It is a pity in a country like India, that so much money of the poor patients is being spent on the tonics. Every pharmaceutical firm comes out with new formulae to claim superiority over the existing ones. Most of the times, general tonics are being used for the following indications:
- Loss of Appetite
Contents of the tonics: The usual contents of the tonics are:
- Iron: Most of the pharmaceutical companies go on stressing that their tonic contains only a small quantity of iron and will not therefore cause GI upset. Yet, the doctors use these tonics for treating anaemias. Anaemia must be treated with full dose of Iron e.g. ferrous Sulphate tablets . in combined deficiency anaemias, pills containing Folic acid or B12 may be used.
- Hormones: Often small doses of hormones are added to tonics. In fact, at times, some hormones may actually cause harm to old people.
- Glycerophosphates: These are the main ingredients of all tonics. But really speaking, there has been no satisfactory evidence to show pharmalogic or metabolic actions of these drugs in human body.
- Alcohol: It is added for the sense of well being and appetite. But then, one may use only alcohol for such purposes, e.g. in old persons, 1 oz of whisky before dinner not only gives appetite but also good sleep.
- Strychnine: It is used as better appetizer. It stimulates the appetite centre of human body.
- Vitamins: They are the ingredients of many tonics. But then, vitamin tablets can be used wherever there is deficiency of these vitamins. These are much cheaper. But there is also a constant danger of toxicity due to over dosage of Vitamin A and D, especially in children. This, by itself, causes loss of appetite, fatigue, weakness, depression, aches all over the body, etc. vitamin K can also cause Jaundice in children, when given in excessive doses. Tons of Vitamin B12 is wasted in tonics. It requires 6 months to 6 years for a well nourished body to be depleted of Vitamin B12 to a point of detectable haematologic relapse. Thus, even when needed, very small doses of Vitamin B12 are required by the body.
Thus a good general practitioner uses tonics as less as possible. In convalescence, a good diet is far superior than tonics, e.g. addition of horlicks to a glass of milk. Disadvantages of General Tonics:
- Unnecessary expense to the patient
- Doctor may miss the diagnosis
- Anaemia will not be treated adequately