処方せんデータベースを活用した処方実態調査（第３報）−糖尿病治療薬の適正使用に関する考察−

Abstract

In order to study the proper use of antidiabetic agents, we searched and analyzed an established database of 86, 991 community pharmacy records of 18, 836 patients for a 7-month period from April 2000 to October 2000. A total of 4, 482 prescriptions in 849 patients taking antidiabetic agents were investigated. The average patients age was 63.25 years, and the average cost of drugs per prescription was ¥ 13, 493.Based on an analysis of the antidiabetic agent groups, sulfonylureas were prescribed most (66.6%), α-glucosidase inhibitors were the second most frequently prescribed (33.3%), followed by insulin (22.1%), biguanides (11.5%), thiazolidinediones (5.1%). The most prescribed drugs is glibenclamide (47.5%) which were used alone or combined with α-glucosidase, the second most frequently prescribed drug is voglibose (26.2%) which were combined with other antidiabetic agents for the most part.The average number of drugs per prescription was 5.13 (range 1 to 20 drugs), and this indicates that patients with diabetes mellitus tend to be prescribed multiple-drug regimens. The most frequently prescribed drug group was antihypertensives (38.5%), vasodilators (36.4%), anticoagulants (33.7%), peptic ulcer agents (32.7%) and antihyperlipidemic agents (32.4%). These findings suggest that patients with diabetes mellitus tend to have arteriosclerotic cardiovascular disease with hyperlipidemia.Inappropriate drug use and combinations were identified as follows : The maximum dose of metformin was 1, 000mg/day and it was less than the UKPDS recommended dose 2, 250mg/day. Pioglitazone may cause water retention and congestive heart failure may take a turn for the worse, but pioglitazone and digitalis were found to be administered concomitantly. Peptic ulcer agents were frequently prescribed (32.7%), so they should be administered only when necessary.These results suggested that doctors and pharmacists need a greater awareness of inappropriate drug use.