–
–
a common drug related problem
a common drug related problem
–
–
but unnecessary?
but unnecessary?
Christer Berg
Christer Berg1, Dan Haupt, Dan Haupt2, Anders Ekedahl , Anders Ekedahl 1,3
1 School of Pure and Applied Natural Sciences, University of Kal
1 School of Pure and Applied Natural Sciences, University of Kalmar, mar, Kalmar, 2 Department of Health Sciences, Lulea University of Kalmar, 2 Department of Health Sciences, Lulea University of Technology, Lulea, 3 R & D, National Corporation of Swedish Technology, Lulea, 3 R & D, National Corporation of Swedish
Pharmacies Pharmacies
Background
Background
Prescriptions on dosages with split tablets are
Prescriptions on dosages with split tablets are
common in Sweden. However many elderly have
common in Sweden. However many elderly have
difficulties to handle packs and tablets due to
difficulties to handle packs and tablets due to
fumbling and impaired vision. Splitting tablets in
fumbling and impaired vision. Splitting tablets in
halves may increase the problem to comply with
halves may increase the problem to comply with
prescribed treatment.
Background 2
Background 2
All data on all dispensed prescriptions in Sweden
All data on all dispensed prescriptions in Sweden
are stored in "
are stored in "ApoteketsApotekets TransaktionsDatabasTransaktionsDatabas –– ATD"
ATD"
ATD contains as a text
ATD contains as a text--string the dosage instruction string the dosage instruction written on the label, pharmacists must attach to the
written on the label, pharmacists must attach to the
package when dispensed
package when dispensed
The text
Objective
Objective
To examine to what extent dosages with split
To examine to what extent dosages with split
tablets are prescribed in Sweden
Design
Design
Data on all dispensed prescriptions during one
Data on all dispensed prescriptions during one
month.
month.
Data included patient gender, year of birth,
Data included patient gender, year of birth,
dispensed drug (ATC
dispensed drug (ATC--code, name, administration code, name, administration form, strength, pack size) and prescribed dosage.
form, strength, pack size) and prescribed dosage.
Drugs: beta blockers, calcium inhibitors, ACE/AII
Drugs: beta blockers, calcium inhibitors, ACE/AII- -inhibitors, lipid lowering agents,
inhibitors, lipid lowering agents,
anxiolytics
Administration form: tablets
Administration form: tablets
Main Outcome Measures: numbers and proportions
Main Outcome Measures: numbers and proportions
of prescriptions with dosages on split tablets
Results
Results
607,520 prescriptions on 74 different
607,520 prescriptions on 74 different
substances were examined.
substances were examined.
Dosages with split tablets were prescribed on
Dosages with split tablets were prescribed on
9.7% of all prescriptions
9.7% of all prescriptions
(7.8±8.6%;
Results Results 8,6% 2,2% 6,7% 1,1% 17,4% 7,0% 14,9% 22,7% 21,4% 0,0% 5,0% 10,0% 15,0% 20,0% 25,0% Betablockers Calciumblockers ACE-inhibitors Lipid low ering agents Thyroxin Neuroleptics Anxiolytics Sedatives/Hypnotics Antidepressants/SSRI´s
0,00% 5,00% 10,00% 15,00% 20,00% 25,00% 30,00% 35,00%
Pindolol PropranololTimolol Sot alol M et oprololAt enolol BisoprololLabet alol Karvedilol M et oprolol+combA mlodipin FelodipinIsradipin Nif edipin Nimodipin LercanidipinVerapamil Dilt iazem Kapt oprilEnalapril LisinoprilRamipril Kinapril Cilazapril Fosinopril Enalapril+HCT Lisinopril+HCTRamipril+HCT Kinapril+HCT Ciazapril+HCTSimvast at in Pravast at inFluvast at in A t orvast at in Rosuvast at inBezaf ibrat Gemf ibrosilFenof ibrat Nicot in acidEzet imib Levot yroxin Klorpromazin LevomepromazinDixyrazin Fluf enazin Perf enazin ProklorperazinTioridazin HaloperidolM elperon Flupent ixol Klorprot ixen Zuklopent ixolPimozid Klozapin OlanzapinQuet iapin SulpiridLit ium Risperidon AripiprazolLorazepam ChlordiazepoxidDiazepam Alprazolam Nit razepam Flunit razepamTriazolam Fluoxet in Cit alopramParoxet in Sert ralin Fluvoxamin Escit alopram
Results
Results
The 4
The 4thth quartile quartile –– 19/74 drugs 19/74 drugs
constituted 92.8% of all prescriptions
constituted 92.8% of all prescriptions
with split tablets
with split tablets
thyroxin; thyroxin; 2 beta blockers; 2 beta blockers; 3 antidepressants and 3 antidepressants and 3 benzodiazepines 3 benzodiazepines
Results
Results
Proportions of prescriptions on split tablets in Sweden
Proportions of prescriptions on split tablets in Sweden
with reference to age and gender for
with reference to age and gender for levothyroxinelevothyroxine (H03), (H03), anxiolyticsanxiolytics (N05BA),(N05BA), sedatives/hypnotics (N05CD) and antidepressants N06 AB
sedatives/hypnotics (N05CD) and antidepressants N06 AB
Age
Age GenderGender
0,0% 5,0% 10,0% 15,0% 20,0% 25,0% 30,0% H03 N05 BA N05 CD N06 AB 0-65 65+ 0,0% 5,0% 10,0% 15,0% 20,0% 25,0% 30,0% H03 N05 BA N05 CD N06AB W omen Men
Results
Results
Thyroxin and
Thyroxin and SSRIsSSRIs were studied separatelywere studied separately Prescribing with split tablets was
Prescribing with split tablets was
"unnecessary"
"unnecessary" -- 50.5 and 44.7%50.5 and 44.7% "avoidable"
Conclusion:
Conclusion:
Prescribing of dosages with split tablets is common but in
Prescribing of dosages with split tablets is common but in
most cases unnecessary.
most cases unnecessary.
Reason for the prescribing may be
Reason for the prescribing may be
Physicians may be
Physicians may be
-- unaware or not updated on available products unaware or not updated on available products
-- OR want to reduce costs OR want to reduce costs
-- OR avoid generic substitution;OR avoid generic substitution;
Pharmaceutical companies may be unaware
Pharmaceutical companies may be unaware
of prescribed dosages
Proposal
Proposal
Allow pharmacists in Sweden to adjust prescribed
Allow pharmacists in Sweden to adjust prescribed
dosages to licensed and available strength without
dosages to licensed and available strength without
previous contact with the
Thank you for your attention!
