Abdaal-e-Advia (Drugs substitution)

 

                                    Abdaal-e-Advia (Drugs substitution)

backgrounds

Drug substitution/ therapeutic interchange (Abdal-e-Advia) is an important concept of Unani medicine pharmacotherapy. It deals with principles, requirements, and related aspects of drug substitution or interchange of drugs for therapeutic purposes.

Zakariya Razi (865–925 AD) authored a treatise Kitab-al-Abdal on the subject of Drug substitution/ therapeutic interchange. he has mentioned substitutes for 122 drugs in this treatise. He also described the concept of Abdaal-e- Advia (Drug substitution/ therapeutic interchange) in detail.

 Ibn-e- Sina (980–1037 AD) also discussed the topic of drug substitution/ therapeutic interchange in his famous treatise the Al Qanoon fil Tib. He has described substitutes for a total of 61 drugs out of the 781 drugs described by him. He also discusses the concept of drug substitution and framed guidelines for alternate drug prescriptions at the time of unavailability of the drugs of choice.

Introduction

Drug substitution/ therapeutic interchange (Abdaal-e- Advia), of a rare or unavailable medicine, is substituted by more readily available medicine. Drug substitution is the replacement of an unavailable drug of therapeutic choice with an available alternate drug. Hence it is an alternate drug prescription at the time of unavailability of the drugs of choice. In other words, drug substitution is the replacement of one plant species by another in special circumstances. The new species is often of a completely different genus, but with similar therapeutic properties and effects/ actions. The concept of substitution of drugs (Abdaal-e- Advia) is an established practice in the Unani system of medicine. The concept of drug substitution (Abdaal-e- Advia) is based on the similarity in action, temperament, and physical properties of drugs mainly botanicals, which are already established and have no need for further evaluation. Recently, scientific studies have proved the efficacy of several botanicals on a phytochemical basis indicating that drugs having similar active constituents may exert similar pharmacological actions.

Need for Substitution

• Non-availability of the drug
• Uncertain identity of the drug
• Cost of the drug
• Geographical distribution of the drug
• The adverse reaction of the drug
• Legal issues

Unani Concept of drug substitution (Abdal-e-Advia)

Drugs are substituted when they are endangered, costly, rare, banned or the procurement is cumbersome. A drug is prescribed as a substitute only for a particular action, as the substitute could differ from the main drug in other actions. In classical Unani text, there are frequent examples of substitutes between drugs of different origins, e.g. a botanical-origin drug can be a substitute for an animal or geological-origin drug. Similarly in the unavailability of a fresh drug, inferior quality of the same may be used in increased doses to maintain efficacy. Similarly, if a particular desired part of a botanical drug is unavailable then other parts of the same botanicals may be used if both of these have the same action.

Criteria for Substitution: In case of non-availability of the intended drug, another drug having similar action or temperament or physical properties or any two or all is substantial for selection of a substitute. The criteria for drug substitution/ therapeutic interchange are as follows.

1. The similarity in Action (Yaksaniyat-e-afal ): Both drugs exhibit similar therapeutic effects. 

2. The similarity in temperament (Yaksaniyat-e-mizaj ) of drugs: Both drugs have similarities in temperament (Yaksaniyat-e-mizaj).

3. The similarity in physical properties (Yaksaniyat-e-zahiri khususiyat ): Both drugs have similar physical properties /organoleptic characters.

Types of substitution of the drug (Abdaal-e- Advia): It is mainly classified into three types

1. Closest substitution (Badal-e-aqrab)
2. Closer to substitution (Badal-e-qareeb)
3. Remote substitution (Badal-e-bayed)

1.      Closest substitution (Badal-e-aqrab): Badal (substitution) is the closest substitution (Badal-e-aqrab) if both drugs have similar action, origin, and type, e.g., a substitute of natural borax is artificial borax.

2. Closer to substitution (Badal-e-qareeb): if both drugs are similar in action and origin is called closer to substitution (Badal-e-qareeb), like ammonium chloride is a therapeutic interchange of natural borax.
3.  Remote substitution (Badal-e-bayed): if both drugs are similar in action only, is called remote substitution (Badal-e-bayeed). e.g., natural borax is a substitute for black mustard.

However, preference is given to similarity in action followed by origin and lastly type of drugs.

Classification of substitution of the drug (Abdaal-e-Advia) based on therapeutic actions: Other classification of Substitution of the drug (Abdaal-e- Advia) is as follows.

1. Complete substitution (Badal-e- Kulli): When, main and substitute drugs are similar in all actions, practically rare, it is called complete substitution (Badal-e- Kulli)
2. Partial substitution (badal-e-juzwi): When the drugs are similar in a few actions, it is called partial substitution (badal-e-juzwi).

 

Abdaal-e-Advia