Essential drugs in thyroidology: A South and South east Asia perspective

Sanjay Kalra; Yashdeep Gupta; Banshi Saboo

doi:10.4103/0973-0354.147268

EDITORIAL

Year : 2015 | Volume : 12 | Issue : 1 | Page : 1-2

Essential drugs in thyroidology: A South and South east Asia perspective

Sanjay Kalra¹, Yashdeep Gupta², Banshi Saboo³
¹ Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
² Department of Medicine, Government Medical College, Chandigarh, India
³ Department of Medicine, Dia Care, Ahmedabad, Gujarat, India

Date of Web Publication

18-Dec-2014

Correspondence Address:
Dr. Sanjay Kalra
Department of Endocrinology, Bharti Hospital and BRIDE, Karnal - 132 001, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0973-0354.147268

How to cite this article:
Kalra S, Gupta Y, Saboo B. Essential drugs in thyroidology: A South and South east Asia perspective. Thyroid Res Pract 2015;12:1-2

How to cite this URL:
Kalra S, Gupta Y, Saboo B. Essential drugs in thyroidology: A South and South east Asia perspective. Thyroid Res Pract [serial online] 2015 [cited 2022 Jan 21];12:1-2. Available from: https://www.thetrp.net/text.asp?2015/12/1/1/147268

Introduction

The List of Essential Medicines (LEM), revised regularly by the World Health Organization (WHO), is a barometer of rational pharmaceutical usage. Enumerating drugs which must be provided at primary, secondary, and tertiary health care levels, the LEM supports the universal availability of these essential medicines. Each country has its own National List of Essential Medicines (NLEM), which is usually similar to, but not the same as, the WHO LEM. The subtle differences between various NLEMs reflect care disease burden, health care facility availability, or prioritization of health challenges.

The South East Asian Region (SEARO) of WHO, headquartered in New Delhi, India, is home to 11 countries. These are Bangladesh, Democratic Peoples Republic of (North Korea), India, Indonesia, Bhutan, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste. Each country has its own NLEM, prepared by local experts. This editorial analyzes the various NLEMs of SEARO, with respect to thyroid drugs. Two member countries of the South Asian Association for Regional Cooperation (SAARC), Afghanistan and Pakistan, which are not SEARO constituents, are also discussed in this analysis. ^{[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13]}

LEVO-Thyroxine and LIO-Thyronine

Levothyroxine (L-thyroxine) is included as an essential drug in the NLEMs of all 13 countries, expect North Korea. The North Korean list clarifies that it includes only "life saving drugs", However, L-thyroxine is certainly a life-saving drug for those who need it, and should be a part of every LEM.

While Bhutan, Indonesia, and Nepal list only the 100 μg strength of L-thyroxine as an essential drug, Thailand does not specify any strength. Myanmar recommends three strengths (25, 50,100 μg) as being essential, while the other nations, which are Afghanistan, Bangladesh, India, Maldives, Pakistan, Sri Lanka, and Timor-Leste require only 50 μg and 100 μg tablets of L-thyroxine [Table 1].

Table 1: Thyroactive drugs listed in National lists of essential medicines

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Liothyronine (no specific strength) is an essential drug in Thailand, but not in any other SEARO country.

Antithyroid Drugs

The most frequently mentioned anti thyroid drug in the NLEMs of South and South East Asia is carbimazole. This drug is listed as an essential molecule by Myanmar (5 mg), Afghanistan (5 mg), Bhutan (5 mg), Nepal (5 mg), Sri Lanka (5 mg), and India (both 5 and 10 mg).

Thailand lists the prodrug methimazole (strength not specified), instead of carbimazole, while Bangladesh, Indonesia, Maldives, Pakistan, North Korea, and Timor-Leste, do not include either carbimazole or methimazole in their NLEMs.

Propylthiouracil 50 mg is accepted as an essential drug by Maldives, Sri Lanka, Timor-Leste, and Pakistan. Thailand does not specify any strength for this essential drug, while Indonesia prefers a 100 mg tablet.

Bangladesh and North Korea are two countries which do not include any antithyroid drug in their NLEM.

Iodine Preparations

There is great heterogeneity in the list of iodine preparations included in NLEMs. Afghanistan includes iodine oil, capsules, iodine ampoules and iodine bottles in its list.

Lugol's iodine is listed by Bhutan, Indonesia, Myanmar, Nepal, while India specifies iodine solution in 8 mg/5 ml and Sri Lanka writes potassium iodide solution. Timor-Leste and Pakistan prefer potassium iodide tablets (60 mg). Thailand requests both Lugol's iodine and saturated solution of potassium iodide (SSKI) as essential drugs.

Bangladesh, Maldives, and North Korea do not have any iodine preparation in their NLEMs. It must be noted here that potassium iodine is the drug of choice for prophylaxis against radioactive iodine exposure. Lugol's iodine on the other hand, has limited therapeutic usefulness in modern thyroidology.

Adjuvant Drugs

Bhutan lists propranolol 40 mg in its section on Thyroid Drugs, thus taking a unique position in the SEARO region.

Summary

Most SEARO and SAARC countries include thyroactive drugs in their lists of essential drugs. The subtle differences between various NLEMs, may reflect local prescription habits (eg, carbimazole vs. methimazole vs. propylthiouracil), or local availability/production. At the same time, perceptions about the need for Lugol's iodine and potassium iodide must be addressed, based upon actual clinical requirement and potential for exposure to radioactive iodine. Most important of all, L-thyroxine must be included in all essential drug lists, in as many strengths as possible. Organizations such as the South Asian Federation of Endocrine Societies (SAFES), in collaboration with national professional bodies, should work to rationalize NLEMs of the region, so as to optimize thyroid health of people in our care.

References

1.	National Essential Drugs List Islamic Republic of Afghanistan. Available from: http://apps.who.int/medicinedocs/documents/s17405e/s17405e.pdf [Last accessed on 2014 Apr 18].
2.	Report on drafting the updated essential drug list. Available from: http://209.61.208.233/LinkFiles/Essential_Drugs_and_Medicines_BAN.pdf [Last accessed on 2014 Apr 18].
3.	National List of Essential Medicines of Bhutan 2012. Available from: http://apps.who.int/medicinedocs/documents/s17826en/s17826en.pdf [Last accessed on 2014 Apr 18].
4.	National List of Essential Medicines of India 2011. Available from: http://mohfw.nic.in/WriteReadData/l892s/7364497513National%20List%20of%20Essential%20Medicine,%202011.pdf [Last accessed on 2014 Apr 18].
5.	National List of Essential Medicines Indonesia 2008. Available from: http://apps.who.int/medicinedocs/documents/s18011en/s18011en.pdf [Last accessed on 2014 Apr 18].
6.	Essential Medicines List 2009 Maldives Food and Drug Authority. Available from: http://apps.who.int/medicinedocs/documents/s17044e/s17044e.pdf [Last accessed on 2014 Apr 18].
7.	Essential and Complementary Medicines and Vaccines for Myanmar. National List (NLEM), 2010. Available from: http://apps.who.int/medicinedocs/documents/s20297en/s20297en.pdf [Last accessed on 2014 Apr 18].
8.	National List of Essential Medicines of Nepal 2011. Available from: http://www.searo.who.int/entity/medicines/neml_nep_2011_govtwebsite_ok.pdf [Last accessed on 2014 Apr 18].
9.	National Essential Medicine List of Pakistan. Ministry of Health. Government of Pakistan. Available from: http://apps.who.int/medicinedocs/documents/s17119e/s17119e.pdf [Last accessed on 2014 Apr 13].
10.	National List of Essential Medicines Sri Lanka 2009. Available from: http://apps.who.int/medicinedocs/documents/s16730e/s16730e.pdf [Last accessed on 2014 Apr 18].
11.	Essential Medicines List for Timor Leste 2010. Available from: http://apps.who.int/medicinedocs/documents/s19453en/s19453en.pdf [Last accessed on 2014 Apr 18].
12.	Essential drugs suggested to be used by international agencies in DPRK. Available from: http://209.61.208.233/LinkFiles/Essential_Drugs_and_Medicines_DPRK.pdf [Last accessed on 2014 Apr 18].
13.	National List of Essential Medicines 2008 [Thailand]. Available from: http://apps.who.int/medicinedocs/documents/s16245e/s16245e.pdf [Last accessed on 2014 Apr 18].