Savita Shastry was diagnosed with Parkinson’s disease almost five years ago. Since she leads an active lifestyle and does a lot of work involving fine hand movements like lacemaking, the disease was not noticeable and was well under control with minimum medication.
A year ago, Savita was diagnosed with cancer. She had the surgery and the necessary chemotherapy. But she was told about the havoc that the chemotherapy would have on her Parkinson’s disease. A long-term, degenerative disorder of the central nervous system, Parkinson’s disease affects a person’s motor skills. The severity varies from patient to patient, with symptoms ranging from tremors, stiffness and slowness to impaired balance and inability to walk.
The 59-year-old now finds that for almost 8-10 of her waking hours she is unable to use her hands for finer movements. One of the things that she needs to do is take her medication. Presently, she is only on medicines for Parkinson’s and has to take a total of ten tablets a day. Her muscle inflexibility is at its peak at the time of her medication.
But Savita says that taking her medication is quite the task. “These tablets are small and wrapped in aluminium foil. It’s quite a job to open the tablets, and I prefer to do it myself. So, ten tablets a day is 300 tablets a month. Since I take three different tablets, it is 100 each. I am sure the companies that make these tablets are aware of how it affects the people. Why can’t they make them in reusable bottles? People like me will be taking these lifelong and will be thankful for making us capable of doing these small jobs by ourselves.”
Hariprasad, who was diagnosed with Parkison’s disease 10 years ago, says, “Since this disease is a progressive one, the number of tablets can increase over the years. Again, it depends from patient to patient and the severity of the disease.” He underwent the Deep Brain Stimulation (DBS) surgery that has helped stabilise the tremors. Leading a fairly healthy life now, Hariprasad suggests, “The drug company can come up with bottles that dispense only one tablet at a time. This can prevent any misuse of the drugs.”
Dr P R Krishnan, Senior Consultant Neurologist at Fortis Hospitals, Bangalore says, “Packaging drugs in reusable bottles might increase the drug prices which might not be received well by the patients.”
However, packaging experts told TNM that packaging has no effect on the price of drugs.
Dr Krishnan says a lot of factors go into having the drugs packed into aluminium strips.
“The drugs are hygroscopic (absorb moisture from the air) and sensitive to sunlight. Their size also plays a role. If drugs are to be packaged in bottles, the pharma companies will have to use a whole new machinery for that, especially if the bottles are the ones that dispense one tablet at a time. This will, in turn, affect the drug prices,” says Dr Krishnan.
He also suggests that instead the drugs be packaged in thinner aluminium strips. “Most of the patients do not find cutting movements difficult. For them tearing, however, is difficult. It’s like how some patients find walking painful, but cycling is all right with them. These patients can use scissors to cut a thinner foil. The foil, however, must have adequate holding space for the fingers and the scissors,” he added.
Some experts are of the opinion that strips help the patients to keep track of their drug intake. Elderly patients with dementia might lose track of the number if the drugs are bottled. Multi-dosage drug toxicity can occur frequently in such cases.
Goutama Buddha, a pharmaceutical packaging consultant says, “Bottles are used for some long-term medications like for cardiovascular diseases and diabetes.”
He argues that the benefit of having tablets in aluminium strips is that each individual tablet is protected and each pocket contains one tablet. “The surrounding area is sealed. So, if you open one tablet, the other tablets in the strip are also protected in the long term. In a bottle, this is not the case. Also carrying a bottle has its inconveniences,” adds Goutama.
Goutama says one solution is a peelable blister strip, which is currently used for packing arthritic drugs for elder patients can be used for packing drugs for Parkinson’s disease. “Here the top aluminium foil, which is thin, can be peeled off to take the tablet. The pharma companies need to explore this option to accommodate the needs of patients with Parkinson’s disease,” he says.