With the rise in cases of vector-borne diseases like dengue, and chikungunya, the Delhi government has issued an advisory to restrict the sale of painkillers like Ibuprofen, Aspirin and Diclofenac without a prescription. The Department of Drug Control’s latest advisory, released on July 19, also emphasizes that the surge in vector-borne diseases, such as dengue and chikungunya, is rising through the rainy season. In response to this alarming trend, the Department has urged chemists to maintain meticulous records of painkiller drugs[1].
The official advisory stated, “There is a likelihood that the number of cases may increase in pre and post-monsoon season, which is to be monitored very strictly.” Even though the flood waters have receded, experts caution that some areas might retain stagnant pools, providing ideal breeding spots for mosquitoes. Keeping up with the numbers, as of July 22 this year, the national capital has unfortunately witnessed a significant spike in dengue cases, reaching nearly 190 reported cases. This is the highest number of cases since 2018, raising concerns among health authorities. The report released by the Municipal Corporation of Delhi (MCD) further indicates that there have been 61 malaria cases in the same time frame[2].
What are Vector-borne Diseases?
Vector-borne diseases are a group of human illnesses caused by tiny parasites, viruses, and bacteria that latch on certain carriers known as vectors. These diseases are responsible for over 17% of all infectious illnesses, like dengue, malaria, chikungunya fever, Zika virus fever, yellow fever, etc, resulting in more than 700,000 deaths yearly. Vectors act as intermediaries, passing these harmful pathogens from one individual to another or even from animals to humans. Among the most common vectors are bloodsucking insects, such as mosquitoes, which transmit these diseases[3].
Reason for Banning Painkillers Without Prescription of a RMP (Registered Medical Practitioner)
“It is desired in the public interest that during the season of dengue and chikungunya, use of drugs like Aspirin, Ibuprofen and Diclofenac group of medicines (which further destroy platelets in human blood) may be restricted to be sold against the prescription of Registered Medical Practitioner only.” mentioned the advisory[1]. Owing to the symptoms of dengue and chikungunya, such as extreme body aches, high-grade fever, headache, swollen glands etc., people tend to buy these painkillers as they can relieve pain and inflammation. However, medical experts emphasize that the unsupervised usage of these NSAIDs (Nonsteroidal anti-inflammatory drugs) like Ibuprofen, Aspirin and Diclofenac can cause platelet destruction, which is dangerous for patients with vector-borne diseases.
In certain instances, patients self-prescribe these readily available medicines, and chemists, in turn, dispense them without requiring any prescription, posing life-threatening consequences. Rommel Tickoo, a senior consultant for internal medicine at Max Hospital, claimed that these medicines could potentially trigger serious health issues for dengue patients, resulting in bleeding and a decline in platelet count. Platelets are multifunctional cells in the bloodstream that help in thrombosis, hemostasis and wound healing[4]. The primary function of platelets is to prevent and control blood from clotting. Therefore, when the body is attacked by dengue virus, it spreads via the bloodstream and attaches itself to platelets, causing a drop in platelet count(also known as thrombocytopenia)[5]. Now when the platelet count drops, the body cannot form clots. This may lead to bleeding, vital organ damage and other life-threatening symptoms.
Due to the prevailing situation, the Department also said that “Retail chemists are, therefore, advised not to indulge in the over-the-counter sale of NSAIDs drugs like Aspirin, Ibuprofen and Diclofenac group of medicines with immediate effect till further directions.” The Department declared strict actions for anyone caught disregarding the advice.
With this letter of caution, the Delhi government aims to set a precedent of staying vigilant against the misuse of readily available over-the-counter painkillers for vector-borne diseases to protect ourselves and our communities from unforeseen consequences.
(The article is written by Dr.Subita Alagh, Senior Executive, and reviewed by Dr. Sachin Gupta, Manager, Clinical Health & Content, Medical Affairs)
References
1. Available from: https://drugs.delhi.gov.in/sites/default/files/drugs/generic_multiple_files/dengue_advisory_19.07.2023.pdf
2. Available from: https://www.businesstoday.in/latest/trends/story/dengue-cases-in-delhi-hit-5-year-high-in-2023-190-infections-reported-till-july-22-391140-2023-07-25
3. World Health Organization. Vector- Borne Diseases. Available online at: https://www.who.int/news-room/fact-sheets/detail/9vector-borne-diseases
4. Holinstat M. Normal platelet function. Cancer Metastasis Rev. 2017 Jun;36(2):195-198.Available online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709181/
5. Das S, Abreu C, Harris M, Shrader J, Sarvepalli S. Severe Thrombocytopenia Associated with Dengue Fever: An Evidence-Based Approach to Management of Thrombocytopenia. Case Rep Hematol. 2022 Aug 12;2022:3358325. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391179/#:~:text=Thrombocytopenia%20in%20dengue%20may%20arise,enhanced%20platelet%20destruction%20in%20patients