Medications on the Bill - Detailed Content

1. DEFCORT 6MG TABLETS (Deflazacort)

• Drug class: Corticosteroid (glucocorticoid)
• Active ingredient: Deflazacort - an oxazoline derivative of prednisolone
• Mechanism: Stabilizes cell membranes, decreases inflammation, inhibits myocyte cell death
• Common uses:
  • Duchenne Muscular Dystrophy (DMD) - a primary/FDA-approved indication; shown to improve muscle strength and prolong ambulation better than prednisone
  • Rheumatoid arthritis, autoimmune conditions, inflammatory disorders, allergies
  • Shown to substantially reduce need for spinal surgery in DMD patients (20% vs 92%)
• Advantage over prednisone: Considered to have a slightly better side-effect profile, particularly less weight gain
• Source: Campbell's Operative Orthopaedics 15th Ed; Fishman's Pulmonary Diseases

2. PANTOCID 40MG TABLET (Pantoprazole)

• Drug class: Proton Pump Inhibitor (PPI)
• Active ingredient: Pantoprazole 40 mg
• Mechanism: Irreversibly inhibits the H+/K+-ATPase (proton pump) in gastric parietal cells, blocking acid secretion
• Common uses:
  • Gastric ulcers, duodenal ulcers
  • Gastroesophageal Reflux Disease (GERD)
  • Laryngopharyngeal reflux
  • Prevention of steroid-induced peptic ulcers (often co-prescribed with corticosteroids like Defcort)
  • Zollinger-Ellison syndrome
• Note: In this prescription, it is very likely prescribed to protect the stomach from the corticosteroid (Defcort), as steroids increase the risk of gastric ulcers
• Source: Katzung's Basic and Clinical Pharmacology, 16th Ed; Lippincott Illustrated Reviews Pharmacology

3. TOFASHINE XR 11MG TABLET (Tofacitinib Extended Release)

• Drug class: JAK inhibitor (Janus Kinase inhibitor) - specifically JAK1/JAK3 inhibitor
• Active ingredient: Tofacitinib 11 mg (extended-release formulation)
• Mechanism: Inhibits JAK1 and JAK3 enzymes, blocking the JAK-STAT signaling pathway responsible for cytokine-driven inflammation
• Common uses:
  • Rheumatoid Arthritis (RA) - major indication; shown non-inferior to adalimumab when combined with methotrexate
  • Psoriatic arthritis
  • Ulcerative colitis
  • Lupus nephritis (under investigation)
  • Systemic sclerosis/scleroderma (emerging use)
  • Alopecia areata (emerging/off-label)
• XR 11 mg: The once-daily extended-release form; bioequivalent to tofacitinib 5 mg twice daily
• Key safety note: Carries a black-box warning for serious infections, malignancies, and thrombosis
• Source: Firestein & Kelley's Textbook of Rheumatology; Lippincott Illustrated Reviews Pharmacology

4. BEPLEX FORTE TABLETS (B-Complex + Vitamin C)

• Drug class: Multivitamin supplement
• Active ingredients: Contains the full B-vitamin complex:
  • Vitamin B1 (Thiamine)
  • Vitamin B2 (Riboflavin)
  • Vitamin B3 (Niacin)
  • Vitamin B5 (Pantothenic acid)
  • Vitamin B6 (Pyridoxine)
  • Vitamin B7 (Biotin)
  • Vitamin B9 (Folic acid)
  • Vitamin B12 (Cyanocobalamin)
  • Vitamin C (Ascorbic acid)
• Uses: Nutritional support, prevention of B-vitamin deficiency, nerve health, co-prescribed with corticosteroids and JAK inhibitors to counter nutritional depletion

5. D-RISE (SACHET 1G) 60,000 IU (Vitamin D3)

• Drug class: Vitamin D supplement
• Active ingredient: Cholecalciferol (Vitamin D3) - 60,000 IU per sachet
• Mechanism: Cholecalciferol is converted in the liver to 25-hydroxyvitamin D, then in the kidneys to the active form 1,25-dihydroxyvitamin D (calcitriol), which regulates calcium absorption and bone metabolism
• Common uses:
  • Vitamin D deficiency / insufficiency
  • Bone protection - especially important here since long-term corticosteroid use (Defcort) causes bone loss and osteoporosis
  • Immune modulation
  • Muscle function support
• Dosing note: 60,000 IU is a weekly or monthly "loading dose" sachet - typically given once weekly for 8-12 weeks to correct deficiency
• Source: Katzung's Basic and Clinical Pharmacology, 16th Ed; Tietz Textbook of Laboratory Medicine 7th Ed

Why These 5 Drugs Together?