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

Authors Zin CS, Nazar NI, Rahman NS, Alias NE, Ahmad WR, Rani NS, Cardosa MS, Ng KS, Ye FL

Received 6 February 2018

Accepted for publication 25 June 2018

Published 20 September 2018 Volume 2018:11 Pages 1959—1966


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Erica Wegrzyn

Che Suraya Zin,1 Nor Ilyani Nazar,1 Norny Syafinaz Rahman,1 Nor Elina Alias,1 Wan Rohaidah Ahmad,2 Nurul Sahida Rani,3 Mary Suma Cardosa,4 Kim Swan Ng,4 Felicia Loh Ye5

1Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, Kuantan, Malaysia; 2Department of Anaesthesiology and Intensive Care, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia; 3Department of Pharmacy, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia; 4Department of Anaesthesiology and Intensive Care, Hospital Selayang, Batu Caves, Malaysia; 5Department of Pharmacy, Hospital Selayang, Batu Caves, Malaysia

Purpose: To 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 methods: This 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.
Results: A 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.
Conclusion: Tramadol was the most frequently prescribed analgesic in hospital outpatient settings in Malaysia. Opioids were prescribed the least, but noted the highest increase in utilization.

Keywords: trends of prescribing, patterns, analgesics, tramadol, NSAIDs, opioids, Malaysia

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