In a recent rural community clinic visit, I came across many patients (4/12 patients), most of them with Chronic Obstructive Pulmonary Disease (COPD) and some with Chronic osteoarthritis who were taking 1mg Betamethasone tablets on the advise of their friends or a local pharmacist.

It was obviously unprescribed.
When asked about the dosing schedule, they replied “Sometimes, I take it twice; sometimes, it’s 4-5 times a day, depends…” (on the shortness of breath or joint pain in patients with COPD and Chronic arthritis respectively). It made their symptoms go away while causing so many other unrecognized deleterious effects like bone resorption, hypothalamo-pituitary-adrenal suppression, predisposition to infections, metabolic disorders, hypertension etc.

We tapered the drug with advise to discontinue & screened for ongoing adverse effects; counselling was done regarding the side effects of the drug which outweighed the benefits and the better alternatives, including standard therapy that could improve their quality of life; but it’s their choice at last to go the pharmacy and purchase “a pill for COPD”.

Unregulated drug dispensing in Nepal is the main culprit where more patients are probably suffering from the preventable and iatrogenic adverse effects than their benefits, the only solution to it being compulsory prescription guided dispersal of drug.

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