3

In conclusion, NSAIDs represent the most commonly prescribed medication class in India outside of anti-hypertensives and anti-diabetics, with paracetamol being the most frequently prescribed individual agent.