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Utilization of two formulations of Nifedipine in primary health care in Albania during 2004-2014

Utilization of two formulations of Nifedipine in primary health care in Albania during 2004-2014. Laerta Kakariqi MD, PhD Sonila Vito PhD. Aim

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Utilization of two formulations of Nifedipine in primary health care in Albania during 2004-2014

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  1. Utilization of two formulations of Nifedipine in primary health care in Albania during 2004-2014 Laerta Kakariqi MD, PhD Sonila Vito PhD

  2. Aim To describe ambulatory utilization of two Nifedipine formulations (Nifedipin plain (immediate release) and Nifedipine slow-release (SR), in Albania using the ATC/DDD methodology (Anatomic Therapeutic Chemical Classification; DDD-Defined Daily Dose). Methods The study was retrospective and we analyzed consumption of this drugs in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII.

  3. Results With regards to the consumption of two formulations of Nifedipine: from 2004 to 2010 the consumption of the Nifedipine in fast release formulation prevails: Nifedipine plain 6.20-3.77 DDD/1000 inhabitants/day, Nifedpine SR:1.29-3.58DDD/1000 inhabitants/day. After 2011, the slow release formulation prevails in consumption.Nifedipine plain: 3.85-3.83 DDD/1000 inhabitants/day 2011-2014, meanwhile Nifedipine SR: 3.86-4.56 DDD/1000 inhabitants/day 2011-2014.(Figure 1)

  4. Figure 1 Consumption of two formulations of Nifedipine (DDD/1000 inhabitants/day) in national level during 2004-2014

  5. Figure 2 Annual average value of consumption of nifedipine plain and nifedipine SR based on import (real consumption) [*] versus consumption based on HII. [*] The “Import” item includes the consumption based on import data as well as the consumption based on domestic production: this represents the factual consumption.

  6. Discussion By analysing these consumption data, it is evident that nifedipine at fast release has been more intensively prescribed compared to the slow release formulation, which is in contradiction with therapeutic guidelines. We have inserted in the analysis also the import data (which represent the real consumption) for both of nifedipine formulations as well as for amlodipine, in order to have a better understanding of the situation (Figure 2). Based on this comparison (Figure 2), it is clear that even the import data show the prevalence in consumption of nifedipine plain (at fast release) versus the slow release (SR) formulation. Almost 90% of the patients receive nifedipine SR under the scheme, an indication of the consistency between import and HII data, whereas the situation with the consumption of nifedipine plain and amlodipine is much different indicating a significant amount flowing out of the reimbursement scheme.

  7. A potential reason for this finding can be the guidelines of HII, which encourage the family doctor to prescribe the cheapest alternative, the one with the lowest impact in the budget of HII. • Thus, the prescription of nifedipine at slow release is discouraged against nifedipine at fast release, contrary to the pharmacological logic. Another reason can be the lack of theraputic knowledge and of adherence of the doctors to contemporary therapeutic guidelines, as well as failure in updating their professional knowledge. • Dihidropiridines of fast release (e.g. nifedipine plain) cause head ache, nausea, and their chronical use may lead to an increased risk of adverse cardiac events. These effects can be avoided with the use of slow release formulations, which are not accused of such risks .

  8. Conclusions: It does exist a significant increase at national level in the use of Nifedipine slow release, but the values are still very low in comparison with developed countries. An important part of the albanian population do not benefit from the reimbursement system, but they take the medicines out-of-pocket.

  9. References: 1. Nelson M (2010)."Drug treatment of elevated blood pressure"(pdf).Australian Prescriber33(4): 108–112. 2. Chen N, Zhou M, Yang M, Guo J, Zhu C, Yang J, Wang Y, Yang X, He L (2010). "Calcium channel blockers versus other classes of drugs for hypertension".Cochrane Database of Systematic Reviews8: CD003654.doi:10.1002/14651858.CD003654.pub4. 3. "Calcium Channel Blockers".MedicineNet. p. 2. 4. Health Insurance Institute; Ministry of Health; 5. General Customs Directorate, Ministry of Finance, Albania 6. No authors listed. Therapeutic Guidelines Ltd, 25 July 2008.

  10. FALEMINDERIT

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