Study on consumers' preferences and habits for over-the-counter analgesics use

The aim of the present study was to investigate consumers' knowledge, preference habits and use of the over-the-counter (OTC) analgesics. Our survey indicates the preferences of respondents in consultation with medical specialists (medical doctors and pharmacists) and their sources of information about drugs. A questionnaire survey was conducted during the periods March/April and July/August 2002 in 11 community pharmacies situated in Sofia (capital) and two towns in different regions in Eastern Bulgaria. From 250 questionnaires 222 were filled in correctly and analyzed (response rate 89%). Metamizole (dipyrone) is the most popular OTC analgesic--35% of the questioned patients prefer it to relieve the pain. In the second place is paracetamole (acetaminophen), but patients prefer to use it mainly for symptomatic treatment of cold/flu and influenza-like symptoms. More than 50% of patients have indicated that medical doctor recommended them the chosen OTC analgesic and in case of health problems during the therapy they prefer to consult him. They had more confidence in medical doctors' than pharmacists' recommendations and consultation. The main conclusion is that the pharmacists do not have the main say in the choice of OTC analgesics and their rational and correct use.

Psychotropic drugs in Bulgaria-frequency and risk of adverse drug reactions

The aim of the study is to determine the frequency and risk of appearance of adverse drug reactions/ADRs/during the treatment with psychotropic drugs. The first part of the study is an analysis of the use of the psychotropic drugs for one-year period of time in our country, performed by DDD methodology. An attempt is made to equalize the Bulgarian list of the psychotropic drugs with the ATC classification and to estimate the DDD/1000/day. The data for Bulgaria is compared with that of the other countries. The collected data for the psychotropic drug use is divided into 2 groups: Psycholeptics and Psychoanaleptics. It is made an attempt to explain the main differences between them. The number of the standard therapeutic courses/NT/is used for assessment of the frequency and risk of ADRs. The results from the study show that the determined frequency of appearance of ADR for the different drugs is within "rare" and "very rare' for 100,000 inhabitants, according to the WHO terminology. Only for the drug Tardyl (EGIS Pharmaceuticals, Hungary) with INN Aminobarbitalum + Glutethimidum + Promethazini hydrochloridum the frequency is above 1%. That fact makes us to recommend a limitation of the prescription and usage of this drug to the Bulgarian Ministry of Health and to the National Drug Agency.

An attempt for complex assessment of the elderly patients' compliance

Compliance is taking the correct amount of the correct medicine at the correct time. Today, the problem of prescription medicine noncompliance is gaining considerably more attention within the pharmacy community as a part of the pharmaceutical care and by the other health professionals. Sometimes, compliance is defined "objectively" by how much medication a patient takes, such as taking a certain percentage of prescribed medication or taking a certain number of pills over a specific time period. Undoubtedly the care for the elderly patients and especially for the elderly patients that are bedridden can be an especially difficult challenge. The extent of non-compliance among them is estimated to be about 40% to 50%. The aim of this research is to assess the level of compliance and the factors, that influence this process among a group of elderly patients. We applied a complex methodology in order to avoid the mistakes that are connected with the use of a single method separately.

Low dose treatment with methotrexate-adverse drug reactions survey

Antineoplastic drugs caused various and frequent adverse drug reactions (ADR) in connection with their pharmacodynamics. Methotrexate (MTX) ADRs are preferably gastrointestinal disorders and hepatotoxicity (hepatic enzyme abnormalities). The aim of this study was to detect and analyse ADR induced by low-dose MTX treatment in rheumatology. We observed 94 patients, 63 with rheumatoid arthritis and 31 with psoriatic arthritis. All patients were co-medicated with nonsteroidal anti-inflammatory drugs (NSAID) as Diclofenacum, Indomethacinum, Piroxicamum and 51% with glycocorticosteroides. During the follow-up study we collected 18 case-reports with ADR for 17% of the patients. From the patients with registered ADR, 11 was treated with standard dose of 7.5 mg MTX for a week and 7 patients received from 10 to 15 mg for a week. The distribution of the cases according patients' gender was 9 females and 7 males. Prevail individuals in age groups' 41-50 and over 61 years. The most frequent adverse drug reactions were leucopenia, trombocytopenia, skin reactions and gastrointestinal disorders as vomiting, melaena, epigastrial pain, etc. The primary risk connected with long therapy of low doses MTX is hepatotoxicity that diagnose and treatment are painful and expensive. As a result of the appearance of ADR in 5 patients the therapy with MTX was not changed, in two cases MTX is stopped timely or the dosage is changed and in the rest 11 patients MTX was excluded from the therapeutic scheme.

Pharmacovigilance: characteristics of the most widely used drugs in Bulgaria

In the present study we analysed registered adverse drug reactions caused by 19 most used drugs in Bulgaria during three-year period. The cases were assembled from the spontaneous reporting system operated in our country. We described demographic characteristics of the patients, clinical diagnosis and reporting rates per 100,000 inhabitants for each drug. The data for antibiotics were compared with the results of our previous research. We analysed 188 adverse drug reactions i.e. 21% of all reports received in the Centre for Drug Safety of the National Drug Institute. Adverse drug reactions type B such as oedema, allergy, coma, etc. predominate. The number of cases with perforated ulcer and melaena caused by acetylsalicylic acid is considerable. The frequency of adverse drug reaction for the investigated drugs in "rare" according to WHO standards. It is necessary to assemble more information on adverse drug reactions and every serious case and inform medical doctors and pharmacists as a first step for improving the pharmacovigilance system in Bulgaria.

Antibacterials: spontaneous report analysis for a six years period in Bulgaria

The pharmacovigilance started in Bulgaria in 1975. The doctors had to send the filled so called "yellow cards" for the suspected Adverse Drug Reactions to the Centre for Drug Safety at the National Drug Institute. In Bulgaria a spontaneous reporting on the adverse drug reactions has been studied during the period 1991-1996 for Antibacterials. The total number of the reports was 2409 and 18% of this number related to the Antibacterials. The reporting rate varied from 0.3 to 1.8 per 100,000 inhabitancy. As a whole 29% of the adverse drug reaction reports concerned the patients in the age groups of 0-5 year old. Amoxicillin is a drug with a majority of reports for the period. This article reveals the limits of the operating spontaneous reporting system in Bulgaria and suggests some possible measures to improve and refine it in a connection to the WHO and EMEA requirements.