Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016: tramadol predominately used

Abstract

PurposeTo examine the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, and opioid patients.Patients and methodsThis cross-sectional study was conducted from 2010 to 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. Annual number of patients and prescriptions were measured in repeat cross-sectional estimates. Descriptive statistics and linear trend analysis were performed using Stata version 13.ResultsA total of 192,747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were given for 97,227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n=72,999) was the most frequently prescribed analgesic, followed by ketoprofen (17.5%, n=33,793), diclofenac (16.2%, n=31,180), celecoxib (12.2%, n=23,487), and other NSAIDs (<4.5%). All the analgesics were increased over time except meloxicam, indomethacin, and mefenamic acid. Opioids, primarily morphine (2.2%, n=4,021) and oxycodone (0.5%, n=1,049), were prescribed the least, but the rate of increase was the highest.ConclusionTramadol was the most frequently prescribed analgesic in hospital outpatient settings in Malaysia. Opioids were prescribed the least, but noted the highest increase in utilization.

Prescribing Pattern of Analgesics in Colombia. Are there Differences between Capital Cities and Municipalities? A Cross-Sectional Study

“…The most frequently prescribed pharmacological group was non-opioid analgesics, which is in line with the recommendations of clinical practice guidelines [ 4 , 6 , 9 ] previously reported in other works [ 5 , 18 , 22 ]. The most commonly used analgesic was acetaminophen, similar to what has been published in other studies [ 16 , 23 ], followed by NSAIDs.…”

“…The most commonly used analgesic was acetaminophen, similar to what has been published in other studies [16,23], followed by NSAIDs. The most commonly used NSAID in this report was naproxen, and its rate of use was very high compared with the rates reported in other studies (25.4% vs. 1.6-8.0%) [5,24,25]; however, in other countries, other active principles predominate, such as diclofenac (Iran: 49.2%, and India: 22.8%) [24,26], acetylsalicylic acid (Nigeria: 62.2%) [25], nimesulide (Italy: 20.0%) [15], and ketoprofen (Malaysia: 17.5%) [5]. The proportion of prescription of COX-2 selective NSAIDs has been demonstrated to be low in different studies [17,25,26], similar to the findings of this report, probably due to its cardiovascular safety problems and its association with various adverse reactions [7].…”

“…Previous opioid use is an important risk factor for future opioid misuse, even when opioids are prescribed for a medical indication [ 10 ]. The misuse of analgesics contributes to increased morbidity and mortality rates, deterioration of quality of life, greater demand for health resources, and increased health care costs [ 5 ]. Consequently, on 26 October 2017, the Department of Health and Human Services declared the opioid crisis a public health emergency in the United States [ 11 ].…”

“…Analgesics are commonly prescribed for pain relief or modulation in a wide variety of clinical contexts [ 2 ]. In recent years, the use of analgesics has increased steadily in both developed and developing countries [ 5 ]. According to the World Health Organization (WHO) analgesic pain scale, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for treating all pain intensities and should be used alone for patients with mild pain or in combination with opioids for other steps on the WHO analgesic ladder, while partial opioid agonists (codeine and tramadol) should be used for moderate pain.…”

Recent trends in opioid prescriptions in Korea from 2002 to 2015 based on the Korean NHIS-NSC cohort

“…Age is closely associated with increased opioid use [ 24 ]. Studies from European countries between 2000 and 2010 reported that the utilization of strong opioids was highest among patients aged 66-80 years [ 21 , 25 ]. A study from Malaysia showed that opioid prescriptions increased with patient age (11% in the 40s, 19% in the 50s, and 47.28% in the 60-80s) [ 25 ].…”