Objectives: To evaluate patterns of dispensing of medicines from private community pharmacies in Tamilnadu and to identify and analyze problems in medicine supply or dispensing toward its rational use. Methods: A cross-sectional study was carried out in two towns of Tamilnadu, India between July 10 and October 25, 2009. Medicines dispensed from 24 randomly selected pharmacies, each from a different area of two towns were investigated. Two 2 hour study visits were made. Data were collected by observations and interviews with pharmacists or drug retailers. Results: A total of 1160 medicines were dispensed; 44.2% on a doctors prescription and the remaining over the counter (26.9% on request by clients themselves and 28.9% on recommendations from pharmacists). Anti-infective agents were the most commonly dispensed (20.6% of all items), followed by medicines acting on the gastrointestinal system (18.2%), vitamins and nutritional supplements (10.9%), analgesics and antipyretics (10.5%). More than three-quarters of the anti-infective agents (n=188; 78.7%) were provided over the counter. The study indicates that 61.2% of prescription-only medicines were dispensed over the counter. Conclusions: Extensive supply of medicines (both prescription-only and over the counter) from private pharmacies, including those used for serious illnesses, has been observed. The study shows trends toward inappropriate dispensing. Educational and managerial interventions to improve dispensers’ knowledge, professional behavior and attitudes are required to improve the situation - Southern Med Review Vol 3 Issue 2 Oct 2010