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Changes in prescribed drug doses after market introduction
Eibert R Heerdink1, John Urquhart, Hubert G Leufkens
1Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), The Netherlands. E.R.Heerdink@pharm.uu.nl
Pharmacoepidemiology and Drug Safety
|November 13, 2002
Summary
Postmarketing drug prescribing often deviates from initial recommendations, with Defined Daily Doses (DDD) changing over time. Antibiotic DDDs increased in the 1980s, while cardiovascular drug DDDs decreased in the 1990s.
Area of Science:
- Pharmacology
- Drug Utilization Research
- Public Health
Background:
- Establishing appropriate drug dosing regimens is a complex challenge in pharmaceutical development.
- Postmarketing drug prescribing patterns can diverge significantly from initial recommended dosages.
- The Defined Daily Dose (DDD) serves as a metric for reflecting national prescribing trends.
Purpose of the Study:
- To analyze changes in Defined Daily Doses (DDD) from 1982 to 2000.
- To investigate factors influencing postmarketing shifts in drug dosing.
- To understand prescribing deviations from initial drug development recommendations.
Main Methods:
- Utilized World Health Organization (WHO) Defined Daily Dose (DDD) data.
- Conducted a case-control analysis comparing drugs with and without DDD changes.
- Examined potential determinants associated with DDD modifications over time.
Main Results:
- Identified 115 instances of DDD changes between 1982 and 2000.
- Observed 45 (39.1%) increases and 70 (60.9%) decreases in DDD.
- Antibiotics showed the most DDD changes (increases in the 1980s), followed by cardiovascular drugs (decreases in the 1990s).
Conclusions:
- DDD alterations reflect a combination of factors, including initial dosing misconceptions.
- Postmarketing pharmacotherapeutic knowledge evolution influences drug dosage.
- Economic factors and changing microbial resistance patterns impact anti-infective dosing.