Aryavaidyan Vol.36-4 & 37-1 Combined issue No.36

Using several medicines together continuously is considered as polypharmacy. This is an umbrella term and definitions vary. But it is often regarded as simultaneous use of five drugs. In some contexts, the number is reduced to two. A drug added with another may increase or decrease its action or even cause adverse drug reactions (ADR).
Off course, multi-morbidity or having too many diseases is the main reason for poly pharmacy. This trend generally occurs in elderly persons[1]. As age increases, the number of chronic diseases affecting the individual also goes up. So, there is a simultaneous rise in medication. There is also a possibility for more number of drugs for single disease. Chances of ADR are more in elderly people due to significant metabolic changes. The drug clearance is also reduced in ageing. According to a case–control study carried out among old age people, in elderly it affects quality of life, decreasing the mobility and cognition. Polypharmacy was found to be an independent risk factor for hip fractures[2]. The clinical effects of drugs used together are not studied fully.
‘Prescribing cascade’ is another problem. ADR may be understood as the signs and symptoms of another disease and this prompts to prescribe more medicines. Side effects of combination of drugs are not easy to predict. Pharmacological profiles of individual drugs put together may not contribute to this. Interestingly, more number of prescribers without coordination especially in a multi specialty centre can also contribute to polypharmacy. There is an experience of a prescription with twenty three dugs for single patient who came out after consultation at such a centre.
Polypharmacy cannot be considered as overmedication always. Too many diseases require too many medicines also. But to de-prescribe (reduce medications) may not be a simple task. It requires clinical wisdom. Physician has to look into the pros and cons of each medication. Appropriate prescription is the only way to limit polypharmacy (appropriate polypharmacy). Evidence is the only source for such a step.
Simultaneous use of drugs of different systems also poses problems. It is usual for the patients to approach ayurveda for some complaints while they are taking medications regularly for some other disease. It is generally considered that ayurvedic medicines are weaker than drugs of conventional system and are not supposed to interact with drugs of conventional medicine. Some physicians suggest more time gap between the intake. Whether the medicines are having same or different receptor site is something to be counted. It has been proposed that in most of the cases the absorption is altered due to drug-to-drug interactions. Many of the single drugs like guggulu, rasona, sunthi,jataamaansi, yashtimadhu, eeranda, kapikacchu and vaasa do interact with drugs of conventional medicines. Interestingly all of these potentiate the action of the drugs with same indication in conventional medicine. It is also known that the side effects of spironolactone is reduced if yashtimadhu is used simultaneously[3]. In another study where combination of Aswagandharishtam and Parthadyarishtam does not interact with the drugs prescribed for cardiac and associated ailments[4]. More is to be explored in these lines. No major finding related to a negative drug interaction is available so far. That does not reduce the importance of pharmaco-vigilance in this particular area.
Constant monitoring of these patients may be followed by physicians. Detailed history is to be taken with emphasis on drug history. The dose and mode of intake may be meticulously planned in those who are on conventional medication. Research agencies or professional associations may initiate preparation of database on drug interactions. There is an abundant scope for pharmacological studies on the commonly involved drugs in polypharmacy.
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References
[1] Dagli RJ, Sharma A. Polypharmacy: a global risk factor for elderly people. J Int Oral Health. Nov-Dec;6(6):i-ii. PMID: 25628499; PMCID: PMC4295469, 2014.
[2] Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC. Polypharmacy correlates with increased risk for hip fracture in the elderly: A population-based study. Medicine (Baltimore);89(5):295–9, 2010.
[3] Dhanya R., Anil Kumar Shukla, Drug Interactions between Ayurvedic and Allopathic Medicines - A Review, World Journal of Pharmaceutical Research, Volume 6, Issue 3, 478-486.
[4] SubrataPandit, et al Evaluation of herb-drug interaction of a polyherbal Ayurvedic formulation through high throughput cytochrome P450 enzyme inhibition assay, Journal of Ethnopharmacology, Volume 197, Pages 165-172, 2017.


OBITUARY

Prof.R.H.Singh
(1942-2023)

With the demise of Prof.R.H. Singh world has lost a scholar and proponent of ayurveda. He has contributed substantially to education, research, literature and clinical practice of Indian medical knowledge system.

Ram Harsh Singh born on 10 January 1942 in Kaniyaripur village of Mau district in the Indian state of Uttar Pradesh, India. After graduating from Banaras Hindu University (BHU) in Ayurveda Medicine and Surgery (ABMS) in 1961, R. H. Singh served as a faculty member, later to hold various positions at his alma mater. He was fortunate to have the guide for doctoral degree (PhD) K. N. Udupa, (a pioneer in integrative medicine and also the founder director of the Institute of Medical Sciences at BHU). Even after retirement his services were available as Emeritus Professor. When Government of Rajasthan established Ayurveda University, he was invited to serve it as Vice Chancellor. He was also instrumental in propagating ayurveda abroad, as the visiting Professor at College of Ayurveda of Mount Madonna Institute, USA.

Dr.R.H. Singh contributed significantly to ayurvedic literature. He had authored nearly twelve books which include ‘The Holistic Principles of Ayurvedic Medicine’, ‘Body Mind Spirit: Integrative Medicine in Ayurveda’ and ‘Yoga and Nature Cure’. He has published more than 200 research papers in Indian and international journals indicating the keen interest in developing Ayurveda on scientific lines as an evidence-based system of medicine.

Dr. Singh was a member of several academic policy making bodies like scientific advisory board of Central Council for Research in Ayurvedic Sciences, National Commission on History of Science etc. He founded Association of Ayurvedic Physicians of India.

This eminent academician was conferred with Padmashree by the Government of India in 2016. Mahatma Gandhi Institute of Medical Sciences honored him with a Lifetime achievement Award in 2007.

Dr.R.H.Singh had not visited Kerala frequently. But Kerala and its ayurvedic tradition attracted him as an academician. In the book ‘Pancha Karma Therapy: Ancient Classical Concepts, Traditional Practices’Dr. Singh specifically highlights the Kerala therapies. It is also noteworthy that this book is dedicated to the ancient physicians of Kerala for keeping the tradition of panchakrma alive. Aryavaidyan Journal was fortunate to have him as a member of its National Advisory Borad since 2016.He was very keen about the highest qualities to be maintained by a scientific journal. It is by following his suggestions that we could achieve the standards.

Our humble pranams to the departed soul.



Dr.P.K. Mohanlal
(1945-2023)

Kerala lost an eminent physician and author with the passing away of Dr.P.K.Mohanlal.

Born in a family of ayurvedic physicians, Dr.Mohanlal had his graduation from Government Ayurveda College, Thiruvananthapuram. He underwent an informal training with his learned father AyurvedacharyaK.KunjiramanVaidyar (Founder of Pourasthya Pharmacy, Perinadu, Kollam District) for a period of time. Later Mohanlal did his post graduation in marma-chikitsa form Government Ayurveda College, Thiruvananthapuram. Immediately after the course he could serve the alma mater as a teacher which was continued in all the Government Ayuveda Colleges of Kerala for more than thirty years. Subsequently he held the positions Medical Superintendent, Professor and Principal. As the Principal newly initiated Government Ayurveda College at Kannur, he was instrumental in developing to higher standards. When the State Government established a separate Directorate for Ayurvedic Medical Education in 2001, he was selected for the post.

Dr.Mohanlal was member many academic bodies at both State and National level. All the Universities in Kerala had him as a member in the Board of Studies. This eloquent teacher was a member in Central Council of Indian Medicine and the Governing Body of National Institute of Ayurveda, Jaipur.

Dr.P.K. Mohanlal was a reputed author in Malayalam. ChilaChikitsannubhavangalis a collection of his clinical experiences. Ayurvedathintesamagraveekshanam contains articles on the basic principles of ayurveda. Keralathile Ayurveda Vidyabhyasam is the documentation of the genesis and development of ayurvedic education in Kerala.

He was recognized for his services to ayurveda by the authorities and different organsiations. Dhanvanthari Award by Government of Kerala for the best ayurveda doctor was conferred in 2008. From Ayurveda Medical Association of India he received Bhishagrathna award in 2009. He was also honoured by SreeSankara Sanskrit University, Kalady in 2019 for his contributions to ayurveda.

With our beloved former Managing Trustee, Dr.P.K Warrior and the founder Chief Editor Dr.N.V.K. Varier, he had an intimate relationship. Dr.P.K.Mohanlal was keen in actively participating the annual seminars of Arya Vaidya Sala. In 1995’s seminar, presented the theme paper Jwarachiktsa- a revalidation’.

Dr.Mohanlal was in the Advisory Board of Aryavaidyan since 2016 and provided us valid suggestions to make the journal better. We pay homage to departed soul.