Trends and patterns of analgesic utilization in Malaysia from 2010 to 2016: preference for tramadol

• Main Authors: Zin, Che Suraya, Mohamed Nazar, Nor Ilyani, Ab Rahman, Norny Syafinaz, Alias, Nor Elina, Ahmad, Wan Rohaidah, Rani, Nurul Sahida, Ng, Kim Swan, Ye, Felicia Loh
• Format: Conference or Workshop Item
• Language: English
• Published: 2018
• Subjects: RM Therapeutics. Pharmacology; RM300 Drugs and their action
• Online Access: http://irep.iium.edu.my/66544/1/180921_abstract_ispe_irep.pdf; http://irep.iium.edu.my/66544/; https://www.pharmacoepi.org/meetings/34icpe/

Introduction Inappropriate or irrational use of analgesics not only leads to increased morbidity and mortality rates and deterioration in quality of life, but can also give rise to misuse of health care resources and increase health care costs. Objective To address the trends of analgesics prescribing at outpatient tertiary hospital settings and examine the patterns of their utilization in NSAIDs, tramadol and opioid users. Methodology This cross sectional study was conducted from 2010-2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid and naproxen), tramadol and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Each prescription contains information on item name and strength, prescription date, frequency, quantity and patients’ age and gender. Annual number of patients, prescriptions, prescriptions per patient were measured in repeat cross sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata v13 Results A total of 192747 analgesic prescriptions of the nine NSAIDs, tramadol and five other opioids were prescribed for 97227 patients (51.8% NSAIDs users, 46.6% tramadol users and 1.7% opioid users) from 2010 to 2016. Tramadol (37.9%, n=72999) was the most frequently prescribed analgesic followed by ketoprofen (17.5%, n=33793), diclofenac (16.2%, n=31180), celecoxib (12.2%, n=23487) and other NSAIDs (<4.5%). All analgesics were increased over time except for meloxicam, indomethacin and mefenemic acid. Opioids, primarily morphine (2.2%, n=4021) and oxycodone (0.5%, n=1049), were prescribed the least but the increase in utilization was greatest. The number of prescriptions/patient per year was higher in the opioid group (3.06 prescription/patient) than in the tramadol (1.30) and NSAID (1.65) groups. Conclusions Tramadol was the most frequently prescribed analgesic at outpatient hospital settings in Malaysia. NSAIDs, primarily for ketoprofen, diclofenac and celecoxib. Opioids were prescribed the least but the increase in utilization was the largest. Further research is required to evaluate the indication of the analgesics used in this study and its relevant clinical outcomes particularly in patients using tramadol for long term and concurrent usage with other CNS depressant drugs such as antidepressants.