Prescription, dispensation and marketing patterns of methylphenidate

Abstract

OBJECTIVETo analyze the patterns and legal requirements of methylphenidate consumption.METHODSWe conducted a cross-sectional study of the data from prescription notification forms and balance lists of drugs sales – psychoactive and others – subject to special control in the fifth largest city of Brazil, in 2006. We determined the defined and prescribed daily doses, the average prescription and dispensation periods, and the regional sales distribution in the municipality. In addition, we estimated the costs of drug acquisition and analyzed the individual drug consumption profile using the Lorenz curve.RESULTSThe balance lists data covered all notified sales of the drug while data from prescription notification forms covered 50.6% of the pharmacies that sold it, including those with the highest sales volumes. Total methylphenidate consumption was 0.37 DDD/1,000 inhabitants/day. Sales were concentrated in more developed areas, and regular-release tablets were the most commonly prescribed pharmaceutical formulation. In some regions of the city, approximately 20.0% of the prescriptions and dispensation exceeded 30 mg/day and 30 days of treatment.CONCLUSIONSMethylphenidate was widely consumed in the municipality and mainly in the most developed areas. Of note, the consumption of formulations with the higher abuse risk was the most predominant. Both its prescription and dispensation contrasted with current pharmacotherapeutic recommendations and legal requirements. Therefore, the commercialization of methylphenidate should be monitored more closely, and its use in the treatment of behavioral changes of psychological disorders needs to be discussed in detail, in line with the concepts of the quality use of medicines.

Using the Lorenz Curve to Characterize Risk Predictiveness and Etiologic Heterogeneity

“…Very few investigators have made use of the Lorenz curve to illustrate public health concepts, though there have been some notable exceptions. For example, Green et al 13 used it to describe regional variations in the incidence of multiple sclerosis, Hickson et al 14 used the tool to characterize the representativeness of African American participants in a study of heart disease, Perini et al 15 used it to characterize the methylphenidale consumption in Brazil, Duarte et al 16 studied the distribution of malaria cases in the Brazilian Amazon, Hashemi et al 17 used it to characterize regional access to cataract surgery, and Gail 18 and Petracci et al 19 have used it in evaluating breast cancer risk.…”

Estudo da utilização de metilfenidato em uma unidade básica de saúde

“…A análise dos padrões e os requisitos legais do consumo de metilfenidato, realizada em um estudo no Estado de Minas Gerais, identificou o consumo elevado em áreas mais favorecidas economicamente, risco de abuso, características de prescrição e dispensação não compatíveis com as determinações legais. Os autores sugerem o monitoramento da venda do medicamento, realizando-se uma análise crítica da farmacoterapia e das alterações comportamentais em concordância com o uso racional de medicamentos 22 .…”

Letter to the Editor: Comment on “Gabapentinoid Benefit and Risk Stratification: Mechanisms Over Myth”

“…The authors cited this study but criticized the methodology of this article, namely the use of Lorenz-1 curves as an economic measure of inequity of distribution of income and goods. However, this methodology is prevalent in pharmacovigilance research as a means of elucidating non-medical use or abuse of medications [13][14][15].…”