Dispensing patterns of prescription-only antiobesity preparations in South Africa

Objectives: The aim of the study was to investigate the dispensing patterns of prescription-only antiobesity preparations in South Africa (classified as Anatomical Therapeutic Chemical (ATC) group A08).Design: Retrospective, cross-sectional drug utilisation study using electronic dispensing records.Setting: Private sector community or retail pharmacies in South Africa.Subjects: Patients who received one or more antiobesity medications in ATC group A08 in 2013.Outcome measures: Number of patients by age and gender, prescribing frequency and cost of antiobesity prescriptions, and trends observed.Results: A total of 27 703 patients were prescribed 52 555 products for antiobesity medication during 2013. The average age of patients was 41.71 (SD = 11.37) years, with male patients older than female patients (46.09 and 40.02 years, respectively). More females (72.19%) were dispensed antiobesity products, and females received their prescriptions at a younger average age than male patients. Five active ingredients were dispensed. Phentermine was prescribed the most, accounting for 92.44% of all the antiobesity prescriptions, followed by orlistat (6.08%), phendimetrazine (1.36%), D-norpseudoephedrine (0.06%) and diethylpropion (0.05%). Most patients (79.44%) received only short-term therapy (one or two prescriptions for an antiobesity product during the year). A small percentage (0.30%) of young patients (18 years and younger) received antiobesity products, despite the fact that the safety of these products in children has not been proven.Conclusions: Most antiobesity preparations were prescribed to females. Phentermine was the most commonly dispensed active ingredient, followed by orlistat. Further studies on patient outcomes and the cost-effectiveness of these products should be conducted.Keywords: antiobesity medicine, dispensing patterns, drug utilisation review, DUR, pharmac

Dispensing of vitamin products by retail pharmacies in South Africa: Implications for dietitians

Objective: The objective of this study was to analyse the dispensing patterns of vitamins (Anatomical Therapeutic Chemical (ATC) group A11) over a one-year period in a group of community pharmacies in South Africa.Design and setting: A retrospective drug utilisation study was conducted on community pharmacy electronic dispensing records in South Africa recorded in 2013. Outcome measures: All products for ATC subgroup A11 were extracted and analysed.Results: A total of 164 233 vitamin products were dispensed to 84 805 patients (62.64% female patients). Males received on average 2.09 (SD = 2.63) vitamin products per year, compared to 1.84 (SD = 2.13) products for females. Ergocalciferol (A11CC01) was the most often dispensed (37.48% of all vitamin products), followed by plain Vitamin B-complex products (A11EA00) accounting for 32.77%. Ergocalciferol (vitamin D2) is only available on prescription (50 000 IU tablets or 50 000 IU/ml oily drops) in South Africa. Tablets were the preferred dosage form (62.84% of products). Most injections were for Vitamin B1 or Vitamin B combination products.Conclusion: Ergocalciferol and injectable vitamins have recently been rescheduled to prescription-only; it is probable that this has impacted on the usage of these products. It is important to monitor future vitamin supplementation behaviour in community pharmacies since pharmacies are selling many of these products and pharmacists can, by counselling patients, determine the reasons for the use of these products. Furthermore, should dietitians and nutritionists choose to work with this captive audience, supplementation patterns can be monitored to develop and implement appropriate awareness campaigns. Further studies to explore these baseline results are recommended.Keywords: dispensing patterns, drug utilisation study, ergocalciferol, retail pharmacies, vitamin

Efavirenz: A review of the epidemiology, severity and management of neuropsychiatric side-effects

South Africa has the highest proportion of HIV-positive people in the world. HIV cannot be cured; however, there are several major classes of drugs used in its management. Efavirenz is one such agent of the class non-nucleoside reverse transcriptase inhibitors which inhibits the replication of the virus. Efavirenz is associated with causing neuropsychiatric side-effects (NPSEs), with almost 50% of patients experiencing at least one NPSE while on treatment. The NPSEs tend to occur within the first few days of initiation of therapy and resolve spontaneously within the first 4 - 6 weeks, with the most commonly reported being dizziness, insomnia, headache, abnormal dreams and impaired concentration. The plasma level of efavirenz and genetic polymorphisms are thought to play a role in the development of such NPSEs. NPSEs need to be treated according to severity. If necessary, efavirenz may be replaced with nevirapine or lopinavir/ritonavir. It should be remembered that nevirapine may also produce some severe side-effects such as skin abnormalities and hepatotoxicity. The monitoring of patients receiving efavirenz therapy should be ongoing, with those with a history of mental illness requiring closer monitoring than others

Dispensing patterns of antimigraine agents with a focus on seasonal variations in prescribing

Purpose: To determine the dispensing patterns of antimigraine agents in a private healthcare setting, focusing on seasonal variations in prescribing.Methods: A retrospective, cross-sectional drug utilization study was conducted using a South African medical insurance scheme administrator database for 2016. The database contained 3 567 170 records for medicines, medical devices and procedures. All products in MIMS category 1.9 (antimigraine agents) were analysed.Results: A total of 914 antimigraine products were dispensed to 505 patients (69.70 % females) at a cost of US$10,988.63. The average age of patients was 41.57 (SD = 13.77) years. Of the eight active ingredients, clonidine was the most often dispensed (34.68 %), followed by rizatriptan (28.01 %) and ergotamine (26.04 %). Prescribing peaks were observed in February to April 2016, and again in October. These months coincide with the change in seasons to winter and to summer, respectively, in South Africa.Conclusion: The sample size was too small to make definite conclusions, but it seems that prescribing of antimigraine agents reaches a peak during seasonal change specifically autumn and spring, confirming that weather is a possible trigger factor in migraine.Keywords: Migraine, Antimigraine agents, Trigger factors, Environmental, Weather, Seasonal, Prescribing patterns, Rizatripta

A review of trials investigating efavirenz-induced neuropsychiatric side effects and the implications

Background: Efavirenz is part of the first-line treatment for HIV patients including South Africa with approximately 50% experiencing neuropsychiatric side effects. Objective: Systematic review of papers reporting neuropsychiatric side effects with efavirenz published between January 2001 and December 2014 to provide guidance. Results: 13 articles were reviewed. Patient ages ranged between 37 to 41 years, with a high percentage males. Scales used to measure incidence and severity of side effects were varied; with disease severity or stage not reported. Patients with psychoses were excluded. Most commonly reported side effects were a reduction in sleep quality, depression, dizziness and anxiety. These were generally mild and not warranting discontinuation of efavirenz. Conclusion: Difficult to directly compare the studies. Standardised methods need to be introduced and all patient groups represented including the elderly, children, patients with active symptomatic illness and more women especially among the African population

Perspectives of healthcare professionals of the neuropsychiatric side effects associated with efavirenz and its management

Background: Efavirenz is associated with neuropsychiatric side effects. The consequences of using efavirenz in human immunodeficiency virus (HIV)-positive patients with mental illness has not been conclusively established, the concern being that efavirenz may worsen the condition of an already mentally ill patient. The absence of guidelines and the lack of evidence for the use of efavirenz in this special population lead to uncertainty and, as a result, varying practices in the clinical setting Aim: To determine the experiences of healthcare professionals caring for mentally ill people living with HIV (PLWH) who are using efavirenz, the associated neuropsychiatric side effects and the management thereof. Setting: Eastern Cape, South Africa. Method: A qualitative, descriptive, exploratory design was used to understand the phenomenon under study and to share the experiences of the participants. Semi-structured interviews were conducted. The data were analysed using thematic framework analysis and coded by the researcher as well as an independent coder. Results: There were conflicting feelings concerning the use of efavirenz in PLWH with active mental illnesses. Some healthcare professionals were willing to prescribe and use efavirenz whilst others were not. All participants indicated that further elucidation in the guidelines on the possible side effects associated with efavirenz and suggested management strategies would be useful. Conclusion: The expansion of the South African National Guidelines for the Treatment of HIV should include descriptions of the side effects caused by antiretrovirals and management strategies thereof to empower healthcare professionals to make informed decisions regarding patient care for mentally ill PLWH

Awareness of the potential risks of printed pharmaceutical advertisements

This article investigates consumer perceptions in the Nelson Mandela Metropole regarding printed advertisements of pharmaceutical products in order to identify potential risks. A focus group discussed various topics regarding pharmaceutical advertising. Thematic analysis was used as investigative tool. It was established that these advertisements evoke various desires, often contain irrelevant and false information that can lead to misinterpretation, and also often contain unintelligible jargon. Participants believed that photographs and pictures enhance the attractiveness and credibility of products. It was concluded that printed pharmaceutical advertisements present potential risks if misunderstood and/or misinterpreted

Statin prescribing among hypertensive patients in south-west Nigeria : findings and implications for the future

Statins reduce cardiovascular risk especially in patients with hypertension due to their concomitant blood pressure reducing effects. Prescribing generic statins minimizes cost and improves access. Our aim is to ascertain current prescribing of statins in Nigeria and potential savings from the increased use of generics. Prospective study involving hypertensive patients attending University College Hospital, Ibadan, Nigeria. 228 hypertensive patients received statins. Atorvastatin was the most prescribed statin, followed by simvastatin, rosuvastatin and finally fluvastatin. Prescribed doses were less than 1 defined daily dose in the majority, with high use of originators. Average monthly potential savings from increased prescribing of generics was US$2,635 for atorvastatin and US$10578 for rosuvastatin. A shift towards increased prescribing generics is recommended to minimize cost

Quality and efficiency of statin prescribing across countries with a special focus on South Africa : findings and future implications

Statins are recommended first-line treatment for hyperlipidemia, with published studies suggesting limited differences between them. However, there are reports of under-dosing. South Africa has introduced measures to enhance generic utilization. Part one documents prescribed doses of statins in 2011. Part two determines the extent of generics versus originator and single-sourced statins in 2011 and their costs. Results: Underdosing of simvastatin in 2011 with average prescribed dose of 23.7 mg; however, not for atorvastatin (20.91 mg) or rosuvastatin (15.02 mg). High utilization of generics versus originators at 93–99% for atorvastatin and simvastatin, with limited utilization of single-sourced statins (22% of total statins – defined daily dose basis), mirroring Netherlands, Sweden and UK. Generics priced 33–51% below originator prices. Discussion: Opportunity to increase simvastatin dosing through education, prescribing targets and incentives. Opportunity to lower generic prices with generic simvastatin 96–98% below single-sourced prices in some European countries