Vzorci ambulantnega predpisovanja benzodiazepinov, zolpidema in kvetiapina v Sloveniji v obdobju od 2010 do 2019

Ribič, Anja (author), Locatelli, Igor (mentor), Čebron Lipovec, Nanča (co-mentor)

Benzodiazepini se uporabljajo za zdravljenje epilepsije, anksioznosti in nespečnosti. Zaradi njihove pogoste uporabe predstavljajo veliko tveganje za razvoj neželenih učinkov, odvisnosti in tolerance, predvsem med starostniki. Za zdravljenje nespečnosti se pogosto predpisujeta tudi zolpidem in kvetiapin. Namen naše raziskave je ovrednotiti vzorce ambulantnega predpisovanja benzodiazepinov, zolpidema in kvetiapina v Sloveniji. Določili smo porabo benzodiazepinov (število receptov in diazepamu ekvivalentnih odmerkov), prevalenco in incidenco prejemnikov izbranih zdravilnih učinkovin in njihove značilnosti ter značilnosti zdravnikov, ki predpisujejo proučevane zdravilne učinkovine. Zaradi zelo široke uporabe benzodiazepinov smo se pri raziskavi osredotočili na tiste, ki delujejo kot hipnotiki in sedativi, kvetiapin v odmerku 25 mg in zolpidem. Pri delu smo uporabili zbirko anonimiziranih podatkov o izdanih zdravilih na recept, ki je last Zavoda za zdravstveno zavarovanje Slovenije. Za obdelavo podatkov smo uporabili statistični program IBM SPSS Statistics 25.0. Osredotočili smo se na izdajo zdravil v obdobju od leta 2010 do 2019 in iz analize izključili mladoletne osebe. Rezultati količinske analize kažejo, da trend predpisovanja benzodiazepinov, zolpidema in 25 mg kvetiapina pada, saj se je med leti 2010 in 2019 predpisano število receptov zmanjšalo iz 743.703 na 616.142, torej za 17,2 %. Največkrat so bili predpisani zolpidem, alprazolam in bromazepam. Vsota diazepamu ekvivalentnih odmerkov (5 mg na dan) se je zmanjšala iz 64.071.189 na 47.813.170 ekvivalentov, torej za 25,4 %. Pri skoraj vseh zdravilnih učinkovinah, razen pri kvetiapinu, vsota pada. Leta 2010 je v Sloveniji 13,1 % odraslih prebivalcev prejemalo izbrane zdravilne učinkovine. Do leta 2019 se je ta odstotek zmanjšal na 11,1 %. Razmerje med prejemniki ženskega in moškega spola je vsako leto približno 2:1. Predpisovanje pa je pogostejše pri starostnikih. Leta 2012 je 55.791, leta 2017 pa 52.543 oseb prvič prejelo proučevane zdravilne učinkovine, kar pomeni upad za 5,8 %. V obeh letih so osebe, ki so prejele izbrane zdravilne učinkovine, najpogosteje začele terapijo z alprazolamom, bromazepamom ali zolpidemom. Ob začetku zdravljenja jim je bila pogosto predpisana ena škatlica zdravila, kar zadošča za en mesec terapije. Povprečno število predpisanih receptov na zdravnika se s starostjo zdravnikov povečuje. Vsa leta je povprečno število predpisanih receptov s strani zdravnic višje za približno 20-30 % v primerjavi z zdravniki. Uporaba proučevanih zdravilnih učinkovin je v Sloveniji še vedno zelo razširjena, je pa v obdobju med letoma 2010 in 2019 upadla, tako po številu receptov, kot po številu diazepamu ekvivalentnih odmerkov. Povečuje se le predpisovanje kvetiapina. Pogostost predpisovanja je večja pri starostnikih in ženskah ter s strani starejših zdravnikov (predvsem zdravnic).

• Language: Slovenian
• Keywords: Predpisovanje zdravil, benzodiazepini, zolpidem, kvetiapin, nespečnost.
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2022
• PID: 20.500.12556/RUL-134942
• Publication date in RUL: 12.02.2022

Secondary language

• Language: English
• Title: Prescribing patterns of benzodiazepines, zolpidem and quetiapine in Slovenia from 2010 to 2019

Abstract

Benzodiazepines are used to treat epilepsy, anxiety, and insomnia. Due to their frequent use, they pose a high risk of developing side effects, addiction and tolerance, especially among the elderly. Zolpidem and quetiapine are also often prescribed to treat insomnia. Our study aims to evaluate the prescribing patterns of benzodiazepines, zolpidem, and quetiapine in Slovenia. We determined the usage of benzodiazepines (number of prescriptions and diazepine equivalent doses), the characteristics of the doctors prescribing the selected medicine and the recipients of that specific medicine, as well as the prevalence and incidence rate of those recipients. Due to the very wide use of benzodiazepines, the study focused on those acting as hypnotics and sedatives, as well as zolpidem and 25 mg quetiapine. We used the database of anonymized data on prescription medicines dispensed, which is owned by the Health Insurance Institute of Slovenia. IBM SPSS Statistics 25.0 was used to process the data. We focused on the dispensing of medicines in the period from 2010 to 2019 and excluded minors from the analysis. The results of the quantitative analysis show that the trend in prescribing benzodiazepines, zolpidem, and 25 mg quetiapine is decreasing, with the number of prescriptions from 2010 to 2019 falling from 743.703 to 616.142, a decrease of 17.2 %. Zolpidem, alprazolam, and bromazepam were the most frequently prescribed. The sum of diazepam equivalent doses (5 mg daily) decreased from 64.071.189 to 47.813.170 equivalents from 2010 to 2019, i.e. by 25.4 %. For almost all active substances, except for quetiapine, the sum is decreasing. Selected active substances were administered to 13.1 % of Slovenian adult population in 2010. By the end of 2019, this percentage had declined to 11.1 %. In general, the ratio of female to male patients each year is approximately 2:1, with prescription increasing with age. In 2012 and 2017, 55.791 and 52.543 people, respectively, received selected active substances for the first time, which amounts to a decrease of 5.8%. In both years, most patients begin treatment with alprazolam, bromazepam or zolpidem. At the start of the treatment one packet of the drug is usually prescribed, which is sufficient for one month of use. Average prescriptions per doctor increase with the age of physicians. Every year, the average number of prescriptions, prescribed by female doctor is approximately 20-30 % higher. Use of the studied active substances is still widespread in Slovenia, but it has decreased between 2010 and 2019, both in terms of the number of prescriptions and the number of diazepam-equivalent doses. Only prescribing quetiapine increases. The frequency of prescribing is higher in elderly and female patients and by older physicians (especially female doctors).

• Keywords: Drug prescriptions, benzodiazepines, zolpidem, quetiapine, insomnia.