Year: 2026 | Month: April-June | Volume: 11 | Issue: 2 | Pages: 136-142
DOI: https://doi.org/10.52403/ijshr.20260217
Development of Personal Formulary for Constipation in Tertiary Care Settings
Pranshu Pandit1, Rahul Kumar2, Nishi1, Sukalyan Saha Roy3, Lalit Mohan4
1Senior Resident, Department of Pharmacology, IGIMS, Patna, Bihar, India
2Assistant Professor, Department of Gastroenterology, IGIMS, Patna, Bihar, India
3Additional Professor, Department of Pharmacology, IGIMS, Patna, Bihar, India
4Professor & HOD, Department of Pharmacology, IGIMS, Patna, Bihar, India
Corresponding Author: Dr. Nishi
ABSTRACT
Background: Constipation is one of the most common gastrointestinal disorders encountered in tertiary care settings and significantly affects quality of life across all age groups. Multiple classes of laxatives are available for treatment, including bulk-forming agents, stool softeners, osmotic purgatives, stimulant purgatives, and newer prokinetic agents. However, prescribing practices often vary due to clinician preference, availability, cost, and pharmaceutical promotion rather than objective comparison of efficacy, safety, convenience, and affordability. The concept of personal formulary (P-drug) development encourages rational and evidence-based selection of medicines.
Aim: To develop a personal formulary for constipation using the P-drug concept among residents of Pharmacology in a tertiary care setting.
Materials and Methods: This study was conducted in the Department of Pharmacology of a tertiary care teaching hospital. The P-drug for constipation in adults was selected using the WHO 6-step approach. Drugs from commonly used laxative groups available under the Janaushadhi scheme were evaluated, including Lactulose syrup, Lactitol and Ispaghula, Bisacodyl tablet, Liquid paraffin & Milk of Magnesia & Sodium Picosulphate suspension, Magnesium hydroxide & Aluminum hydroxide & Dimethicone tablet and Prucalopride tablet. Drugs were compared based on four parameters: efficacy, safety, cost, and convenience according to the P-drug concept of Joshi and Jayawick Ramarajah. Scores were given to each four parameters from 1 to 10 for each drug. Each parameter was given a fractional numerical rating (β) according to the importance i.e. 0.4 for efficacy, 0.3 for safety, 0.2 for cost and 0.1 for convenience. The total weighted score was calculated for each drug, and the highest-scoring drug was selected as the personal formulary drug.
Results: Among the evaluated drug groups, Osmotic purgatives achieved the highest score of 8.3 followed by bulk forming agents. Among the osmotic purgatives, Lactulose syrup achieved the highest total score (8.0), followed by Lactitol and Ispaghula combination (7.6) and Magnesium hydroxide & Aluminium Hydroxide & Dimethicone tablet. Though Ispaghula as a standalone formulation is not available in Janaushadhi, it’s high safety and efficacy profile has influenced its comparison with Lactulose where it scored 8.3 but amongst the drugs available under Janaushadhi, Lactulose demonstrated good efficacy, favorable safety profile, reasonable cost, and excellent convenience, making it the preferred P-drug for constipation.
Conclusion: By applying rational drug selection principles with greater emphasis on efficacy and safety, Lactulose syrup emerged as the most suitable personal formulary drug for constipation. The structured evaluation enhanced critical appraisal skills among residents and promoted safe, effective, convenient, and economical prescribing practices in routine clinical care.
Keywords: Constipation, P-drug, Lactulose, Rational drug use, Laxatives, Personal formulary.