Javier García del Pozo

Trends in the consumption of opioid analgesics in Spain. Higher increases as fentanyl replaces morphine

ObjectiveDuring the past few years there have been changes in the availability of opioids in Spain, and new policies on palliative care have been implemented. The aim of this study was to describe the new pattern of opioid consumption in Spain and the associated economic impact.MethodsA search in the ECOM (Especialidades Consumo de Medicamentos) database of the Ministry of Health and Consumer Affairs for the 1992–2006 period was carried out. This database contains information on prescriptions of primary care medicines that are covered by the National Health System in Spain.ResultsSince 1992, overall opioid consumption has increased 14-fold, from 0.3 DDD/1000 inhabitants per day to 4.4 DDD/1000 inhabitants per day. For the six drugs that require a special prescription form – morphine, methadone, oxycodone pethidine, tilidine and fentanyl – consumption increased from 0.1 DDD/1000 inhabitants per day in 1992 to 1.2 in 2006. During this same period, the total costs of these prescriptions increased by 36.8-fold, and the cost per day and per patient doubled.ConclusionA huge increase in opioid consumption has occurred during the time period covered by this study, with fentanyl consumption accounting for most of that increase. Although oral morphine is the first-choice drug among strong opioids, fentanyl is currently the most consumed.

Non-steroidal anti-inflammatory drug-related hepatic damage in France and Spain: analysis from national spontaneous reporting systems.

Several non‐steroidal anti‐inflammatory drugs (NSAIDs) have been associated with liver damage. The aim of this study was to compare proportions of hepatic adverse drug reaction reports associated with NSAIDs in France and Spain. Information from the Spanish and French pharmacovigilance databases were used from 1982 to 2001. To assess the risk of liver injury, the case/non‐case methodology was applied, ‘cases’ being reports of liver damage and ‘non‐cases’ or controls, all other reports. Exposure was considered as the presence of at least one NSAID. Liver injury risk was estimated for each drug in the two databases by calculation of reporting odds ratio in cases and non‐cases, with its 95% confidence interval. Out of 62 456 reports from the Spanish database, 2114 (3.38%) were identified as liver injuries, whereas there were 27 372 liver injuries out of 200 046 (13.68%) in the French database. In Spain, there was a significant association between liver injuries and droxicam, sulindac, and nimesulide. The risk was also slightly above 1 for aceclofenac. In France, the risk was very high with clometacin, followed by sulindac, and was slightly above 1 for naproxen, diclofenac, piroxicam, and tenoxicam. This study shows that some NSAIDs are associated with reports of hepatic injuries when compared with other drugs, and most of those have been withdrawn from the market for this reason. However, the frequency of drug‐related hepatic injuries reported differed in the French and Spanish databases, and some drugs did not show the same risk level in the two countries. These discrepancies could be explained in part not only by reporting rates, but also by difference in drug use patterns and/or by genetic or environmental factors.

Utilización de antihipertensivos en España (1995–2001)

Introduccion y objetivos En los ultimos anos se han producido cambios en el patron de utilizacion de los antihipertensivos en Espana. Describir este patron de utilizacion entre 1995 y 2001, su adecuacion a las recomendaciones y sus repercusiones economicas ha sido el objetivo del presente trabajo. Se ha dedicado particular atencion al impacto que la introduccion de los antagonistas de los receptores de la angiotensina II ha podido tener en el consumo de otros subgrupos. Pacientes y metodo La informacion sobre el consumo de antihipertensivos en Espana se obtuvo de la base ECOM del Ministerio de Sanidad y Consumo, que contiene las especialidades farmaceuticas facturadas con cargo al Sistema Nacional de Salud en el ambito extrahospitalario. El consumo se expreso en dosis diarias definidas (DDD) por 1.000 habitantes y dia (DHD). Resultados El consumo de antihipertensivos en Espana paso de 113,1 DHD en 1995 a 182,8 DHD en 2001 (un 61,6% de incremento). Para el ano 2001, los antagonistas de receptores de la angiotensina II supusieron casi el 25% de los costes, frente a un 14% del consumo. Para el conjunto de los antihipertensivos, los costes han pasado de 646,42 millones de euros en 1995 a 1.144,77 en 2001. Conclusiones El consumo de antihipertensivos en Espana se ha incrementando de un modo notable en los ultimos 7 anos. El coste global se ha incrementado de forma proporcional, aunque la contribucion de los diferentes subgrupos es muy desigual. El impacto de la introduccion de los antagonistas de receptores de la angiotensina II ha sido muy importante, tanto en el consumo como en el coste.

Utilización de ansiolíticos e hipnóticos en España (1995-2002)

Fundamento: Estudios recientes han senalado un aumento en el consumo de ansioliticos e hipnoticos, asi como su uso inadecuado, en paises occidentales. El objetivo de este trabajo es conocer su patron de utilizacion en Espana entre los anos 1995 y 2002. Metodos: Los datos de consumo de medicamentos se obtuvieron de la base de datos ECOM (Especialidades Consumo de Medicamentos) del Ministerio de Sanidad y Consumo, que contiene informacion sobre el consumo de medicamentos dispensados con cargo al Sistema Nacional de Salud en farmacias comunitarias. Los datos se expresaron en Dosis Diarias Definidas por 1.000 habitantes y dia. Resultados: La utilizacion de ansioliticos e hipnoticos crecio desde 39,71 Dosis Diarias Definidas por 1.000 habitantes y dia en 1995 a 62,02 en 2002. A lo largo del periodo estudiado las benzodiazepinas de vida media intermedia (8-24 horas) fueron los medicamentos mas utilizados, en especial lorazepam, alprazolam y lormetazepam. El principio activo que mas disminuyo su consumo fue el flunitrazepam. Conclusiones: Aunque el consumo de ansioliticos e hipnoticos en Espana experimento un notable incremento en los ultimos anos, el patron de consumo no presento modificaciones sustanciales.

Gastroprotection during the administration of non-steroidal anti-inflammatory drugs. A drug-utilization study.

There has been an increase of anti-ulcer drug consumption in Spain. A high proportion of this consumption may be due to the use of those drugs as gastroprotective agents when co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to learn how these treatments are being used: the prevalence of use, the type of drug and the main features of patients. A sample of patients going to pharmacies with a NSAID prescription, with or without a gastroprotective agent, was obtained. A survey questionnaire was distributed to learn clinical and demographic data of the patients. Of the 942 patients interviewed, 41.6% were co-treated with a gastroprotective agent in addition to the NSAID. Most of these patients received proton-pump inhibitors and, to a lesser extent, histamine-2-receptor antagonists, antacids and prostaglandin analogues. The use of gastroprotective agents increased with age, treatment duration and illness chronicity; specialists prescribed a higher proportion of those co-treatments than did general practitioners. There was a high prescription rate of gastroprotective agents; in general, these were used according to recommendations. However, the type of gastroprotective agents being used does not seem to be justified by the current guidelines: histamine-2-receptor antagonists and antacid drugs have not proved their efficacy in this indication. The fact that one in four treatments with gastroprotective drugs was issued to patients without associated risk factors identifies a possible problem where an intervention could be appropriate.

Tratamiento hormonal sustitutivo en España. Un estudio de utilización

BACKGROUND The consumption of hormonal replacement therapy (HRT) in Spain is not known. Therefore, we have conducted a study to know the mean features of that consumption and to find out the prevalence of use among women older than 40. SUBJECTS AND METHOD To know the consumption, we have used the information contained in ECOM database from the Ministry of Health regarding medicines sold to the Spanish Health System. Also, data gathered by the General Practitioner Sentinel Network of Castilla y Leon had been used. The data of consumption are presented in daily defined dose per 1000 women more than 40 years (DHD); prevalence of use per year and for ages was also estimated. RESULTS The HRT consumption in Spain throughout the National Health System was 6,94 DHD in 1989 and 39.92 DHD in 1999. The percentage of women using this therapy was 0.7% in 1989 and 3,4 in 1999; the group 50-54 years had the highest prevalence of use, 10,84% (IC 95%, 10.66-11.01). CONCLUSIONS The release into the market of those transdermal forms of HRT facilitated an increase in the consumption. Nonetheless, the proportion of postmenopausal women on HRT in Spain is lower than that of the other countries from the European Union. The proportion of women treated with estrogens and progestins is also small compared with current recommendations.Fundamento El consumo del tratamiento hormonal sustitutivo (THS) en Espana no se conoce con exactitud. Por este motivo, nos hemos planteado un estudio que permita conocer el consumo cuantitativo del THS, sus caracteristicas y la prevalencia de uso de esta terapia de sustitucion. Sujetos y metodo Para conocer el consumo, se utilizo la informacion que ofrece la base de datos de medicamentos ECOM del Ministerio de Sanidad y Consumo. Tambien se empleo la informacion proveniente de una encuesta a mujeres a las que fue prescrito THS por los medicos pertenecientes a la Red de Medicos Centinelas de Castilla y Leon. Los datos de consumo se presentan en dosis diarias definidas por 1.000 mujeres con mas de 40 anos por dia (DHD); se estimo tambien la prevalencia de uso por ano y por grupos de edad. Resultados El consumo de THS en Espana a traves de Sistema Nacional de Salud paso de 6,94 dosis diarias definidas (DDD) por 1.000 mujeres mayores de 40 anos en 1989 a 39,92 en 1999. El porcentaje de mujeres mayores de 40 anos que usaban THS paso del 0,7% en 1989 al 3,4% en 1999; el grupo de edad 50–54 anos, con el 10,8% (intervalo de confianza del 95%, 10,7–11,0), fue el de mayor consumo. Los sintomas de la menopausia fueron el motivo mas frecuente de prescripcion de esta medicacion. En la mitad de los casos se prescribieron estrogenos solos. Conclusiones La introduccion en el mercado de las formas transdermicas de administracion de THS propicio un aumento del consumo; no obstante, la proporcion de mujeres posmenopausicas que reciben THS en Espana es baja si se compara con la de otros paises. La proporcion de terapia combinada de estrogenos y progestagenos es igualmente baja si tenemos en cuenta las recomendaciones para su empleo.

DOXAZOSIN AND PRIAPISM

The causal relationship between doxazosin and priapism, in the absence of other alternative causes, was suspected in our patient in view of the temporal sequence of the drug administration, particularly when the dosage had been increased, and the appearance of the condition. Furthermore, prazosin has been associated with priapism, although the dosage used for hypotension differs from that used for BPH. To our knowledge no other cases of priapism following treatment with doxazosin or other new a-1 blockers have been reported. Given the high prevalence of BPH and the widespread use of these medications, priapism may appear more frequently.

Trends in the consumption of antidepressants in Castilla y León (Spain). Association between suicide rates and antidepressant drug consumption

To learn the evolution of antidepressant and lithium use in Castilla y León (Central Spain) and its relationship with suicide rates.

Use of Antihypertensive Drugs in Spain (1995-2001)

Objectives. In the last few years there have been changes in the pattern of consumption of antihypertensive drugs in Spain. This study aimed to describe the pattern of use in Spain from 1995 to 2001, its compliance with guidelines, and its economic impact. An aim of particular interest for our study was the impact of angiotensin II receptor antagonists on the consumption of the drugs from other therapeutic subgroups. Patients and method. Information on drug utilization was obtained from the ECOM database of the Spanish Ministry of Health, which records the number of packages charged to the National Health System. Data were expressed in defined daily dose (DDD) and DDD per 1000 inhabitants per day (DDD/1000). Results. Antihypertensive consumption in Spain increased from 113.1 DDD/1000 in 1995 to 182.8 in 2001 (an increase of 61.65%). In 2001, angiotensin II receptor antagonists accounted for 25% of the costs and 14% of the consumption. Overall, costs increased from 646.42 million euros in 1995 to 1144.77 million euros in 2001. Conclusions. The consumption of antihypertensive drugs in Spain has increased remarkably in the last 7 years. Likewise, costs have increased proportionately, although the contributions of different therapeutic subgroups have been unequal. The impact of angiotensin II receptor antagonists has been considerable, both on consumption and on costs.

Strontium ranelate may cause alopecia

From May 2005 to January 2008, the Spanish pharmacovigilance system received 56 reports in which strontium ranelate, a drug intended for the treatment of osteoporosis, was associated with different adverse reactions; five of them (8.9%) were reports of alopecia (table⇓; figure⇓). From the start of pharmacovigilance activities in Spain in 1982 up to January 2008, 102 540 reports were collected, of which 393 (0.4%) were cases of alopecia; the corresponding reports for postmenopausal women were 39 640, of which 205 (0.5%) cases were of alopecia. Alopecia in case 3 (see table). This was accompanied by some features compatible with …