Prescriptions filled during pregnancy for drugs with the potential of fetal harm.

OBJECTIVE: To assess the extent of prescriptions filled by pregnant women for drugs with recognised potential of fetal harm, and to document the outcomes of these pregnancies. DESIGN: Cross-sectional study. POPULATION: Quebec Pregnancy Registry. METHODS: We identified women who were pregnant during a five-year period and who were insured for prescription medications under the provincial drug plan. We obtained information on prescriptions filled during pregnancy for drugs with known potential of fetal harm. MAIN OUTCOME MEASURES: Prescriptions filled for study drugs during the first, second and third trimesters of pregnancy; termination of pregnancy (TOP) or delivery, and whether the baby was diagnosed with a major congenital malformation (MCM). RESULTS: Of 109 344 women, 56% filled at least one prescription for a medication during pregnancy; 6.3% filled at least one prescription for a drug known to pose a risk to the fetus. Overall, 47% (95% CI, 45.8-48.2) of pregnancies exposed to drugs under study ended in TOP versus 36.2% (95% CI, 35.9-36.5) of those not exposed; 8.2% (95% CI, 8.0-10.0) of live births were diagnosed with an MCM during the first year of life versus 7.1% (95% CI, 6.9-7.3) of those not exposed. CONCLUSIONS: This study documents an important level of prescriptions filled during pregnancy for drugs harmful to the developing fetus. The proportions of both TOPs and babies born with MCMs were elevated compared with the expected values. Clinicians caring for women during pregnancy should conduct a medication inventory prior to a planned pregnancy, or as soon as an unplanned pregnancy is recognised.

Drug-related hospital admissions in a generic pharmaceutical system.

1. Generically based pharmaceutical systems exist in a few countries of the world, such as Iran. Most developed countries have free market pharmaceutical systems. Drug-related problems (DRP) have been reported mostly in the Western world but few data are available for generic systems. In this study, we tried to measure the prevalence of drug-related problems leading to hospital admissions in Isfahan, Iran. 2. One thousand consecutive hospital admissions in three major teaching hospitals were studied for a period of 6 months for the presence of DRP as a cause of hospital admissions. Two subcategories of DRP were considered: (i) drug therapy failure; and (ii) adverse drug reactions. Preventability and outcome measures were also assessed. Medications responsible for DRP were classified according to the Anatomic Therapeutic Chemical (ATC) classification of the World Health Organization. 3. Of the 1000 admissions studied, 115 (11.5%) were owing to DRP, 81% as a result of drug therapy failure and 19% as adverse drug reactions. A total of 106 out of the 115 DRP cases (92%) were either preventable or probably preventable, most of which had to do with either prescriber or patient error. An overview of DRP showed that 58.3% resulted in complete recovery, 33.9% in relative recovery and 7.8% in death. Close to 1% of hospital admissions resulted in DRP-related deaths. 4. The overall prevalence of hospital admissions caused by DRP is similar to that in free market pharmaceutical systems. The high preventability rate of these problems should alert clinicians and policy makers to design strategies to curtail this. Also, reasons for differences in subtypes of DRP between the results of this study and those of the literature from free market systems needs to be investigated further.

A survey on the extent of medication storage and wastage in urban Iranian households.

BACKGROUND: Prescription and nonprescription medications constitute a substantial proportion of the health care costs of countries. National drug policies and attitudes toward medication use may play a role in irrational prescribing and consumption of medicines, leading to drug wastage. The limited resources of developing countries warrant more careful assessments of current national drug policies. OBJECTIVE: This study quantified the amounts and types of medications that are stored in a sample of urban Iranian households and estimated the extent of drug wastage in these families. METHODS: A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts for 1966 to 2004 to identify articles on drug utilization and wastage. Randomly selected households in a large city in Iran were visited to determine the amounts and types of medicines stored in these households. A questionnaire was used to collect information about medication use in these families. RESULTS: A total of 512 households were assessed. The mean (SD) family size of household respondents was 4.3 (1.6) members. Mothers were responsible for managing medications in 58.1% (291/501) of families. Presence of chronic illness, insurance coverage, higher economic status, literacy among fathers, and siblings without medically related jobs were the variables that showed a significant relationship with the amount of medicines found in the households. The mean (SD) numbers of unit doses of medicines and of drug products found in these households were 238.5 (198.6) and 22.99 (20.1), respectively. The most common therapeutic classes of medications kept at home were central nervous system agents, anti-infectives, and gastrointestinal medications. The real and potential medication wastage was estimated to be 38.8% and 53.8%, respectively. CONCLUSIONS: Medications were stored in large quantities in these urban Iranian households, and a large percentage was being wasted. Drug-use assessments and a comprehensive evaluation of the current national drug policies are warranted to curtail this problem.