The stagnant price of paracetamol contributes to its shortage

Kul Prasad Bhattarai, a resident of Kuleshwar in the metropolitan city of Kathmandu-14, went to many pharmacies in his area in search of paracetamol on Wednesday, as he was suffering from severe body pain due to dengue fever infection. .

However, he could not find the medicine in any of the pharmacies.

“I sent my children to different places to get the medicine but they came back without a single pill,” said Bhattarai, 74, who was infected with dengue virus nine days ago. “My wife has also been infected and has severe body pain, but we can’t even get paracetamol.”

It’s a problem facing hundreds of patients infected with dengue fever, a disease that has seen an alarming spread in recent times, infecting around 20,000 people and killing around two dozen across the country.

Paracetamol, or acetaminophen, is a drug used worldwide to relieve pain and reduce fever.

It is used to treat many conditions including headache, muscle pain, arthritis, back pain, toothache, sore throat, menstrual pain, musculoskeletal pain, colds and fever.

The Nepalese government has classified paracetamol as an essential medicine and provides it free of charge in government health facilities across the country. The drug is available in the market under different brands, with Cetamol, manufactured by the state-owned Nepal Drug Limited, the most commonly available brand.

Paracetamol is the only drug prescribed by doctors as safe for dengue fever patients.

With the massive spread of dengue fever throughout the country, the demand for paracetamol has increased several times. This caused a slump in the market, forcing patients to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

Doctors warn that the use of NSAIDs increases the risk of internal bleeding, including in the eyes, and raises liver enzymes, damaging the organ.

“Many patients complain about the shortage of paracetamol in the market,” said Dr. Sher Bahadur Pun, head of clinical research unit at Sukraraj Tropical and Infectious Diseases Hospital. “Patients took nonsteroidal anti-inflammatory drugs – Flexon, Nims and Rynex tablets, among others – to treat body pain caused by dengue fever. The use of such drugs is very risky in dengue infection.

Some patients who use NSAIDs in excess also suffer from internal bleeding. According to doctors, such patients need to transfuse platelet-rich plasma and platelet concentrate.

Officials from the Department of Drug Administration, the national pharmaceutical regulator, said the paracetamol crisis is the result of its high demand caused by soaring dengue fever cases and people’s tendency to hoard the drug. medicine at home.

“We have deployed pharmacy inspectors to drug manufacturing plants that produce paracetamol to increase production starting today [Thursday]said Santosh KC, spokesperson for the department.

“We also asked drug manufacturing companies to increase production by importing more raw materials.”

Paracetamol was also lacking during the first and second waves of the Covid-19 pandemic.

Experts say the authorities’ indifference to raising drug prices is the main reason for the crisis. Paracetamol is among 96 drugs whose prices were determined by the department some 14 years ago.

The price of a 500 mg paracetamol tablet has been set at Re1, which remains unchanged. The U.S. dollar exchange rate required to buy commodities overseas was half as low then as it is now. The price per kg of raw material, which was around 2 dollars at the time, has increased fourfold. The price per liter of diesel was 58 rupees at the time and the cost of labor has also increased, drug makers complained.

“We are forced to sell the drug at Re1 as the manufacturing cost exceeds the price,” said Deepak Dahal, former president of the Pharmaceutical Producers Association of Nepal.

“Dirty political games are being played over paracetamol and the authorities seem indifferent to the problem, even when patients have had to search the whole city for a single file of paracetamol.”

Nepal needs about 100 million paracetamol tablets every year. The association said drugmakers produced and supplied 30 million doses to the market in the past two months. Medicines sent to districts outside Kathmandu are also being withdrawn to meet growing demand in the valley, but even that has not solved the crisis, Dahal said.

As the government has not raised the price of paracetamol, Indian drug manufacturers are not exporting the drug to Nepal. Nepal imports more than 60% of the drugs used in the country from India. Meanwhile, private pharmaceutical companies in Nepal are also not producing drugs in sufficient quantities to avoid losses, health ministry officials said.

“We have reached an agreement with the drug manufacturers to increase the price of paracetamol and other essential drugs whose prices were fixed years ago and have not been revised since,” said Bharat Bhattarai, director General of the Department of Drug Administration. “I hope the paracetamol crisis will be resolved in the next few days.”