Analysis of Alprostadil Injection in Real-World Usage and a Review of Literatures

Abstract

Background：The irrational use of medicines has become a major problem worldwide. The World Health Organization (WHO) estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately, and advised the pursuit of the responsible use of medicines.In China regulations require that a pharmacist must audit the prescription.Alprostadil injection is a vasodilator and an inhibitor of platelet aggregation There is no obvious or clear indication for its use in the ear, nose and throat (ENT) Department. It came to our notice that in our hospital, alprostadil injection has been prescribed in the ENT Outpatient Department to treat some diseases. Aim: This utilization review on the use of alprostadil injection was carried out in the ear, nose and throat (ENT) Outpatient Department of our hospital to determine its utilization patterns and promote its rational use. Methods: A prescription survey was conducted, and detailed demographic information, including the patient’s age, gender, diagnosis and so on, were recorded in an Excel spreadsheet. The rationality for these prescriptions were retrospectively evaluated.Results: Based on the evaluation results, all alprostadil injections were found to be used off label in the Otolaryngology Department. Furthermore, 98.3% of the prescriptions were for the treatment of sudden hearing loss, 1.1% of the prescriptions for the diagnosis of hypoacusis were considered empirical and should have been more specific, and 0.6% of the prescriptions were for the treatment of Ménière’s disease and large vestibular aqueduct syndrome. There were various dosage regimens for alprostadil injection in clinical practice. However, there was no statistically significant difference in dosage between the different age groups. Moreover, most of the alprostadil injections were given by IV bolus, while 12.2% of patients received this by intravenous drip.Conclusion: The present review indicated that improvements should be made in the quality of prescriptions for alprostadil injection in the Otolaryngology Outpatient Department. Furthermore, there is no strong evidence to support the use of high doses. Future audits of such use may be combined with an awareness campaign to reduce and discourage the irrational use of off label medications.