Prescription pattern of analgesics in orthopedics outpatient department at a tertiary care hospital
Keywords:
Analgesics, Prescription pattern, Orthopedics, Non-steroidal anti-inflammatory drugsAbstract
Background: Analgesics are the most common class of drugs prescribed for various conditions in the orthopedics outpatient department (OPD).
This study is performed for a better understanding of analgesics prescribing pattern in orthopedics and to correlate the use of selective cyclooxygenase-2 (COX-2) inhibitors, conventional non-steroidal anti-inflammatory drugs (NSAIDs), and opioid analgesics in practice in the present scenario.
Methods: The prescriptions from the OPD of Orthopedics at Dr. B. R. Ambedkar Medical College was reviewed between June 2013 and November 2013, entered in a pre-designed proforma. Pain was quantified using numeric rating scale. The type of analgesics administered, whether monotherapy or combined therapy and the duration of therapy, was analyzed to obtain an overview of the current prescribing pattern.
Results: A total of 300 prescriptions were analyzed. 800 drugs were prescribed with an average of 2.6 drugs per prescription. Of these, 62.3% were NSAIDs, 15.4% were opioid analgesics and 22.3% were gastroprotective agents. 61% of the NSAIDs were prescribed as monotherapy and 39% were prescribed as fixed drug combination (FDC). The ratio of selective to non-selective NSAIDs is 1.3:1.
Conclusions: The results of the present study show frequent use of selective COX-2 inhibitors, although non-selective NSAIDs topped the list of various selective NSAIDs, non-selective NSAIDs, and opioid analgesics. This suggests that gastrointestinal safety was an important concern while prescribing these drugs. Many FDCs were found to be irrational.
References
Birkett D, Smet PD, Adjei DO, Trolin I. Introduction to Drug Utilization Research. Geneva: WHO; 2003: 6-9.
Shankar PR, Pai R, Dubey AK, Upadhyay DK. Prescribing patterns in the orthopaedics outpatient department in a teaching hospital in Pokhara, western Nepal. Kathmandu Univ Med J (KUMJ). 2007;5(1):16-21.
Sharma HL, Sharma KK. Principles of Pharmacology. 2nd ed. New Delhi: Paras Medical Publisher; 2011: 490.
Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat New Biol. 1971;231(25):232-5.
Graumlich JF. Preventing gastrointestinal complications of NSAIDs. Risk factors, recent advances, and latest strategies. Postgrad Med. 2001;109(5):117-20, 123.
Tandon VR. Painkillers and cardiovascular toxicity. Health Line Fam Med J. 2006;4(4):33-34.
Brunton LL, Chabner BA, Knollman BC. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 12th Edition. New York: McGraw-Hill Companies Inc.; 2011: 501, 508, 992.
Gautam CS, Saha L. Fixed dose drug combinations (FDCs): rational or irrational: a view point. Br J Clin Pharmacol. 2008;65(5):795-6.
