[india-drug] Is buclizine an appetite stimulant

[owner-india-drug@healthnet.org]

(Directed to Idrug by edrug's moderator.Thanks

This issue of drug promotion is important in India's perspective where
we have more than 60,000 formulations in the market and do not have a
central database to record them.The issue of promotions of the industry
that are promoting sales rather than science, needs to be dealt with
amongst health care professionals.Thanks....SS)


E-DRUG: Is buclizine an appetite stimulant?
-------------------------------------------
[The question should be: do children require appetite stimulants at
all? In
my view, they need food, not appetite stimulants! Cyproheptadine was
unethically promoted as an appetitie stimulant, and MSD removed that
indication after some campaigning by HAI. The same ethical arguments
should
be valid for buclizine. WB]

Dear Friends,

A company in India promoting Buclizine as an appetite stimulant for
children. The label of the Buclizine syrup carries the words ?for
increase
in appetite and weight gain?.

1) The BNF lists Buclizine but as an ingredient in an antimigraine
formulation.

2) The USP DI lists Buclizine for prophylaxis of motion sickness. Even
the
adverse effects do not mention about appetite stimulation.

3) CIMS (Current Index of Medical Specialties) (a commercial,  Indian
drug
index) probably goes by the information supplied by the pharmaceutical
company. Buclizine here is listed under appetite stimulants; Category-
antihistamine; Indications- Anorexia, Malnutrition, convalescence,
constitutional underweight.
Under adverse drug reactions ? besides other things is listed, -
?weight
gain?.
Under action- ?mainly used for anti emetic action, particularly in
prevention of motion sickness, also used in combination with analgesics
to
treat migraine attacks.

4) The company literature which tries to tempt doctors to prescribe
Buclizine for weight gain, gives comparisons why Buclizine is superior
to
Cyproheptadine (the prevailing most common appetite stimulant for
children
being used in India) and an obvious ?competition? to Buclizine.
The following comparisons are listed :

Effect on growth hormone
Buclizine ? stimulates appetite without affecting growth hormone levels
Cyproheptadine ? increases appetite by inhibiting growth hormone.
Therefore
can affect growth in children.

Actions

Buclizine ? increases both appetite and assimilation of food
Cyproheptadine- increases only appetite. No effect on assimilation

Maintenance of weight gain

Buclizine ? due to dual action, it helps to maintain weight gain even
after
discontinuation of therapy

Cyproheptadine ?  weight gain is not maintained after discontinuation
of
therapy.

Safety

Buclizine ? better safety profile
Cyproheptadine ? not safe as it affects growth hormone levels

Use in constitutional underweights

Buclizine ? has effect in constitutional underweights due to protein
sparing action (+ ve nitrogen balance)
Cyproheptadine ? no effect in constitutional underweights

Ban on use

Buclizine ? no ban on use as appetite stimulant
Cyproheptadine ? banned in U.K.

Economy

Buclizine ? economical- 70 paise per tablet
Cyproheptadine ? 1.15 per tablet

Clinical proof

Buclizine ? superior to Cyproheptadine in terms of reappearence of
appetite
and weight gain
Guevera et al, Revista de la clinica de la conducta, 1972,5/11,34-38
Cyproheptadine- inferior to Buclizine

Buclizine ? superior to Cyproheptadine in terms of weight gain weeks
after
treatment (Devera ?kelker)
Cyproheptadine- inferior to Buclizine

Recent published reference

Buclizine ? Rajadhyaksha et al, Indian medical gazette, nov. 1998, vol
CXXXII no. 11, 327-330
Cyproheptadine- no references as not used as appetite stimulant

Additional weaponry supplied by this manufacturer to Doctors is
literature
such as:
    * An  announcement in Scrip World Pharmaceutical News,(1995) which
says
that MS and D has withdrawn Cyproheptadine syrup in the U.K.
    * a copy of the Government Gazette of India which banned a
combination
of Cyproheptadine with lysine or peptone(2001)
    * photocopy of a page from Goodman and Gilman which attribute
weight
gain and increased growth in children to an interference with
regulation of
the secretion of growth hormone
    * chart of mechanism of action of Buclizine, leading to increased
appetite and protein sparing effect!
    * a published paper(1998) in an Indian Journal showing appetite
stimulant and weight gain effects of a few clinical trials of Buclizine
(from 1966-1972!)
    *  Photocopy of Martindale page showing Cyproheptadine as being no
longer recommendd as a appetite stimulant.

The pharmaceutical company has made a lot of efforts to scare the
doctors
into not prescribing Cyproheptadine.

My question to e-druggers is, for all this decrying of Cyproheptadine
by
the company, is Buclizine itself really effective and safe, and
recommended
as an appetite stimulant and to increase weight gain?

Raj Vaidya, M.Pharm,
Community Pharmacist,
Hindu Pharmacy,
Cunha Rivara Road, P.B.No. 149,
Panaji - Goa - India 403001.
Tel : 91-832- 2223176, 2432903 (O), 2463926 (R).
Email : pharmhin@sancharnet.in



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