An Essential Drug List, also known as a core drug list or medication list, is a carefully selected inventory of medications that are deemed essential for addressing the most prevalent health conditions within a specific population or country. It serves as a key component of national drug policies and pharmaceutical programs, ensuring the availability, accessibility, and affordability of essential medicines. The list is typically developed based on rigorous criteria, taking into consideration the medications' safety, efficacy, cost-effectiveness, and suitability for primary healthcare settings. Rational Drug Therapy refers to the systematic and evidence-based approach to prescribing medications, aiming to maximize therapeutic benefits while minimizing the risk of adverse effects. It involves following established therapeutic guidelines and clinical protocols to ensure that medications are prescribed in a manner that is appropriate for the patient's condition, taking into account factors such as age, weight, co-existing conditions, drug interactions, and individual response. Rational drug therapy promotes the use of medications based on sound scientific evidence, emphasizing the principles of efficacy, safety, and cost-effectiveness to optimize patient outcomes and improve overall healthcare quality.

1. Essential Drug Concept
&
Rational Drug Therapy
Dr.Navaneethakrishnan PharmD.,
Assistant Professor
Department of Pharmacology

2. Essential Drug Concept
 Drugs those satisfy the healthcare needs of the majority of the
population.
 The WHO has developed the first essential medicines list in
1977 and since then the list has been revised every 2 years. The
current one is the 22nd model list released in 2021 and contains
479 medications.
 The essential medicine list contains limited cost-effective and
safe medicines, while the open pharmaceutical market is
flooded with large number of medicines many of which are of
doubtful value.

3. Essential Drug Concept
 This concept of essential medicines is relatively new to India
and Tamil Nadu is the first state to develop the essential
medicine list as early as in 1994. Then government of Delhi too
had developed its own list.
 The government of India and many other individual states
have their own essential medicines list, and the current
national list was compiled during 2003. Unfortunately, the list
is not regularly up dated except for Tamil Nadu.

4. Essential Drug Concept
 WHO model list had 325 drugs in 1999.
 National essential drug list was published by the Indian
government in 1996 on an average 250 drugs are essential to
treat the majority of diseases in the country.
 The selection of the drugs are based on: prevalent disease,
treatment facilities, safety and efficacy, cost, administration
and storage, benefit/risk ratio and patients acceptability

5. Selection of Essential Drugs
 The process by which medicines are selected is critical. An essential
medicines list which is imposed from above will not reflect the need of
the users or be accepted by them.
 It is therefore very important that the process be consultative and
transparent, selection criteria be explicit, selection of the medicines be
linked to evidence-based standard clinical guidelines, clinical guidelines
and the list be divided into levels of care, and are regularly reviewed
and updated.
 A review of the clinical guidelines and the list should be carried out at
least every second year, and their use and the impact should be

6. RATIONAL DRUG THERAPY

7. DEFINITION
 Rational Drug Use (RDU) is defined as the use of an
appropriate, efficacious, safe and cost effective drug given for
 The right indication
 The right dose and formulation
 At right intervals
 The right duration of time.

8.  The rational use of Medicines (RUM) is defined as “Patients
receive medications appropriate to their clinical needs, in doses
that meet their own individual requirements, for an adequate
period of time, and at the lowest cost to them and their
community.”
 Prescribing right drug, in adequate dose for the sufficient
duration & appropriate to the clinical needs of the patient at
lowest cost.
 The promotion of rational drug use involves the adoption of the
essential drug concept, training of health professional in rational
DEFINITION

9. Why Rational Use?
Drug explosion
 Increase in the number of drugs available has incredibly
complicated the choice of appropriate drug for particular
indication.
Efforts to prevent the development of resistance
 Irrational use of drugs may lead to the premature demise of
highly efficacious & life saving new antimicrobial drug due
to development of resistance

10. Growing awareness:
 Today, the information about drug development, it’s uses &
adverse effects travel from one end of the planet to the other
end with amazing speed through various media.
Increased cost of the treatment:
 Increase in cost of the drug increases economic burden on the
public as well as on the government. This can be reduced by
rational drug use.
Consumer protection Act. (CPA):
 Extension of CPA in medical profession may restrict the
irrational use of drugs.

11. Factors affecting Rational drug use
 Lack of information
 Poor communication between health professionals and
patients
 Inappropriate use of antibiotics
 Non-adherence of dosing regimen
 Demand from patient
 Self medication
 Drug regulation

12. Strategies to Promote Rational Use of
Medicines
 The following strategies have been advocated by WHO for
promoting rational use of medicines.
There is 3 M concept in Rational Use of Medicines (RUM):
Medicines Mean Money.
 Thus, RUM means less profit and income for those dealing
with medicines; prescribers, and sellers.
 This conflict of interest is particularly relevant in our
country where just only 3-5% of population are covered
under any form of health insurance.

13. Reasons for Irrational use of drugs
 Lack of information
 Faulty & inadequate training & education of medical
graduates
 Role models – Teachers or seniors
 Lack of diagnostic facilities/Uncertainty of diagnosis –
medicine for all possible causes
 Demand from the patient – prompt and quick action
 Patient load
 Promotional activities of pharmaceutical industries

14. Reasons for Irrational use of drugs
 Promotional activities of pharmaceutical industries
 Poor communication between health professional & patient
 Drug promotion and exaggerated claim by companies
 Defective drug supply system & ineffective drug regulation

15. Hazards of Irrational use
 Ineffective & unsafe treatment
 over-treatment of mild illness
 inadequate treatment of serious illness
 Exacerbation or prolongation of illness, Distress & harm to
patient
 Increase the cost of treatment
 Increased drug resistance - misuse of anti-infective drugs
 Increased Adverse Drug Events
 Loss of patients confidence to doctor

16. Irrational fixed dose combination available in the
indian market
 Norfloxacin + metronidazole
 Ofloxacin + metronidazole
 Ciprofloxacin + tinidazole
 Nimesulide + diclofenac
 Simvastatin + nicotinic acid
 Domperidone + rabeprazole
 Enalapril + losartan
 Cetrizine + phenylpropanoloamine + paracetamol

17. Measures to promote rational drug use
 Critical assessment & evaluation of benefits and risk of
drug used.
 Compare the advantages, disadvantages, safety & cost of
the drug with existing drug for same indication

18. Steps to improve rational drug use prescribing
recommendations of WHO for rational drug
use
 Establishment of multi-disciplinary national body to
coordinate medicine use policies
 Use of Clinical guidelines
 Essential medicines list based on treatments of choice
 Establishment of Drugs and therapeutics committees in
districts and hospitals
 Inclusion of Problem-based pharmacotherapy training in
undergraduate curricula

19.  Continuing in-service medical education as a licensure
requirement
 Supervision, audit and feedback
 Independent information on medicines
 Public education about medicines
 Sufficient government expenditure to ensure availability of
medicines and staff
Steps to improve rational drug use prescribing
recommendations of WHO for rational drug
use

20. Pharmacist’s role in rational drug use
Drug procurement:
 Selection of drugs based on the essential drugs concept relevant
to the needs of the situation. All measures to provide affordable
and quality drugs.
Inventory control:
 Monitor to minimize the out of stock situations. The use of a drug
formulary or drug list to restrict the number and brands of drugs
stocked.

21. Pharmacist’s role in rational drug use
Information and education:
 Patient education, monitoring compliance, community education
progs; interaction with the healthcare professionals about drugs,
related problems, new drug or ADRs.
Pharmaceutical care :
 Optimize the patients health related quality of life, achieve
positive outcomes. Professional relationship must be established
and maintained with the patient as well as healthcare personnels

22.  The pharmacist is now no longer a supplier of medicines
but a coordinator between different members of healthcare
team and the patients.
 Pharmacist can play a key role in promotion of rational
drug use.
 Good pharmacy practice
 Patient counseling
 Educate other healthcare professionals
Pharmacist’s role in rational drug use

23. Guidelines for Rational Prescribing
Step:- I
 Identify the patient’s problem based on symptoms &
recognize the need for action
Step:- II
 Diagnosis of the disease – define the diagnosis
Step:- III
 List possible intervention or treatment (drug or no drug)
– Identify the drug

24. Step:- IV
 Start the treatment by writing an accurate & complete
prescription e.g. name of drugs with dosage forms, dosage
schedule & total duration of the treatment
Step:-V
 Given proper information instruction & warning regarding
the treatment given e.g. side effects (ADR), dosage schedule
& dangers/risk of stopping the therapy suddenly

25. Step:-VI
Monitor the treatment to check, if the particular treatment has
solved the patient’s problem.
Passive monitoring – done by the patient himself.
Explain him what to do if the treatment is not effective
or if too many side effect occurs
Active monitoring - done by physician and he make an
appointment to check the response of the treatment

26. Conclusion
The demands of rational drug use are:
 Availability of essential & life saving drugs and unbiased
drug information with generic name.
 Adequate quality control and drug control.
 Withdrawal of hazardous & irrational drugs.
 Drug legislation reform.

27. Thankyou..