Analgesic use in dentistry in a tertiary hospital in western Nepal (2004)

The present study had been planned to determine the pattern of drug utilization of analgesics (non-opioid and opioid analgesics) in dental outpatients in a referral hospital in western Nepal. A total of 1820 prescriptions of dental patients attending the dental outpatient at Manipal Teaching Hospital (MTH), Fulbari, Pokhara, Nepal were collected by a random once-weekly survey between March 2001 and February 2002. The analgesic-containing prescriptions (n = 1346) were separated from the total prescriptions collected. This information was compiled, scored and analyzed in consultation with dentists using WHO guidelines. There were more female patients (56%) than male patients (44%) in this study. The dental disorders most frequently reported in our study were diseases of pulp and periapical tissue (36.5%), gingivitis and periodontal diseases (28.5%) and dental caries (16%) etc. In total, 74% prescriptions contained analgesics which are the second-most commonly prescribed drugs after anti-microbials (44.9%) in dental OPD. The total analgesics prescribed were 1358 that account for 36.7% of total drugs prescribed. Only 5 and 37.8% of analgesics were prescribed generically and from the essential drug list of WHO respectively. All the analgesics were administered orally which included 89.7 and 10.3% of non-opioid analgesics and opioid analgesics (propoxyphene and dextropopoxyphene) respectively. The average duration of analgesic use was 3.5 +/- 0.3 days. The most commonly prescribed non-opioid analgesic was ibuprofen (41%) followed by nimesulide (22%). A total of 38.9% analgesics were fixed-dose combinations (FDCs) of two drugs and the most common analgesic combination used was ibuprofen + paracetamol and paracetamol + opioid analgesics. All opioid analgesics were prescribed in combination with paracetamol (10.3%) only. In total, 1.6% analgesics were prescribed concomitantly with gastroprotective agents. All gastroprotective agents (n = 22) were prescribed concomitantly with opioid analgesics only. No gastroprotective was used when NSAIDs were prescribed alone or in combination with paracetamol. Our present study indicate that all the analgesics were prescribed in oral dosage forms but analgesics prescribed in generic name (5%) and from essential drug lists (37.8%) were very less. There was an inclination to prescribe the older non-opioid analgesics. Selection of analgesics was quite rational in our study but some lacunae were observed. A total of 38.9% analgesics were FDCs and most common FDC analgesics were ibuprofen + paracetamol. Avoiding unnecessary FDCs may help in reducing prescribing costs because FDCs usually cost more than single ingredient preparations. It is best to avoid combination therapy with more than one non-opioid analgesic; there is little evidence of extra benefit to the patient and the incidence of side effects generally is additive. Prescribing generic names aids in avoiding confusion and minimizing the costs. In the present study, coprescription of gastroprotective agents with analgesic use was low compared to a previous study but when opioid analgesics were prescribed, concurrent use of gastroprotective agents were irrational as opioid analgesics usually decrease the secretion of hydrochloric acid. It is also surprizing that, no gastroprotective was used when NSAIDs were prescribed alone, irrespective of sex, age, dose or duration or type of NSAID treatment in our study. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of analgesics in dentistry.