Prescription pattern & adverse drug reactions of prokinetics

Abstract

Background & objectives: Prokinetics are extensively prescribed leading to several adverse events (AEs). The aim of this study was to assess the prescription pattern in patients receiving prokinetics, and characteristics of adverse drug reactions (ADRs) in an outpatient department set up in a tertiary care hospital in western India.

Methods: Patients attending outpatient departments of a tertiary care hospital and who had received prokinetic agent for at least seven days over the last one month were enrolled. Causality assessment of AEs was done and assessed for severity, preventability, seriousness and predictability.

Results: A total of 304 patients [161 males (52.96%); 143 females (47.04%)] were enrolled. Most prescriptions (299/304, 98%) included domperidone, most commonly prescribed as fixed-dose combination (FDC) with pantoprazole (274/304, 90%). Prokinetic dose was not mentioned in 251/304 (83%) prescriptions, and 18/304 (6%) did not mention frequency. Of the 378 AEs reported from 179 patients (47.35%), 306 (81%) were mild, all non-serious; 272 (72%) not preventable and 291 (77%) predictable in nature. Decreased appetite (n=31, 8.2%) and fatigue (n=27,7.14%) were most commonly reported. Causality assessment by the World Health Organization-Uppsala Monitoring Centre scale showed that 180 AEs were related to suspected drug (17 probable and 163 possible ADRs). Significant correlation was observed for AEs with increasing number of drugs per prescription (Spearman's R=+0.8, P =0.05) and with increasing therapy duration (Spearman's R=+1.00, P <0.001).

Interpretation & conclusions: Our findings showed that prokinetics were often prescribed as FDCs, with incomplete prescriptions. Domperidone was found to be associated with multiple AEs. It is suggested that regular prescription monitoring should be done in hospitals to encourage rational use of drugs.

Keywords: Domperidone; gastric acid suppression; hypomotility; levosulpiride; prescription audit; proton pump inhibitor.

Fig. 1

Number of prescriptions with different prokinetic agents, single or in combination (n=304). D, domperidone; P, pantoprazole; R, rabeprazole; O, omeprazole; L, levosulpiride; E, esomeprazole; PPI, proton pump inhibitor.

Fig. 2

Percentage of prescriptions with concomitant medications. ^*Others include cefixime, betadine gargle, ondansetron, probiotics, doxofylline, iron+folic acid, clotrimazole ointment, clonazepam, proton pump inhibitors, ranitidine, betahistine, mebendazole, metoprolol, cetirizine, chlorpheniramine maleate, chlorhexidine mouthwash, mucaine gel, salbutamol metered dose inhaler, oxymetazoline nasal drops, hyoscine, furosemide, levofloxacin, anti-tuberculosis drugs, doxycycline, mupirocin ointment, aspirin, calcium, pyridoxine, phenytoin, rifaximin.

Fig. 3

Distribution of adverse events according to the World Health Organization-Adverse Reactions Terminology Organ System Classification Code (n=378). Absolute number of adverse events is provided in the pie chart followed by percentage in parenthesis.