処方せんデータベースを活用した処方実態調査-高脂血症治療薬の適正使用に関する考察-

抄録

In order to study the proper use of anti-hyperlipidemic agents, we searched and analyzed a recently estalished database of 142, 752 community pharmacy records of 25, 359 patients for a one year period from November 1998 to October 1999. A total of 12, 495 prescriptions in 1, 507 patients taking anti-hyperlipidemic agents were investigated. The average patient age was 64.09 years, and the average cost of drugs per prescription was ¥13, 996.
Based on an analysis of the anti-hyperlipidemic agent groups, statins, including pravastatin and simvastatin were prescribed the most (82.4%), fibric acids including bezafibrate were the second most prescribed (12.4%), followed by probucol (4.6%), nicotinic acid (2.1 %) and bile acid sequestrants (1.0%) including cholestyramine. Statins, which are highly effective in lowering LDL cholesterol, were used alone for the most part, and approximately 75% of all the patients received statin monotherapy.
The average number of drugs per prescription was 5.75 (range 1 to 23 drugs) thus indicating that patients with hyperlipidemia tend to be prescribed multiple-drug regimens. Based on the analysis of the patients and concomitant drugs, the most frequently prescribed drug was found to be aspirin dialuminate for children (15.1%), followed by teprenone (14.2%), ticlopidine (13.7%) and amlodipine (12.7%). The most frequently prescribed drug group was peptic ulcer agents (42.4%), followed by vasodilators (41.6%), antihypertensives (37.2%), anticoagulants (35.4%), benzodiazepines (41.6%) and antidiabetics (14.0%). These findings suggest that patients with hyperlipidemia tend to have multiple risk factors for coronary heart disease (CHD) such as ischemic cardiopathy, hypertension and diabetes mellitus, and patients at high risk for CHD should receive more intensive therapy than patients at lower risk.
Inappropriate drug use and combinations are as follows : In patients at lower risk for CHD who take only anti-hyperlipidemic agent, intensive dietary therapy and exercise should first be considered before drug treatment. The most frequently prescribed peptic ulcer agents, which may be used easily, should be analyzed for its cost-effectiveness. The combination of statin and fibrate (2.9%) may lead to a severe rhabdomyolysis and should be avoided. When simvastatin and CYP 3 A 4 inhibitor such as clarithromycin is administered concomitantly (0.5%), severe rhabdomyolysis may also occur.
These results suggest that doctors and pharmacists need a greater awareness of inappropriate drug use and harmful drug interactions.