# Rational Prescribing > Rational prescribing for FMGE Pharmacology: WHO six-step cycle, P-drugs, prescription parts, the 2016 FDC ban and generic prescribing in India. - Canonical URL: https://prepelephant.com/topics/fmge/pharmacology/rational-prescribing-fmge - Exam / course: FMGE · Subject: Pharmacology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Rational Prescribing", PrepElephant, https://prepelephant.com/topics/fmge/pharmacology/rational-prescribing-fmge ## Direct answer Rational prescribing follows the WHO's six-step cycle from the Guide to Good Prescribing: define the patient's problem, specify the therapeutic objective, verify the chosen P-drug is appropriate (efficacy, safety, suitability, cost), write the prescription, inform and instruct the patient, and monitor — and stop, correct, or continue. The WHO's yardstick of rational use: patients receive medications appropriate to their clinical needs, in doses meeting individual requirements, for an adequate duration, at the lowest cost to them and the community. Irrational prescribing in India has recognisable faces — polypharmacy, antibiotics for viral infections, injection overuse, over-the-counter self-medication and irrational fixed-dose combinations, 344 of which were banned by central notification in 2016. The prescription itself is an examinable document: superscription (the Rx symbol), inscription (drug, dose, strength), subscription (quantity to dispense), signatura (directions to the patient), with generic naming now an ethical expectation and dose abbreviations a recognised source of error. ## What you must remember - **Six steps in order:** (1) define the problem, (2) set the therapeutic objective, (3) choose the P-drug and verify suitability for this patient, (4) write the prescription, (5) educate the patient, (6) monitor and decide stop/adjust/continue. - **P-drug concept:** the personal, well-understood drugs a prescriber selects in advance for common conditions — efficacy, safety, suitability and cost weighed before the patient arrives. - **Prescription anatomy:** superscription (Rx), inscription (drug and dose), subscription (dispensing instructions to the pharmacist), signatura (label directions to the patient); date, signature, refill count and prescriber registration complete it. - **Error-prone abbreviations:** "U" for units (misread as zero or 4), µg misread as mg, QD/QID confusion, trailing zeros — write "units" and "micrograms" in full. - **Irrational patterns India-wide:** antibiotic + antipyretic for every fever, corticosteroid combinations for rash, high-end antibiotics for community infections, and injections where tablets would do — each drives resistance, cost and harm. - **The 2016 FDC ban:** 344 fixed-dose combinations (including several paracetamol-nimesulide and codeine-containing mixtures) prohibited as irrational — a milestone FMGE likes because it joins pharmacology to policy. - **Generic prescribing** is a professional-ethics expectation (and government-policy push) in India; Jan Aushadhi (PMBJP) outlets make quality generics affordable, strengthening the lowest-cost limb of the WHO definition. - **Special-dose populations:** renal impairment, hepatic disease, extremes of age, pregnancy — "one standard dose fits all" is itself an irrational prescription. ## A first prescription, walked through the six steps A 30-year-old presents with a sore throat, cough and fever for two days; examination shows congested throat, no exudate, no cervical nodes, no chest signs. Step one — the problem is an upper respiratory infection, overwhelmingly viral in this setting. Step two — the therapeutic objective is symptom relief and reassurance, not bacterial eradication. Step three — P-drugs: paracetamol 500–650 mg as needed for fever and pain, saline gargles; an antibiotic fails the suitability test because it adds nothing but resistance pressure and adverse-effect risk. Step four — write it generically: paracetamol 650 mg, one tablet up to four times daily for three days, maximum daily dose stated. Step five — counsel: expected course, danger signs that mandate return, why no antibiotic was given. Step six — review if symptoms exceed a week or worsen. Notice how the six steps convert a pressure situation (the patient "expects a course of tablets") into a defensible, teachable decision — and how each step, isolated, becomes one MCQ: which step is "specify the therapeutic objective", what makes a drug a P-drug, which prescription part is the signatura. The framework rewards understanding over recall. ## Where students slip Candidates can recite the steps but scramble their order — objective-setting (step 2) precedes drug choice (step 3), and monitoring (step 6) includes the explicit stop-or-continue decision. Second, prescription-part questions are pure terminology marks: inscription versus subscription versus signatura; the signatura is the patient-direction element, the subscription is pharmacist-directed. Third, rationality is judged against the four criteria — appropriate need, individual dose, adequate duration, lowest cost — so a clinically correct drug given at a fixed adult dose in advanced renal failure is still irrational. Finally, the FDC-ban and generic-prescribing items tie this chapter to national policy; treating them as "general knowledge" rather than syllabus is how marks leak. ## Frequently asked questions ### What are the WHO's six steps of good prescribing? Define the problem, specify the therapeutic objective, verify the suitability of the P-drug, write the prescription, give information and warnings, and monitor treatment with a stop/adjust/continue decision. ### What is a P-drug? A drug a prescriber has pre-selected from evidence for a common condition, knowing its efficacy, safety, suitability and relative cost — the prescriber's personal first choice, adapted to the individual patient. ### Which parts make up a written prescription? Superscription (Rx), inscription (drug, dose, strength), subscription (dispensing quantity/instructions to the pharmacist) and signatura (directions for the patient), plus date, signature and identity of the prescriber. ### Why were 344 fixed-dose combinations banned in India in 2016? They were found irrational — no therapeutic justification, unsafe or ineffective combinations — making them a policy-level example of irrational prescribing. ### What does the WHO definition of rational drug use require? That patients receive medicines appropriate to clinical needs, in doses meeting individual requirements, for an adequate duration, and at the lowest cost to them and society.