Backgroud: The paucity of information on prescribing patterns and use of antidepressants in accordance with practice guidelines necessitated this study in Nigeria. Objective: To assess the prescribing patterns of antidepressants, average cost of prescriptions and the index of rational drug prescribing (IRDP) in a Nigerian tertiary care hospital. Methods: A retrospective study which involved the assessment of 683 prescriptions and case records of patients who received antidepressants from 1 st January 2013 to 31 st December 2014 was conducted. Information on diagnosis, patients' demographics, prescribing patterns and cost of medications was obtained therefrom. Compliance to the World Health Organization (WHO) prescribing indicators and Nigerian Standard Treatment Guidelines (STG) was assessed. The IRDP for antdepressants was determined using a validated mathematical model. The statistical analysis was performed using SPSS version 20. Results: Tricyclic antidepressants (TCAs) were the most commonly prescribed drug group (61.3%), followed by selective serotonin re-uptake inhibitors (SSRIs) with a total of 38.7%. On the average, three drugs were prescribed per prescription, while 60.3% and 38.3% of the drugs were prescribed from National Essential Medicine List (NEML) and STG respectively. The IRDP was 3.96 over 5 points. The average cost of drugs per prescription was 4.2 USD. The cost of drugs in the prescriptions written according to STG was lower compared to that in prescriptions not compliant with the STG (p < .001).Conclusions: TCAs are the most commonly prescribed antidepressants due to their affordability. The generic prescribing, medicines prescribed from the NEML and in compliance with the STG were less than the WHO standard. The rational drug use is suboptimal. Better prescribing habits, affordability and use of newer antidepressants should be encouraged by the hospital management.
Over 20% of US Food and Drug Administration (FDA)‐approved drugs in the United States are metabolized by the hepatic enzyme cytochrome P450 2D6 (CYP2D6). The gene encoding CYP2D6 is highly polymorphic and genetic variation has been shown to impact drug response for many commonly dispensed drugs including opioids and antidepressants. Thus, it is important to understand an individual's CYP2D6 metabolizer status to optimize treatment outcomes for patients taking medications that are metabolized by this enzyme. Consequently, clinical CYP2D6 pharmacogenetic testing is being implemented by a growing number of health centers. Furthermore, clinical guidelines currently recommend adapting therapeutic regimens based on CYP2D6 genotype‐informed phenotype. However, CYP2D6 genetic variation varies considerably across global populations and many allelic variants, or star alleles, are predominantly found in certain ancestral populations. Although CYP2D6 genetic variation has been extensively studied, there is still a paucity of information for many non‐European populations. As has been shown for other pharmacogenes in randomized controlled trials, results from European populations cannot simply be extrapolated to other groups and, in some cases, even has the potential to cause harm. Therefore, enhanced inclusion in pharmacogenetic studies is urgently needed to increase ancestral representation, determine the extent of global CYP2D6 genetic variation (e.g., ancestry‐specific variants), and determine the clinical impact of this variation on clinical treatment outcome. This review highlights knowledge gaps, challenges, and future directions in CYP2D6 pharmacogenomics through a unique pharmacoequity lens to address health inequities that hamper our ability to optimize drug therapy for improved pharmacological outcomes in diverse populations globally.
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