Steven-Johnson syndrome may NOT be due to ayurvedic drugs - 1.

Sir,

A recently published article in IJP[1] (Steven-Johnson syndrome due to Ayurvedic drugs) has a number of flaws. The medicine quoted by the authors fulfills the criteria for “misbranded” drug rather than anything else. Authors say that the pills resembled small balls and were white in color. Usually, Ayurvedic pills are herbal extracts and no dosage forms in Ayurveda resemble this description. It is somewhat suggestive of Allopathic or Homeopathic pills (if they are sweet in taste). As per the case report, the patient was under medication for 12 years. Sudden appearance of SJS (within 3 days) suggests some other etiology. SJS is said to be frequently associated with recent drug ingestion or autoimmune disease. The authors have given a vague list of drugs under the heading “Ayurvedic drugs” (Ginko, Echinasia, St. John's wart, Ginsing, etc.). These are western herbal drugs and not Ayurvedic medicines. The safety of Ayurvedic drugs (including that of Swarna Bhasma[2]) has been documented in several useful research works. Regarding Parad (mercury) preparations, these are not used in elemental form and are usually prescribed as sulfides and safety of these is also established.[3]

It is requested that the information on adverse drug reaction to Ayurvedic medicines, if any, should be passed onto the regional or national pharmacovigilance centers of AYUSH for proper registration. Although a technical term equivalent to “pharmacovigilance” does not feature in Ayurvedic texts, the spirit of pharmacovigilance is vibrant throughout Ayurveda's classical literature. Pharmacovigilance aims to improve patient care and safety during treatment, and thus to promote rational use of medications. These are the recurrent themes of Ayurvedic pharmacology (Dravyaguna), pharmaceutics (Rasa Shastra and Bhaishjya Kalpana), and therapeutics (Chikitsa).