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Chapter 23 |Use of Antihistamines and Nasal MALAYSIAN STATISTICS ON MEDICINES 2008 CHAPTER 23 | USE OF ANTIHISTAMINES AND NASAL DECONGESTANTS Valuyeetham K.A.1, Saraiza A.B.2, Suliyana Y.3, Aswani Yanti B.4, Primuharsa PutraS.H.A.5 1. Tuanku Ja’afar Hospital, Seremban, 2. Serdang Hospital, Selangor, 3. Hospital Kuala Lumpur, Kuala Lumpur, 4. AmpangHospital, Selangor, 5. KPJ Seremban Specialist Hospital. Nasal decongestants and antihistamines are commonly used drugs for allergy and nasal symptoms in otorhinolaryngology clinics in Malaysia. The 2008 survey showed usage of nasal preparations was 1.4881 DDD/population/year and usage of antihistamines for systemic was 4.1654 DDD/ population/year. For nasal preparations, it showed significant reduction in daily and yearly usage since the year 2007. This may due to decreasing usage of the older drugs such as betamethasone and beclomethasone. The nasal steroids used in Malaysia are beclomethasone, budesonide, betamethasone, fluticasone, mometasone, triamcinolone and fluticasone furoate. Among these, the commonly used nasal steroids in 2008 are fluticasone, mometasone and triamcinolone in both public and private sectors. Budesonide nasal spray which has comparable efficacy with other corticosteroid nasal decongestants at lower costs of treatment is most commonly used in both public and private sectors. However our usage in 2008 was lower than the Australian data (1.5 DDD/1000 population/day)1. For mometasone, the usage was comparable with the Australian data (0.4 DDD/1000 population/day).1 The common nasal decongestant used in Malaysia is oxymetazoline. Despite the overall reduction in year 2008, the usage of oxymetazoline has increased in both public and private sectors. This data is still lower than the Australian data (1.2 DDD/1000 population/day).1 For plain sympathomimetic ephedrine, usage was uncommon and in year 2008 there was further reduction. This is probably because of its short acting properties and rebound phenomena. Antihistamines can be divided into several subgroups that are sedative and non-sedative antihistamines. The most common sedative antihistamines used in Malaysia are chlorpheniramine, dexchlorpheniramine, promethazine and triprolidine while the most common non-sedative antihistamines are loratadine, cetirizine, desloratadine and levocetirizine. In general the usage of sedative and non-sedative antihistamines has reduced in 2008. This also applies to the combination of antihistamines and pseudoephedrine. In comparing with the Nordic data which comprises of Denmark, Greenland, Finland, Aland, Iceland, Norway and Sweden, the usage of antihistamines in Malaysia is lower except for Greenland (7.9 DDD/1000 population/day).2 Table 23.1: Use of Anti-Histamines and Nasal Decongestants, in DDD/1000 population/day and DDD/population/year 2007-2008 DDD/1000 population/day DDD/population/YEAR ATC Drug CLASS 2007 2008 2007 2008 R01 Nasal preparations 4.4978 4.0657 1.6417 1.4881 R06 Antihistamine for systematic use 11.5803 1.3807 4.2268 4.1654 Table 23.2.1: Use of Nasal Decongestants by Drug Class, in DDD/1000 population/day and DDD/population/year 2007-2008 DDD/1000 population/day DDD/population/YEAR ATC Drug CLASS 2007 2008 2007 2008 R01A Decongestant and other nasal preparation for topical use 2.1523 2.2279 0.7856 0.8154 R01A A Sympathomimetics, plain 0.3460 0.3635 0.1263 0.1331 R01A C Antiallergic agents, excl. corticosteroids 0.0018 0.0007 0.0007 0.0003 R01A D Corticosteroids 1.8045 1.8636 0.6586 0.6821 R01B Nasal decongestant for systemic use 2.3455 1.8379 0.8561 0.6727 R01B A Sympathomimetics 2.3455 1.8379 0.8561 0.6727 142 143 MALAYSIAN STATISTICS ON MEDICINES 2008 Table 23.2.2: Use of Nasal Decongestants by Drug Class and Agents, in DDD/1000 population/day and DDD/population/year 2007-2008 DDD/1000 population/day DDD/population/YEAR ATC Drug CLASS AND AGENTS SECTOR 2007 2008 2007 2008 R01A A Sympathomimetics, plain Public 0.0003 0.0003 0.0001 0.0001 R01A A03 Ephedrine Private 0.0004 - 0.0002 - Total 0.0008 0.0003 0.0003 0.0001 Public 0.034 0.0588 0.0124 0.0215 R01A A05 Oxymetazoline Private 0.2896 0.2916 0.1057 0.1067 Total 0.3235 0.3504 0.1181 0.1282 Public - - - - R01A A07 Xylometazoline Private 0.0217 0.0128 0.0079 0.0047 Total 0.0217 0.0128 0.0079 0.0047 R01A C Antiallergic agents, excl. corticosteroids Public - - - - R01A C01 Cromoglicic acid Private 0.0018 0.0007 0.0007 0.0002 Total 0.0018 0.0007 0.0007 0.0002 Public - - - - R01A C03 Azelastine Private - <0.0001 - <0.0001 Total - <0.0001 - <0.0001 R01A D Corticosteroids Public 0.1031 0.0914 0.0376 0.0334 R01A D01 Beclometasone Private 0.0669 0.0285 0.0244 0.0104 Total 0.1700 0.1198 0.062 0.0439 Public 0.5859 0.6241 0.2139 0.2284 R01A D05 Budesonide Private 0.5107 0.4472 0.1864 0.1637 Total 1.0967 1.0713 0.4003 0.3921 Public - - - - R01A D06 Betamethasone Private 0.0020 - 0.0007 - Total 0.0020 - 0.0007 - Public 0.0134 0.0274 0.0049 0.0100 R01A D08 Fluticasone Private 0.0653 0.1500 0.0238 0.0549 Total 0.0787 0.1773 0.0287 0.0649 Public 0.2213 0.2565 0.0808 0.0939 R01A D09 Mometasone Private 0.2017 0.1922 0.0736 0.0704 Total 0.4230 0.4487 0.1544 0.1642 Public 0.0018 0.0021 0.0007 0.0008 R01A D11 Triamcinolone Private 0.0325 0.0442 0.0118 0.0162 Total 0.0343 0.0463 0.0125 0.0171 Public - - - - R01A D12 Fluticasone furoate Private - 0.0001 - <0.0001 Total - 0.0001 - <0.0001 R01B A Sympathomimetics Public - 0.0111 - 0.0041 R01B A02 Pseudoephedrine Private 0.0241 0.0142 0.0088 0.0052 Total 0.0241 0.0253 0.0088 0.0093 Public 0.4273 0.4211 0.156 0.1541 R01B A52 Pseudoephedrine, combinations Private 1.8941 1.3843 0.6913 0.5066 Total 2.3214 1.8053 0.8473 0.6607 Public - - - - R01B A53 Phenylephrine, combinations Private - 0.0072 - 0.0027 Total - 0.0072 - 0.0027 144 MALAYSIAN STATISTICS ON MEDICINES 2008 Table 23.3.1: Use of Anti-Histamines by Drug Class, in DDD/1000 population/day and DDD/population/year 2007-2008 DDD/1000 population/day DDD/population/YEAR ATC Drug CLASS 2007 2008 2007 2008 R06A Antihistamines for systematic use 11.5803 11.3807 4.2268 4.1650 R06A A Aminoalkyl ethers 0.1592 2.0331 0.0581 0.7441 R06A B Substituted alkylamines 4.9112 3.4621 1.7926 1.2671 R06A D Phenothiazine derivatives 0.9502 1.0480 0.3468 0.3836 R06A E Piperazine derivatives 2.6022 2.3296 0.9498 0.8526 R06A X Other antihistamines for systemic use 2.9574 2.5079 1.0795 0.9179 Table 23.3.2: Use of Anti-Histamines by Drug Class and Agents, in DDD/1000 population/day and DDD/population/year 2007-2008 DDD/1000 population/day DDD/population/YEAR ATC Drug CLASS AND AGENTS SECTOR 2007 2008 2007 2008 R06A A Aminoalkyl ethers Public - 0.4351 - 0.1593 R06A A02 Diphenhydramine Private 0.1433 0.245 0.0523 0.0897 Total 0.1433 0.6801 0.0523 0.2489 Public - - - - R06A A04 Clemastine Private 0.0039 0.0047 0.0014 0.0017 Total 0.0039 0.0047 0.0014 0.0017 Public - - - - R06A A08 Carbinoxamine Private 0.012 0.0032 0.0044 0.0012 Total 0.012 0.0032 0.0044 0.0012 Public - 0.0599 - 0.0219 R06A A52 Diphenhydramine, combinations Private - 1.2852 - 0.4704 Total - 1.3451 - 0.4923 R06A B Substituted alkylamines Public - - - - R06A B01 Brompheniramine Private 0.0011 0.0020 0.0004 0.0007 Total 0.0011 0.0020 0.0004 0.0007 Public 0.0259 0.0209 0.0095 0.0077 R06A B02 Dexchlorpheniramine Private 0.7892 0.6102 0.2881 0.2233 Total 0.8152 0.6311 0.2975 0.2310 Public 2.6345 1.775 0.9616 0.5026 R06A B04 Chlorphenamine Private 1.4605 1.0482 0.5331 0.3837 Total 4.095 2.8233 1.4947 0.8862 Public - - - - R06A B54 Chlorphenamine, combinations Private - 0.0057 - 0.0021 Total - 0.0057 - 0.0021 R06A D Phenothiazine derivatives Public - - - - R06A D01 Alimemazine Private 0.0001 <0.0001 <0.0001 <0.0001 Total 0.0001 <0.0001 <0.0001 <0.0001 Public 0.6597 0.2703 0.2408 0.0767 R06A D02 Promethazine Private 0.2881 0.2312 0.1052 0.0846 Total 0.9478 0.5015 0.3460 0.1613 Public - - - - R06A D07 Mequitazine Private 0.0022 0.0015 0.0008 0.0006 Total 0.0022 0.0015 0.0008 0.0006 Public - - - - R06A D52 Promethazine, combinations Private - 0.5450 - 0.1995 Total - 0.5450 - 0.1995 144 145 MALAYSIAN STATISTICS ON MEDICINES 2008 DDD/1000 population/day DDD/population/YEAR ATC Drug CLASS AND AGENTS SECTOR 2007 2008 2007 2008 R06A E Piperazine derivatives Public 0.0004 0.0010 0.0001 0.0004 R06A E01 Buclizine Private 0.0471 0.0180 0.0172 0.0066 Total 0.0474 0.0189 0.0173 0.0069 Public - - - - R06A E05 Meclozine Private 0.0014 0.0049 0.0005 0.0018 Total 0.0014 0.0049 0.0005 0.0018 Public 0.333 0.3205 0.1215 0.1173 R06A E07 Cetirizine Private 2.0058 1.8055 0.7321 0.6608 Total 2.3388 2.126 0.8536 0.7781 Public 0.0031 0.0042 0.0011 0.0016 R06A E09 Levocetirizine Private 0.2115 0.1595 0.0772 0.0584 Total 0.2146 0.1638 0.0783 0.0599 Public - 0.0101 - 0.0037 R06A E55 Meclozine, combinations Private - 0.0059 - 0.0022 Total - 0.016 - 0.0059 R06A X Other antihistamines for systemic use Public - 0.0062 - 0.0023 R06A X07 Triprolidine Private - 0.0105 - 0.0038 Total - 0.0167 - 0.0061 Public - - - - R06A X09 Azatadine Private 0.0005 - 0.0002 - Total 0.0005 - 0.0002 - Public - - - - R06A X12 Terfenadine Private - 0.0003 - 0.0001 Total - 0.0003 - 0.0001 Public 0.9022 0.8055 0.3293 0.2890 R06A X13 Loratadine Private 1.5124 1.2091 0.5520 0.4425 Total 2.4147 2.0146 0.8813 0.7316 Public <0.0001 - <0.0001 - R06A X17 Ketotifen Private 0.2190 0.2063 0.0800 0.0755 Total 0.2191 0.2063 0.0800 0.0755 Public - - - - R06A X18 Acrivastine Private 0.0055 0.0021 0.0020 0.0008 Total 0.0055 0.0021 0.0020 0.0008 Public 0.0012 0.0033 0.0004 0.0012 R06A X26 Fexofenadine Private 0.0982 0.0729 0.0358 0.0267 Total 0.0994 0.0761 0.0363 0.0279 Public 0.0299 0.0191 0.0109 0.0070 R06A X27 Desloratadine Private 0.1884 0.1727 0.0688 0.0632 Total 0.2183 0.1918 0.0797 0.0702 References: 1.
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