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Malaysian STATISTICS ON MEDICINE
20042004
C09A A01 Captopril 3.8928
C09A A02 Enalapril 3.8315
H02A B06 Prednisolone 3.5837
A02B A02 Ranitidine 3.1843
C03A A03 Hydrochlorothiazide 3.0603
J01C R02 Amoxicillin+enzyme inhibitor 2.9569
R06A E07 Cetirizine 2.6469
R03B A02 Budesonide 2.5996
C02C A01 Prazosin 2.4520
R06A D02 Promethazine 2.2757
C03B A11 Indapamide 2.1897
C01E B15 Trimetazidine 2.0636
C09C A01 Losartan 1.9803
Edited by:Sarojini Sivanandam
Lim T.O.
With contributions from:Shanthi V, Goh A, Lee KK, Leong KC, Rosminah MS, Letchuman Ramanathan,
Yap PK, Muruga Vadivale, Tamil Selvan M, Sim KH, Khoo KL, Zaki Morad, Rozina Ghazalli, Tan KK, Lim YS, Beena Devi, R. Ramanathan, Lee CK, Manmohan Singh, Suraya Yusoff,
Suarn Singh, Syed Fadzli SS, Norzila MZ, Molly Cheah
A publication of the Pharmaceutical Services Division and the Clinical Research Centre
Ministry of Health Malaysia
ATC Drugs DDD/1000 population/day
A10B B01 Glibenclamide 14.4913
C07A B03 Atenolol 13.0782
A10B A02 Metformin 11.7436
C07A B02 Metoprolol 10.9895
C08C A05 Nifedipine 9.8874
C10A A01 Simvastatin 7.9016
C08C A01 Amlodipine 6.5788
R03A C02 Salbutamol 6.3364
R06A B04 Chlorphenamine 5.7326
A10B B09 Gliclazide 5.6477
R03C C02 Salbutamol 5.4231
M01A B05 Diclofenac 5.3498
R06A B04 Chlorphenamine 5.7326
A10B B09 Gliclazide 5.6477
R03C C02 Salbutamol 5.4231
M01A B05 Diclofenac 5.3498
M01A G01 Mefenamic acid 4.7901
R06A X13 Loratadine 4.6098
C03C A01 Furosemide 4.4716
C03A A04 Chlorothiazide 4.0854
C10A A02 Lovastatin 4.0799
J01C A04 Amoxicillin 4.0243
C09A A04 Perindopril 4.0141
C10A A05 Atorvastatin 3.9146
C09A A01 Captopril 3.8928
C09A A02 Enalapril 3.8315
A02B A02 Ranitidine 3.1843
C03A A03 Hydrochlorothiazide 3.0603
J01C R02 Amoxicillin+enzyme inhibitor 2.9569
R06A E07 Cetirizine 2.6469
R03B A02 Budesonide 2.5996
C02C A01 Prazosin 2.4520
R06A D02 Promethazine 2.2757
C03B A11 Indapamide 2.1897
C01E B15 Trimetazidine 2.0636
C09C A01 Losartan 1.9803
R03D A04 Theophylline 1.8599
J01A A02 Doxycycline 1.7350
R03B B04 Tiotropium bromide 1.7158
C09A A03 Lisinopril 1.6354
M04A A01 Allopurinol 1.5786
A10A B01 Insulin, fast-acting ( human) 1.4590
2
Malaysian Statistics On Medicine
20042004
Edited by:Sarojini Sivanandam
Lim T.O.
With contributions fromShanthi V, Goh A, Lee KK, Leong KC, Rosminah MS, Letchuman Ramanathan,
Yap PK, Muruga Vadivale, Tamil Selvan M, Sim KH, Khoo KL, Zaki Morad, Rozina Ghazalli, Tan KK, Lim YS, Beena Devi, R. Ramanathan, Lee CK, Manmohan Singh, Suraya Yusoff,
Suarn Singh, Syed Fadzli SS, Norzila MZ, Molly Cheah
A publication of the
Pharmaceutical Services Division and the Clinical Research Centre
Ministry of Health Malaysia
Malaysian Statistics On Medicine 2004
April 2006
© Ministry of Health Malaysia
Published by:The National Medicines Use Survey
3rd Floor, MMA House
124, Jalan Pahang
53000 Kuala Lumpur
Malaysia
Tel. : (603) 40439 300
Fax : (603) 40439400
e-mail : [email protected]
Web site : http://www.crc.gov.my/nmus
This report is copyrighted. However it may be freely reproduced without the permission of the National Medicines
Use Survey. Acknowledgement would be appreciated. Suggested citation is: Sarojini S, Lim T.O. (Eds). Malaysian
Statistics On Medicine 2004. Kuala Lumpur 2006
This report is also published electronically on the website of the National Medicines Use Survey at:
http://www.crc.gov.my/nmus
Funding:
The National Medicines Use Survey is funded by a grant from the Ministry of Health Malaysia (MRG Grant
Number 00311)
i
FOREWORD
The Ministry of Health Malaysia has embarked on a landmark project, The National Medicines Use Survey
(NMUS), to capture data on the use of medicines in both the government and private sectors in Malaysia and this
report is a culmination of the project.
This NMUS report is very relevant in the present environment of ever increasing expenditure on medicines in
the government sector, which is likely to be similar in the private sector. While we have some data on the use of
medicines in the government sector, there is a lack of information from the private sector. This publication will
help in some ways to rectify the situation.
I am confi dent this publication will be a very useful reference to the government, the industry and the public and
I must congratulate those who are involved in the survey for successfully completing the project. I am looking
forward to see that the data are regularly updated through follow-up surveys.
DATUK DR HAJI MOHD ISMAIL MERICAN
Director General of Health Malaysia
ii
FOREWORD
In tandem with the advancement of the healthcare delivery system and increasing drug expenditure, there is a need
to ensure optimisation and quality use of resources. Since medicines are critical and essential for health sustenance
and improvement, quality use of medicines by healthcare providers and consumers which can contribute towards
quality care and cost-effective therapy remains to be an important component of any healthcare system and the
proposed Malaysia’s National Medicines Policy clearly addresses this.
Promoting rational prescribing by prescribers and appropriate use of medicines by consumers can be achieved
through various strategies including training, education, provision of evidence based drug information and
development of standard treatment guidelines. However, in order to translate strategies into outcomes, data on
the use of medicines in the country need to be collected to provide a general view and description of the pattern
of medicines used by various sectors. The National Medicines Use Survey (NMUS) was conducted with the
intent to continuously and systematically collect these data to improve its use, especially on the aspect of rational
prescribing, as well as providing a tool for better decision making in the allocation of healthcare resources for the
population. Apart from that, Malaysian drug use data will certainly be useful for comparing prescribing patterns
with other developed countries.
The conduct of NMUS required meticulous planning and hard work and I would like to express my deepest thanks
to each and every individual who had contributed to the success of the survey. The Pharmaceutical Services
Division appreciates the tremendous effort and commitment by the Clinical Research Centre to drive this project
which had resulted in the fi rst publication of the preliminary fi ndings of the survey.
I must also congratulate all doctors and pharmacists from the various expert panel groups who had selfl essly
contributed towards analysing the data, providing useful input on limitations of the survey so that corrective
actions can be taken for subsequent surveys, and for successfully completing the reports on time to enable this
fi rst publication. This survey had also paved the way for a healthy working partnership between doctors and
pharmacists from the public and private sectors for the common aim of promoting quality use of medicines.
Thank you
DATO’ CHE MOHD ZIN BIN CHE AWANG
Director
Pharmaceutical Services Division
Ministry of Health Malaysia.
iii
PREFACE
Data on the utilization of medicines in a country is important as it provides a picture of the state of the quality
use of medicines.
Drug utilization in a country could be different from other countries or even between areas within that country.
These differences could be because of several factors, such as demographic differences, differences in epidemiology
of disease, difference in medical approach or differences in economic conditions. This type of information allows
for better decision-making in the allocation of resources and in the listing of medicines in the country’s formulary.
The use of this information can enhance appropriate use of medicines for better health outcomes.
There has not been a large survey on the utilization of medicines in Malaysia so far and this aptly called National
Medicines Use Survey [NMUS] is believed to be the fi rst of its kind. However in carrying out this survey, in a
country like Malaysia that does not have one central database of sales or prescriptions or dispensing of medicines,
the task of compiling data on utilization of medicines was huge and fraught with problems. Data needed to be
collected from multiple sources and some of these sources were less than forthcoming in providing data due to
apprehension on the actual or possible use of the data or possibly, some sources were too busy to be able or want
to provide the data needed.
After the hurdle of data collection was surmounted, the next problem was data analysis. There was a need for
intelligent and expert analysis to distill credible information out of all these data as the data from various sources
were not always complete or clean or in the format or depth that was wanted. Under such conditions, therefore it
is not surprising that the target publication of end of 2005 for NMUS has not been met.
However, these experiences will stand us well in the future as this present report of NMUS will not mean the
end of NMUS. NMUS will continue to be an ongoing activity to track the utilization of medicines, which will
change with time. These changes may be due to various reasons such as ageing population, the entrance of new
medicines, the changing life style of the population or the shifting of population from the rural to the urban. With
continuous monitoring, the changing utilization of medicines in the country will be clear.
We would like to thank all staff who has worked so hard in this survey.
We would also like to thank all agencies and institutions who have helped in providing data and who have helped
in one way or another.
Dr. Zaki Morad bin Mohd Zaher Mr. Lai Lim Swee
Chairman Co-Chairman
National Medicines Use Survey
Ministry of Health Malaysia
iv
ACKNOWLEDGEMENTS
The National Medicines Use Survey would like to thank the following:
All the medical doctors, pharmacists and pharmacist assistants who participated in NMUS surveys
The Association of Private Hospitals Malaysia, Malaysian Organisation of Pharmaceutical Industries and
Pharmaceutical Association of Malaysia for encouraging their members to contribute data to the NMUS
Participating private hospitals for allowing access their medicines procurement data
Pharmaniaga Sdn Bnd for assistance in downloading MOH procurement data
The National Pharmaceutical Control Bureau, Primary Care Division, Procurement Division, all of the MOH,
for valuable assistance
The Malaysian Royal Custom Service for permission to download pharmaceutical import data
The Malaysian Medical Council, Malaysian Medical Association, The Academy of Family Physicians, Primary
Care Doctors Association Malaysia, Malaysian Dental Association, Malaysian Private Dental Practitioner’s
Association, and the Malaysian Pharmaceutical Society, University Malaya Medical Centre, Hospital University
Kebangsaan and Hospital Universiti Sains for supporting this project.
&
All who have in one way or another supported and/or contributed to the success of the NMUS and this report
Dr. Zaki Morad
Chairman
Mr. Lai Lim Swee
Co-Chairman
National Medicines Use Survey
Ministry of Health Malaysia
v
vi
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY
Hospitals participating in NMUS survey
1. Hospital Daerah Lundu
2. Hospital Alor Gajah
3. Hospital Alor Setar
4. Hospital Ampang
5. Hospital Bahagia
6. Hospital Balik Pulau
7. Hospital Baling
8. Hospital Banting
9. Hospital Batu Gajah
10. Hospital Batu Pahat
11. Hospital Bau
12. Hospital Beaufort
13. Hospital Beluran
14. Hospital Bentong
15. Hospital Besar Sultanah Aminah
16. Hospital Besut
17. Hospital Betong
18. Hospital Bintulu
19. Hospital Bukit Mertajam
20. Hospital Changkat Melintang
21. Hospital Daerah Lawas
22. Hospital Daro
23. Hospital Dungun
24. Hospital Gerik
25. Hospital Gua Musang
26. Hospital Hulu Terengganu
27. Hospital Ipoh
28. Hospital Jasin
29. Hospital Jelebu
30. Hospital Jeli
31. Hospital Jengka
32. Hospital Jerantut
33. Hospital Jitra
34. Hospital Kajang
35. Hospital Kampar
36. Hospital Kanowit
37. Hospital Kapit
38. Hospital Kemaman
39. Hospital Keningau
40. Hospital Kepala Batas
41. Hospital Kinabatangan
42. Hospital Kluang
43. Hospital Kota Belud
44. Hospital Kota Marudu
45. Hospital Kota Tinggi
46. Hospital Kuala Kangsar
47. Hospital Kuala Krai
48. Hospital Kuala Kubu Bharu
49. Hospital Kuala Lipis
50. Hospital Kuala Lumpur
51. Hospital Kuala Nerang
52. Hospital Kuala Pilah
53. Hospital Kuala Terengganu
54 Hospital Kudat
55. Hospital Kulim
56. Hospital Lahad Datu
57. Hospital Langkawi
58. Hospital Likas
59. Hospital Limbang
60. Hospital Machang
61. Hospital Marudi
62. Hospital Melaka
63. Hospital Mersing
64. Hospital Mesra
65. Hospital Miri
66. Hospital Muadzam Shah
67. Hospital Muar
68. Hospital Mukah
69. Hospital Pakar Sultanah Fatimah
70. Hospital Papar
71. Hospital Parit Buntar
72. Hospital Pasir Mas
73. Hospital Pekan
74. Hospital Permai
75. Hospital Pontian
76. Hospital Port Dickson
77. Hospital Pulau Pinang
78. Hospital Putrajaya
79. Hospital Queen Elizabeth
80. Hospital Raja Perempuan Zainab (Hospital
Kota Bahru)
81. Hospital Ranau
82. Hospital Raub
83. Hospital Sandakan(Hospital Duchess of Kent)
84. Hospital Saratok
85. Hospital Sarikei
86. Hospital Seberang Jaya
87. Hospital Segamat
88. Hospital Selama
89. Hospital Selayang
90. Hospital Semporna
91. Hospital Sentosa
92. Hospital Serdang
93. Hospital Seremban
# MOH Hospitals
vii
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY
Hospitals participating in NMUS survey
94. Hospital Seri Manjung
95. Hospital Serian
96. Hospital Setiu
97. Hospital Sibu
98. Hospital Sik
99. Hospital Simunjan
100. Hospital Sipitang
101. Hospital Slim River
102. Hospital Sri Aman
103. Hospital Sungai Bakap
104. Hospital Sungai Buluh
105. Hospital Sungai Petani
106. Hospital Sungai Siput
107. Hospital Taiping
108. Hospital Tambunan
109. Hospital Tampin
110. Hospital Tangkak
111. Hospital Tanjung Karang
112. Hospital Tapah
113. Hospital Tawau
114. Hospital Teluk Intan
115. Hospital Temenggung Seri Maharaja Tun
Ibrahim
116. Hospital Temerloh
117. Hospital Tengku Ampuan Afzan ( Hospital
Kuantan)
118. Hospital Tengku Ampuan Jemaah Sabak
Bernam
119. Hospital Tengku Ampuan Rahimah Klang
120. Hospital Tengku Anis, Pasir Putih
121. Hospital Tenom
122. Hospital Tuanku Fauziah
123. Hospital Tumpat
124. Hospital W.P Labuan
125. Hospital Yan
126. Institut Perubatan Respiratori
127. Rajah Charles Brooke Memorial Hospital
128. Sarawak General Hospital
# MOH Hospitals
1. Hospital Universiti Kebangsaan Malaysia
2. University Malaya Medical Centre
3. Hospital Universiti Sains Malaysia
# University Hospitals
1. Lumut Armed Forces Hospital
2. Terendak Armed Forces Hospital
# Armed Forces Hospitals
#` Private Hospitals
1. Johor Specialist Hospital
2. Puteri Specialist Hospital
3. Medical Specialist Centre (JB) SB
4. Putra Medical Centre
5. Hospital Pantai Ayer Keroh
6. Columbia Asia Medical Centre
7. Hospital Pantai Mutiara
8. Gleneagles Medical Centre
9. Island Hospital
10. Lam Wah Ee Hospital
11. Penang Adventist Hospital
12. Tanjung Medical Centre
13. Kuantan Medical Centre
14. Kuantan Specialist Hospital
15. Hospital Pantai-Putri
16. Sabah Medical Centre
17. Timberland Medical Centre
18. Columbia Asia Medical Centre
19. Pantai Klang Specialist Medical Centre Sdn
Bhd
20. Damansara Specialist Hospital
21. Sunway Medical Centre
22. Darul Ehsan Medical Centre
23. Subang Jaya Medical Centre
24. Hospital Pantai Indah
25. Institut Jantung Negara Sdn Bhd
26. Pantai Cheras Medical Centre
27. Pantai Medical Centre
28. Hospital Pusrawi Sdn. Bhd
29. Taman Desa Medical Centre
viii
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY
1. Klinik Kesihatan Kuala Lumpur
2. Poliklinik Komuniti Petaling Bahagia
3. Poliklinik Komuniti Sungai Besi
4. Poliklinik Komuniti Jinjang
5. Poliklinik Komuniti Dato Keramat
6. Poliklinik Komuniti Kampung Pandan
7. Poliklinik Komuniti Cheras Baru
8. Poliklinik Komuniti Cheras
9. Poliklinik Komuniti Tanglin
10. Poliklinik Komuniti Pantai
11. Poliklinik Komuniti Putrajaya
12. Poliklinik Komuniti Bandar Tun Razak
13. Poliklinik Komuniti Setapak
14. Poliklinik Komuniti Sentul
15. Poliklinik Komuniti Batu
16. KK Bagan
17. Klinik Pesakit Luar Johor Bahru, Jln
Mahmoodiah
18. Poliklinik Komuniti Taman Tun Aminah
19. Poliklinik Komuniti Pasir Gudang
20. Poliklinik Komuniti Simpang Renggam
21. Poliklinik Komuniti Layang-Layang
22. Poliklinik Komuniti Bandar Mas
23. Poliklinik Komuniti Sening
24. Poliklinik Komuniti Bandar Penawar
25. Poliklinik Komuniti Pagoh
26. Klinik Kesihatan Bakri
27. Poliklinik Komuniti Parit Ismail
28. Poliklinik Komuniti Bekok
29. Poliklinik Komuniti Guar Chempedak
30. Poliklinik Komuniti Banai
31. Poliklinik Komuniti Serdang
32. Poliklinik Komuniti Lunas
33. Jabatan Peasakit Luar Hospital Alor Setar
34. Poliklinik Komuniti Sungai Tiang
35. Poliklinik Komuniti Jeniang
36. Poliklinik Komuniti Cabang 3 Perol
37. Poliklinik Komuniti Kubang Kerian
38. Poliklinik Komuniti Balai
39. Poliklinik Komuniti Kemendore
40. Poliklinik Komuniti Peringgit
41. Poliklinik Komuniti Ujong Pasir
42. Klinik Kesihatan Simpang Empat, Alor Gajah
43. Poliklinik Komuniti Pertang
44. Poliklinik Komuniti Palong 7&8 (Felda)
45. Poliklinik Komuniti Seri Jempol
46. Poliklinik Komuniti Pedas
47. Poliklinik Komuniti Kuala Tembeling
48. Klinik Pesakit Luar Jalan Lim Hoe Leck,
Kuantan
49. Poliklinik Komuniti Beserah
50. Poliklinik Komuniti Jaya Gading
51. Poliklinik Komuniti Bandar Tun Abdul Razak
52. Poliklinik Komuniti Kemayan
53. Poliklinik Komuniti Bayan Lepas
54. Poliklinik Komuniti Butterworth
55. Poliklinik Komuniti Kepala Batas
56. Poliklinik Komuniti Penaga
57. Klinik Kesihatan Nibong Tebal
58. Poliklinik Komuniti Jalan Damai Tapah
59. Poliklinik Komuniti Bagan Datoh
60. Poliklinik Komuniti Lenggong
61. Poliklinik Komuniti Lawin
62. Poliklinik Komuniti Kuala Kurau
63. Poliklinik Komuniti Kuala Kangsar
64. Poliklinik Komuniti Manong
65. Poliklinik Komuniti Lintang
66. Poliklinik Komuniti Taiping
67. Poliklinik Komuniti Kuala Sepetang
68. Poliklinik Komuniti Kangar
69. Poliklinik Komuniti Weston
70. Poliklinik Komuniti Sunsuron
71. Klinik Kesihatan Luyang
72. Poliklinik Komuniti Sikuati
73. Poliklinik Komuniti Kuala Sapi
74. Poliklinik Komuniti Tuaran Jabatan Pesakit
Luar
75. Poliklinik Komuniti Tatau
76. Poliklinik Komuniti Jalan Masjid Kuching
77. Poliklinik Komuniti Kota Sentosa
78. Poliklinik Komuniti Long Lama
79. Poliklinik Komuniti Betanak
80. Poliklinik Komuniti Julau
81. Poliklinik Komuniti Batu Arang
82. Poliklinik Komuniti Kajang
83. Poliklinik Komuniti Ampang
84. Poliklinik Komuniti Bandar Baru Bangi
85. Poliklinik Komuniti Rasa
86. Poliklinik Komuniti Telok Datok
87. Poliklinik Komuniti Bandar
88. Jabatan Pesakit Luar Tanjung Karang
89. Poliklinik Komuniti Kuala Selangor
90. Poliklinik Komuniti Seri Kembangan
91. Poliklinik Komuniti Puchong
92. Poliklinik Komuniti Shah Alam
93. Poliklinik Komuniti Sungai Besar
94. Poliklinik Komuniti Sungai Pelek
# MOH ClinicsPrimary Care Clinics participating in NMUS survey
ix
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY
# MOH ClinicsPrimary Care Clinics participating in NMUS survey
95. Poliklinik Komuniti Jerteh
96. Poliklinik Komuniti Kg. Raja Besut
97. Poliklinik Komuniti Kuala Berang
98. Poliklinik Komuniti OPD Hospital Kuala Terengganu
99. Poliklinik Komuniti Hiliran
100. Poliklinik Komuniti Jengka 22
101. Klinik Kesihatan Cinta Sayang
# Private Clinics1. Klinik J.D.
2. Dr Amir Abbas-Kma Sdn Bhd
3. Ing Insurance Berhad In-House Clinic
4. Klinik Harun
5. ASP Medical Clinic
6. Drs Abraham George & Partners
7. Drs Young Newton & Partners
8. Klinik Aishah
9. Klinik Baba
10. Klinik Bandar Raya
11. Klinik K J Lim, Off Jln Genting Kelang
12. Klinik K J Lim, Gombak
13. Klinik Leow
14. Klinik Everlasting Sdn Bhd
15. Klinik Thean
16. Klinik Wong
17. Drs Young Newton & Rakan Rakan, Jalan
Ampang
18. Kelinik Thurai
19. Klinik Ahmad Nizam & Surgeri
20. Klinik Desa Jaya
21. Klinik Gunn
22. MAA In House Clinic
23. Vaithiyanathan Clinic
24. Klinik Imbi
25. Klinik Bakti
26. Healthcare Medical Centre
27. Klinik Sri Permaisuri
28. Medi-Klinik Lee, Goh & Rakan Rakan
29. Klinik dan Surgeri Ng
30. Klinik Desa
31. Klinik Hsu Dan Ng
32. Chye Clinic
33. Horeb Sdn Bhd, Jalan Ampang
34. Horeb Sdn Bhd, Leboh Ampang
35. Klinik Kucai
36. Klinik Dr Hamid
37. Poliklinik Chew & Rakan - Rakan
38. Klinik Catterall Khoo
39. Poliklinik Dr Norliza
40. Klinik K I P Sdn Bhd
41. Klinik Mediviron Sri Damansara
42. Klinik Chang
43. Klinik Maniraj
44. Klinik Leong
45. Reddy Klinik
46. Jose Clinic & Surgery
47. Dispensary Martin Dan Lalitha
48. Klinik Ramabai & Surgeri Sdn Bhd
49. Drs Young Newton & Rakan-Rakan, Jalan
Stesen Sentral
50. Klinik Shafi
51. Klinik & Surgeri Uni-Sentul
52. Klinik T.A.R.
53. Poliklinik Central & Surgeri Sdn Bhd
54. Poliklinik Sg. Besi
55. Klinik Ian Ong
56. Klinik Low
57. Klinik Dan Surgeri Sri Damansara
58. Poliklinik Ludher
59. Dr Leela Ratos Dan Rakan - Rakan (Pudu)
Sdn Bhd
60. Klinik Care Poliklinik Dan Surgeri
61. Poliklinik Seri Mas
62. Poliklinik East Asia
63. Klinik Bukit Maluri & Surgeri
64. Klinik Medisquare
65. Klinik Tan
66. Klinik TA
67. Bakti Healthcare - NSTP
68. Klinik Medimetro
69. Drs Fateh, Mydin Dan Rakan-Rakan
Poliklinik & Surgeri
70. Klinik Primecare
71. Klinik Setapak & Surgeri
72. Klinik Medi Al-Hilmi
73. Klinik Chew
x
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY
Primary Care Clinics participating in NMUS survey# Private Clinics
74. Klinik Shankar Sdn Bhd
75. Klinik Perkasa
76. Klinik Kaulsay
77. Jaya Clinic
78. Klinik Reddy
79. Klinik Senan
80. Poliklinik Central & Surgeri
81. The KL Clinic
82. Poliklinik Kong
83. Klinik Setia
84. Poliklinik Lai
85. Poliklinik Kumpulan City
86. Klinik Medic Bestari
87. Klinik Sharani
88. Klinik Dr Shashikala Sdn Bhd
89. Care Clinic Pudu
90. Medi-Klinik Lee, Goh & Rakan -Rakan
91. Kumpulan Medi-Systems Sdn Bhd
92. Klinik Catterall, Khoo And Raja Malek
93. Klinik Medi-Pro
94. Klinikah Sdn Bhd
95. Klinik Mediviron(Sentul Raya)
96. Klinik Raja
97. Klinik Mitter Dan Rakan -Rakan
98. Klinik Aminah
99. Leela Ratos Dan Rakan-Rakan
100. Poliklinik Meranti
101. Drs Young Newton & Rakan-Rakan, Pusat
Bandar Damansara
102. Klinik Arun
103. Klinik Hamidah
104. Klinik Famili Wangsa Melawati
105. Klinik Khairat
106. Klinik Oziar Darus
107. Klinik Pakatan Medik
108. Klinik Fateh Mohd & Rakan-Rakan
109. Klinik Choo
110. Dr Mohamed Mydin & Rakan-Rakan Sdn
Bhd
111. Klinik Alam Medic - Oug
112. Klinik Family TTDI
113. Klinik Lee dan Chia
114. Klinik Leong
115. Klinik Reddy Pudu
116. Klinik S K Leong
117. Klinik Zain & Zakaria
118. Poliklinik Siti Fatimah
119. Pusat Rawatan Islam - MAIS
120. Klinik Faiza Woon
121. Dr Oorloff, Rajakumar & Partners
122. Klinik Al Ikhwan
123. Klinik Boon
124. Klinik Idzham
125. Klinik Jayaraman
126. Klinik Keluarga Dr. Hj Mohd Khadzali
127. Klinik Maamor
128. Klinik Nathan
129. Klinik Segara
130. Klinik Tan & Appaduray
131. Clinic Wellness Lab
132. Klinik Setapak Dan Surgeri
133. Klinik Bakti
134. Poliklinik Subasari Dan Gan
135. Poliklinik Dan Surgeri Ren-Ai
136. Klinik Dr Rahim Omar & Rakan-Rakan
137. Global Doctors (Malaysia) Sdn Bhd
138. Klinik City
139. Klinik Indah
140. Sundaram Dispensary
141. Klinik Anthony
142. Kiara Medical Clinic
143. Horeb Sdn Bhd, Jln P Ramlee
144. WCL Medical Associates Sdn Bhd
145. Klinik Medicare
146. Poliklinik Dan Surgeri Khor
147. Klinik Ludher S/B
148. Klinik Idzham Sdn Bhd
149. Klinik Raj & Rakan-Rakan
150. Poliklinik Dan Surgeri Di-G
151. Pusat Rawatan Desa Pandan
152. Poliklinik Central
153. Klinik Reddy Setapak
154. Klinik Setiajaya
155. Klinik Idzham Sdn Bhd
156. Klinik Sannasees
157. Klinik Rahman
158. Poliklinik Soo & Tan
159. Klinik Rakyat
160. Yuli Poliklinik & Surgeri Sdn Bhd
161. Klinik Tan See Kin
162. Klinik Templer
163. Klinik Mediviron Sri Hartamas
164. Klinik Raj dan Rakan Rakan
165. Klinik Fauziah dan Rakan-Rakan
166. Poliklinik Yazmeen & Mahanum
xi
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY
Primary Care Clinics participating in NMUS survey# Private Clinics
167. Poliklinik Rani
168. Klinik Akashah
169. Poliklinik Medics
170. Klinik Sundram
171. Poly Klinik dan Surgery Kampung Pandan
172. Aman Putri Dispensary
173. Klinik Primecare
174. Klinik Utama
175. Klinik Murugasu
176. Klinik Meena
177. Kumpulan Medic Brickfi elds
178. Dr Mohamed Mydin & Rakan-Rakan Sdn
Bhd.
179. Poliklinik Healthsense
180. Kelinik S Suren
181. Klinik & Surgeri Gill
182. Klinik Medi-Pro
183. Klinik Kok dan Segeri
184. Dispensari Sharil
185. Klinik K. H. Ong
186. Klinik Keluarga
187. Klinik Mediviron Brickfi elds
188. Klinik Medi Pembangunan
Pharmacies participating in NMUS survey
# Private Pharmacies1. Farmasi Abc Sdn Bhd, Taman Maluri,
Kuala Lumpur
2. Farmasi Abc Sdn Bhd, Pandan Indah,
Kuala Lumpur
3. Farmasi Kepong
4. Farmasi Maxheal Sdn. Bhd
5. Farmasi Vitacare Sdn Bhd-Tmw
6. Plaza Pharmacy Sdn Bhd
7. Pharmway Sdn Bhd Sdn Bhd
8. Guardian Alpha Angle, Kuala Lumpur,
Wangsa Maju
9. Guardian Ampang Park Shopping Centre,
Jalan Ampang
10. Guardian Bandar Sri Damansara,
Kuala Lumpur , Bandar Sri Damansara
11. Guardian Bangsar Baru, Kuala Lumpur,
Jalan Telawi 5, Bangsar Baru
12. Guardian BB Plaza, Kuala Lumpur,
Jalan Bukit Bintang
13. Guardian Carrefour Wangsa Maju, Wangsa
Maju
14. Guardian Desa Sri Hartamas, Desa Sri
Hartamas
15. Guardian Endah Parade, Kuala Lumpur,
Sri Petaling
16. Guardian Great Eastern Mall , Jalan Ampang
17. Guardian Jalan Tun Perak, Kuala Lumpur
18. Guardian Jusco Metro Prima Kepong, Kepong
19. Guardian Kepong, Kuala Lumpur, Kepong
20. Guardian Lot 10 Shopping Centre,
Jalan Sultan Ismail
21. Guardian Lucky Garden, Bangsar, Lucky
Garden, Bangsar
22. Guardian Maju Junction Shopping Centre,
Jalan Sultan Ismail
23. Guardian Mid Point Pandan Indah, Pandan
Indah
24. Guardian OUG Plaza, Kuala Lumpur,
Old Klang Road
25. Guardian Pearl Point Shopping Mall,
Old Klang Road, KL
26. Guardian Suria KLCC, Kuala Lumpur,
Jalan Ampang
27. Guardian Taman Danau Desa, Jln 3/109F,
Taman Danau Desa
28. Guardian Taman Permata, Ulu Klang , Ulu
Kelang
29. Guardian Taman Tun Dr Ismail, Kuala
Lumpur
30. Guardian The Weld, Kuala Lumpur,
Jalan Raja Chulan
31. Guardian University Hospital, Kuala Lumpur,
Lembah Pantai
32. Farmasi Komuniti UKM
xii
ABOUT THE NATIONAL MEDICINES USE SURVEY
The National Medicines Survey (NMUS) is a service initiated and supported by the Ministry of Health (MOH) to
collect information on the supply, procurement, prescription, dispensing and use of drugs in Malaysia. The NMUS
is designed to support the implementation of our proposed National Medicines Policy (NMP). The objectives of
NMP are to ensure only safe, effi cacious and good quality medicines are available for use in Malaysia, as well as
to promote equitable access to, rational and cost-effective use of these medicines, ultimately leading to improved
health for all Malaysians. In supporting this, the NMUS provides the functional capacity for the collection,
analysis, reporting and dissemination of data on drug utilisation in Malaysia
Sponsors and Governance of the NMUSThe NMUS is jointly sponsored by Pharmaceutical Services Division and the Clinical Research Centre, Ministry
of Health.
A Governance Board is established to oversee the operations of the NMUS. Governance via a Board is necessary
to ensure that the NMUS meets the needs and expectations of all interested parties, and thereby to assure the
continuing relevance and justifi cation of the NMUS. All major groups involved in pharmaceutical issues in
Malaysia such as the MOH, Universities, professional bodies, private healthcare providers and the pharmaceutical
industry are represented on this board. The board also works as a consultative forum and provide advice on issues
pertaining to the NMUS and other aspects of the quality use of medicines.
Purpose of the NMUSThe availability of high quality, reliable and timely information on medicines use is crucial for any discussion on
improving the use of medicines in Malaysia.
The objective of the NMUS is therefore to quantify the present state and time trends of medicines utilization at
various level of our health care system, whether national, regional, local or institutional.
Routinely compiled statistics on medicines utilization have many uses, such as to:
1. Estimate the number of medicine users overall, by age, sex and geography and over time
2. Estimate on the basis of known disease epidemiology to what extent medicines are under or over-used.
3. Describe pattern of medicines use through assessing which alternative drugs are being used for particular
conditions and to what extent.
4. Relate the number of adverse drug reactions reported to our pharmacovigilance system to the number of
people exposed to the drug in order to assess the magnitude of the problem, or to estimate the degree of
under-reporting of adverse events
5. Provide a crude estimate of disease prevalence based on its prescription rate.
6. Estimate expenditure on pharmaceuticals, which constitutes a signifi cant proportion of our healthcare
expenditure.
7. Monitor and evaluate the effects of interventions to improve the use of medicines. These interventions may
be educational effort, promotional campaign, formulary restriction, medicines reimbursement scheme or
regulatory measures.
xiii
NMUS GOVERNANCE BOARD
CHAIRMAN: Dato’ Dr Zaki Morad b Mohd Zaher
CO- CHAIRMAN: Mr Lai Lim Swee
MEMBERS
Medical services of the MOH Dato’ Dr Zaki Morad b Mohd Zaher
Pharmaceutical services MOH Mr Lai Lim Swee
Drug Control Authority Ms Eishah bt Abd Rahman
Clinical Research Centre Dr Lim Teck Onn
Primary Care Division Ms Sahidah Said
Procurement Division Mr Abdullah Abdul Rahman
Malaysian Medical Council Prof Dr Raymond Ali
Malaysian Pharmaceutical Society Ms Usha Rajasingam
The Academy of Family Physicians of Malaysia Dr Mohd Husni B Jamal
Primary Care Doctors Organisation Malaysia Dr Molly Cheah
Malaysian Medical Association Dr M. Ponnusamy A/L Muthaya
Malaysian Dental Association Dr Shubon Sinha Roy
Malaysian Private Dental Practitioner’s Association Dr Nedunchelian Vengu
Association of Private Hospitals Malaysia Dr T. Mahadevan
Malaysian Organisation of Pharmaceutical Industries Mr Jimmy Piong
Pharmaceutical Association of Malaysia Mr Tom Hart
University Malaya Medical Centre Prof Liam Chong Kin
Hospital University Kebangsaan Malaysia Prof Dr Mohammad Abdul Razak
Hospital Universiti Sains Malaysia Dr Zaidun Kamari
Universiti Sains Malaysia Prof Madya Dr Mohamed Izham b Mohamed Ibrahim
xiv
MEMBERS OF NMUS EXPERT PANELS
Expert Panel1 Anti- Hypertensives, Steroid & Immunosuppressive, Renal Therapeutics
Members Institution Dato Dr Zaki Morad (Chairman) Department of Nephrology,
Kuala Lumpur Hospital
Dr Lim Teck Onn CRC, Kuala Lumpur Hospital
Dr Rozina Ghazalli Medical Department, Penang Hospital
Ms Sahida bt Said Primary Health Care Division MOH
Ms Siti Shahida Md. Shariffudin Pharmacy, Kuala Lumpur Hospital
2 Anti- Diabetics, Endocrine therapeutics
Members Institution
Dr G. R. Letchuman Ramanathan (Chairman) Medical Department, Ipoh Hospital
Ms Ernieda bt. Md Hatah Pharmacy, Putrajaya Hospital
Dr Muruga Vadivale Sanofi Aventis
Prof Dr.S.P.Chan Faculty of Medicine, University Malaya
Dr Selva Malar Rasiah Out Patient Clinic, Kuantan
Dr Zanariah Hussein Medical Department, Putrajaya Hospital
Ms Loh Kiaw Moi Xepa-Soul Pattinson
Dr Ariza Zakaria CRC, Kuala Lumpur Hospital
Dr Yap Piang Kian Subang Jaya Medical Centre
Ms Oiyammal Chelliah Pharmacy, Penang Hospital
Dr Badrulnizam Medical Department, Putrajaya Hospital
3. Anti-Lipidaemia and Cardiovascular therapeutics
Members Institution
Dato Dr Khoo Kah Lin (Chairman) Klinik Dr Khoo Kah Lin
Dr Tamil Selvan Muthusamy Damansara Specialist Hospital
Prof Dr Sim Kui Hian Dept of Cardiology, Sarawak General Hospital
Ms Chai Swee Chin CRC, Kuala Lumpur Hospital
Dr Selvarajah Sathaya Klinik Prime Care
Dr. Mohd Husni B Jamal Governance Board
Ms Noraini bt. Mohamad Pharmacy, Putrajaya Hospital
Dr David Quek Kwang Leng Dr Quek Specialist Heart Clinic
4 Antineoplastic, Oncology
Members Institution
Ms Lim Yeok Siew (Chairman) Pharmacy Division Kuala Lumpur Hospital
Dr Beena Devi Dept of Radiotherapy & Oncology,
Sarawak General Hospital
xv
MEMBERS OF NMUS EXPERT PANELS
Expert Panel4 Antineoplastic, Oncology
Members Institution
Ms Kamarun Neasa Begam Pharmacy, Kuala Lumpur Hospital
Ms Nik Nuradlina Nik Adnan Pharmacy, Kuala Lumpur Hospital
Ms Sujatha Suthandiram Pharmacy, Tengku Ampuan Rahimah Hospital,
Klang
Ms Tajunisah bt. M. Eusoff Pharmacy, Penang Hospital
Ms Yuzlina Muhamad Yunus Pharmacy, Kuala Lumpur Hospital
Dr Kananathan Ratnavelu NCI Cancer Hospital
Dr S. Visalachy PuruShotaman Hematology Dept, Kuala Lumpur Hospital
Dr Gucharan Singh Damansara Specialist Centre
5. Antiinfectives
Members Institution
Dr Tan Kah Kee (Chairman ) Dept of Paediatrics, Seremban Hospital
Ms Sameerah bt. Shaikh Abdul Rahman Pharmaceutical Services Division MOH
Ms Rahela Ambaras Khan Pharmaceutical Services Division MOH
Dr Victor Chuang Tuan Giam Pharmacy, University Kebangsaan Malaysia
Ms Usha Rajasingam Bio Collagen Tech Sdn Bhd
Ms Zuhaila bt. Muhamad Ikbar Pharmacy, Penang Hospital
Dr Sharmini Selvarajah University of Malaya
Ms Rohaizan bt Mohd Hanafi ah Pharmacy, Penang Hospital
Ms Yuen Shalyn CRC, Kuala Lumpur Hospital
6. Musculo-skeletal therapeutics
Members Institution
Dato’ Dr Ramanathan A/L Ramaiah (Chairman) Orthopaedics Dept, Ipoh Hospital
Dr Lee Chee Kuan Orthopaedics Dept, Ipoh Hospital
Dr Manmohan Singh Orthopaedics Dept, Ipoh Hospital
Ms Jennifer Tan Farmasi Alychem
Ms Suhadah Ahad Pharmacy, Melaka Hospital
7 Analgesic and Anaesthetics
Members Institution
Dr Mary S.Cardosa (Chairman) Dept of Anaesthesiology, Selayang Hospital
xvi
MEMBERS OF NMUS EXPERT PANELS
Expert Panel8 Psychiatric therapeutics
Members Institution
Dr Suraya Yusoff (Chairman) Psychiatric Dept, Sultanah Aminah Hospital JB
Mr Syed Fadzli bin Syed Sailuddin Phamaceutical Services Division MOH
Ms Noor Ratna bt. Naharuddin Pharmacy, Permai Hospital JB
Ms Mariam Bintarty Rushdi Pharmacy, Hospital Kuala Lumpur
Ms Tengku Malini Tg.Mohd.Noor Izam Pharmacy, Hospital Kuala Lumpur
Dr Ahmad Hatim Sulaiman Dept of Psychological Medicine UM
Dr Benjamin Chan Teck Ming Permai Hospital
Dr Suarn Singh A/L Jasmit Singh Hospital Bahagia
Dr Zoriah bt. Aziz Pharmacy UM
9. Respiratory therapeutics
Members Institution
Dr Norzila Zainuddin (Chairman) Department of Paediatric, Kuala Lumpur Hospital
Dr Molly Cheah Governance Board (PCDOM)
Ms Nurdita bt. Hisham Pharmacy, Seremban Hospital
Ms Rahayu bt. Shahperi Pharmacy, Kuala Lumpur Hospital
Ms Sarina Anim bt. Mohd. Hidzir Outpatient Department Sg Buluh
Datin Dr Aziah Ahmad Mahayiddin Institute of Respiratory Medicine
10 Pharmaco-economics
Members Institution
Dr Shanthi Varatharajan (Chairman) Institute for Health Management
Dr Lim Teck Onn CRC, Kuala Lumpur Hospital
Ms Rosminah bt. Mohd. Din Pharmaceutical Services Division MOH
Adrian Goh CRC, Kuala Lumpur Hospital
Dr Leong Kwok Chi Klinik Leong
Dr Nour Hanah bt. Othman Planning and Development Division MOH
En Chua Kee Long Planning and Development Division MOH
Lee Kin Kok CRC, Kuala Lumpur Hospital
xvii
NMUS STAFF
Project Leader Dr Sarojini Sivanandam
Clinical Research Manager Dr Lim Chiao Mei
Pharmacist Liaison Mr Syed Fadzli Syed Sailuddin
Clinical Research Coordinator Ms Esther Yong
Ms Ang Swee Ling
Ms Lee Kim Tin
Research Assistants Ms Raihan bt Mohd Raimee
Ms Aida Baharuddin
Pharmaco-Epidemiologist Dr Sharmini Selvarajah
Ms Yuen Shalyn
Ms Chai Swee Chin
Ms Sameerah binti Sheik Abdul Rahman
Dr Nour Hanah binti Othman
Ms Rosminah binti Md Din
Ms Hasnizan binti Hazan
Ms Zaiton Kamaruddin
Economist Mr Adrian Goh
Statistician Ms Teh Poh Geok
Ms Raja’ah binti Meor Yahyauddin
IT Manager Ms Celine Tsai Pao Chien
Database Developer/ Administrator Ms Tang Roh Yu
Mr Patrick Lum See Kai
Ms Lim Jie Ying
Mr Sebastian Thoo
Network Administrator Mr Kevin Ng Hong Heng
Mr Adlan Ab Rahman
Desktop Publisher Ms Azizah Alimat
Webmaster Mr Patrick Lum See Kai
NMUS Project Staff
Technical Support Staff
xviii
CONTENTS
FOREWORDS ....................................................................................................................... i
PREFACE .............................................................................................................................. iii
ACKNOWLEDGEMENTS ................................................................................................ iv
PARTICIPANTS OF THE NATIONAL MEDICINES USE SURVEY .................... vi
ABOUT THE NATIONAL MEDICINES USE SURVEY ............................................ xii
NMUS GOVERNANCE BOARD ...................................................................................... xiii
MEMBERS OF NMUS EXPERT PANELS .................................................................... xiv
NMUS STAFF ......................................................................................................................... xvi i
CONTENTS ............................................................................................................................ xviii
METHODS .............................................................................................................................. xix
ABBREVIATIONS ................................................................................................................ xxvii
Chapter 1: Use of Medicines in Malaysia .................................................................................. 1
Chapter 2: Expenditure on Medicines in Malaysia .................................................................... 5
Chapter 3: Use of Drugs for Acid Related Disorders [Reserve] ................................................ 7
Chapter 4: Use of Antiobesity Medicines [Reserve] .................................................................. 7
Chapter 5: Use of Antidiabetics ................................................................................................. 9
Chapter 6: Use of Antianaemic Drugs [Reserve] ....................................................................... 13
Chapter 7: Use of Antihaemorrhagic Drugs [Reserve] .............................................................. 13
Chapter 8: Use of Drugs for Cardiovascular Disorders ............................................................. 15
Chapter 9: Use of Antihypertensives ......................................................................................... 21
Chapter 10: Use of Lipid Lowering Medicines .......................................................................... 27
Chapter 11: Use of Dermatologicals [Reserve] .......................................................................... 31
Chapter 12: Use of Gynaecologicals, Sex Hormones and Hormonal Contraceptives [Reserve] 31
Chapter 13: Use of Urologicals [Reserve] ................................................................................. 31
Chapter 14: Use of Drugs for Endocrine Disorders [Reserve] .................................................. 31
Chapter 15: Use of Antiinfectives .............................................................................................. 33
Chapter 16: Use of Antineoplastic Agents ................................................................................. 45
Chapter 17: Use of Systemic Corticosteroids and Immunosuppressive Agents [Reserve] ........ 47
Chapter 18: Use of Drugs for Rheumatological and Bone Disorders ........................................ 49
Chapter 19: Use of Analgesics and Anaesthetics [Reserve] ....................................................... 55
Chapter 20: Use of Drugs for Neurological Disorders [Reserve] .............................................. 55
Chapter 21: Use of Drugs for Psychiatric Disorders .................................................................. 57
Chapter 22: Use of Drugs for Obstructive Airway Diseases ...................................................... 65
Chapter 23: Use of Antihistamines & Nasal Decongesants [Reserve] ....................................... 69
Chapter 24: Use of Ophthalmologicals [Reserve] ...................................................................... 69
Chapter 25: Use of Otologicals [Reserve] .................................................................................. 69
xix
METHODS
Introduction
The NMUS is designed, broadly speaking, to estimate the quantity and pattern of use of medicines in Malaysia,
as well as to estimate our expenditure on pharmaceutical. This is an ambitious project, which requires multiple
surveys at the various levels of the medicines supply and distribution chain in the country (Figure 1) in order
to capture all the required data to meet its purpose. Clearly, all these could not be accomplished overnight, and
of necessity must be undertaken in phases. We had realistically targeted data sources that are absolutely critical
and/or accessible initially, while piloting less accessible ones, and leaving the most inaccessible data sources for
the future, hoping to build on the foundation laid by earlier surveys as well as to capitalize on early successes.
Hence, the statistics on medicines use and expenditure in this report are estimated based on data from only a
limited number of surveys (though they were the critical ones) that could be successfully completed nation-wide
or on a more local pilot basis. The scope was also deliberately limited to prescription only medicines (obviously
the pharmaceuticals of greatest interest) and excludes Over-the-Counter (OTC) medicines, traditional or herbal
products and food supplements. No doubt, the NMUS will mature over time as coverage of existing nation-
wide surveys broaden, local pilot surveys are rolled out nation-wide, and presently less accessible data sources
become available. Over time, we should be able to provide more accurate and reliable estimates, as well as more
informative and detailed analyses.
Figure 1: Medicines supply & distribution system and Sources of
medicines data
Manufacturer/ Importer
Distributor
Purchaser
Hospital Primary care/ GP Pharmacy
Consumer
xx
NMUS Surveys
The NMUS conducts several surveys in order to capture data at the various levels of the medicines supply and distribution system in the country. The sources of data, surveys to collect the data, data availability, comment on
data inclusion in this report are summarized in the table below.
# Data sources and Surveys Year data
available
Inclusion in
present report
1. Medicines import or production data
1.1 Medicines import data from Royal Malaysian Custom 2004, 2005 No
1.2 Local pharmaceutical manufacture Data not collected No
2. Domestic sales data
2.1 Domestic sales data from local pharmaceutical
companies
Failed to collect
the data
No
3. Medicines procurement data
3.1 Public hospitals’ medicines procurement data from
several sources:
a. MOH procurement through central tender 2001 to 2005 Yes
b. MOH individual hospitals’ local purchase 2001 to 2005 Yes
c. University and Armed forces hospitals’ procurement 2004 Yes
3.2 Private hospitals procurement 2000 to 2004 Yes
3.3 Private GPs procurement Not done yet No
3.4 Private specialist practice procurement Not done yet No
3.5 Private pharmacies’ procurement Not done yet No
4. Medicines prescription data
4.1 Public (MOH) primary care practice prescription
Pilot survey limited to WP only
2005 Yes
4.2 Private GP prescription
Pilot survey limited to WP only
2005 Yes
4.3 Private specialist practice prescription of highly
specialized medicines
Not done yet No
4.4 Hospital practice prescription Data not collected No
5. Medicines dispensing data
5.1 Public hospital pharmacy dispensing Data not collected No
5.2 Private free-standing retail pharmacy dispensing
Pilot survey limited to WP only
2005 Yes
6. Household medicines consumption data
6.1 Household survey on medicines consumption Not done yet No
Thus, the statistics presented in this report are derived from only a limited number of data sources. As shown above:• Of the 6 theoretical data sources, NMUS primarily targeted data sources on medicines procurement and
prescription.• Collection of prescription data is limited to clinic practices, while hospital prescription is assumed to be
included in hospital procurement data• Many private medical specialists however may self-procure and dispense, rather than use hospital pharmacy
dispensing service. Hence, separate procurement and prescription survey on highly specialized medicines are required, and are being piloted. Thus in so far that prescription of highly specialized medicines for a particular condition is concentrated in private ambulatory specialist practices (unlikely as most are probably prescribed in hospital setting), they will be under-estimated in this report
• Similarly, hospital dispensing data are assumed to be included in hospital procurement data, except of course for private free-standing pharmacies. Dispensing survey is therefore limited to this only.
xxi
• It is well known that consumers do access medicines through both formal as well as informal channels. Household survey will be required to obtain information on such use of medicine in the community.
• Finally, medicines import data while not used for statistical estimation, are however used for cross-checking the reliability of results estimated from the other data sources.
Survey population, sampling and response or coverage rate
The surveys conducted by NMUS, its survey population, its sampling unit and sample size, and the survey
response or coverage rates are summarized in the table below.
# Surveys Survey population
and sampling unit
Sample size Coverage or response rate,
and completeness
1. MOH Pharmaceutical
procurement
128 MOH hospitals 128 hospitals
77 hospitals
100% for APPL
60% for non-APPL
2. Private hospitals’
pharmaceutical
procurement
123 Private Hospitals 29 hospitals 23.6%
3. University and Armed
Forces’ hospital
pharmaceutical
procurement
3 University hospitals
3 Armed Forces’
hospitals
1 University
2 Armed Forces’
hospital
33% for University
66% for Armed Forces
4. MOH primary care
practice prescription
15 clinics in WP KL 15 clinics 100%
5. Private GP prescription 622 clinics in WP KL 188 30.2%
6. Private pharmacy
dispensing
72 pharmacies in WP
KL
32 44%
Data collection
The surveys conducted by NMUS collected the data either by
1. Download from existing databases
2. Primary data collection
These are described below.
# Surveys Data download from existing databases
1. MOH Pharmaceutical procurement Pharmaniaga pharmaceutical procurement databases,
central database as well as local individual hospitals’
databases.
2. Private hospitals’ pharmaceutical procurement Individual hospitals’ pharmaceutical procurement
databases
3. University and Armed Forces hospital
pharmaceutical procurement
Individual hospitals’ pharmaceutical procurement
databases
# Surveys Primary data collection
4. MOH primary care practice prescription All MOH clinics in WP collected prescription data in a
randomly selected week half yearly
5. Private GP prescription A sample of GPs collected prescription data in a randomly
selected week. The sample being distributed over two half
yearly cycle
6. Specialist practice prescription All dialysis facilities collected data on prescription of
certain highly specialized medicines for all patients in
their facility at the end of each year
7. Private pharmacy dispensing A sample of pharmacies with resident pharmacist collected
dispensing data in a randomly selected week. The sample
being distributed over two half yearly cycle.
xxii
Data management
The collected data, whether in downloaded databases or in paper or electronic data collection form must be
compiled into a single database, appropriately processed and coded prior to statistical analysis.
The NMUS database was created in Ms Access 2000. The application has 2 modules: Contact Management and
Data Entry.
• Contact Management module is used to collect the establishment survey details, log and track all the
correspondence documents with SDP, and forecast, plan and schedule the conduct of the survey.
• Data Entry module is used to collect the data submitted by the SDP in paper form. It has been designed to
collect data from GP prescription survey and pharmacy dispensing survey.
The database server is running on Windows 2000 Server. The server environment is Intel Xeon 2.4 Mhz, with a
total of 2GB RAM memory and 67.8GP Raid5 Hard disk
The data processing steps are as follows:
# Data processing for downloaded database
1. Data were downloaded from the existing database of the following data sources
• MOH APPL Procurement
• MOH non APPL Procurement
• Private Hospital
• GP Prescription
The data downloaded could be in fl at fi le format, e.g. TXT/ XLS and etc, or database fi les such as Access/
Oracle/ SQL and etc.
2. The structure of each of the downloaded database/ data fi le would be studied and analyzed to identify the
required data fi elds/ variables. Sometimes the project team might have to consult the SDP to get a better
understanding of the data provided.
Some of the required variables are drug registration number, drug description, packaging description,
supplier name, value procured, quantity procured, year procured and etc.
3. Next, the required fi elds/ variables would be extracted using SQL queries based on the understanding of
the database structure.
The extracted data each of the downloaded database/ data fi le would then be normalized by separating into
multiple, related tables in a single compiled database.
4. Data from some of the sources would require aggregation, e.g. total a few transactions on the same drug
into 1 record, to speed up subsequent query performance
5. The data would then be linked to the respective SDP in the main contact table.
# Data processing for primary survey data
1. Data entryData is entered into the Data Entry module of the database.
Prior to data entry, data entry personnel are briefed on how to use the database and enter the data. Necessary
precautions were given verbally for example to check each clinic by offi ce id and name, as they are clinics
with many branches of the same name.
A demonstration was done on data entry during the briefi ng.
Personnels were supervised while doing the fi rst few entries to make sure they know how to do it
correctly.
A standard document on steps/ precautions of data entry would be mailed to each personnel.
They are also given a softcopy of the list of pharmaceutical products (scheduled poison and non-scheduled
poison) obtained from National Pharmaceutical Control Bureau, to cross check the spellings of drugs when
the writing is less legible.
xxiii
# Data processing for primary survey data
2. Edit checksSurvey forms are crosschecked against the database.
Selection of survey form is as follows:
a. By data entry personnel: volume is 5% of total days entered by each individual
b. Selection of which day and which SDP is random
c. First fi ve pages of the selected day are then checked.
Items to check:
a. Number of patients are same in survey form and database
b. Number of drug entry/ drug prescribed is same in survey form and database.
c. Age, sex of patient is entered correctly.
d. Drug particulars are entered correctly.
3. Calculations and Derived variables• Dose per day is obtained by Dosage*frequency
• Dose per visit is obtained by Dosage*frequency* duration
4. Visual review and manual assessment of entries if they are misspellings.
# ATC Coding and Total Dosage Calculation
1. BPFK Registered Product ListAn estimated 7000 poison products registered with NPCB were manually coded to 2005 ATC INN (Level
5). The coded NPCB drug list would serve as an internal drug dictionary for medicines data coding later.
2. Data Parsing and Standardization by programmingThe variables ‘Drug description’ and ‘Packaging Description’ in medicines (procurement/ prescription/
dispensing) data are parsed and standardized into smaller parts using specially written computer program.
Parsing and standardization help facilitating auto coding process and dosage calculation later.
The variable ‘Drug description’ will be parsed and standardized into ‘Brand’, ‘INN’, ‘Dosage’, ‘Unit’ and
‘Route’
e.g. Zocor Tab 80 mg
Brand – Zocor
Inn – none
Dosage – 80
Unit- mg
Route – Oral (Tab)
The variable ‘Packaging Description’ will be parsed into ‘Big Unit’, ‘Small Unit’ and ‘Factor’
e.g. Pack of 10 tabs
Big Unit – Pack
Small Unit – tabs
Factor – 10
3. ATC Coding by programming• Drugs were automatically coded to ATC using specially written computer program
• The parsed ‘Brand’ would then be linked to the coded BPFK drug list to obtain the ATC INN and DDD.
However, if a certain brand has more than 1 DDD, the administration route has to be considered when
assigning the DDD.
• On the other hand, the parsed ‘INN’ would be linked to the ATC Level 5 to obtain the INN and DDD.
Similarly, if a certain INN has more than 1 DDD, the administration route has to be considered when
assigning the DDD.
• Visual review and manual coding of residual medicines data to ATC; most of these residual data are due
to incomplete or inconsistent data.
xxiv
# ATC Coding and Total Dosage Calculation
4. Drug Description Dosage and Unit Calculation by programmingThe Drug Description Dosage and Unit would be the parsed ‘Dosage’ and ‘Unit’ unless more than 1 dosage
exists, e.g. 2MG/ML 100ML. This kind of data would require further processing.
The results of this step are ‘Total Drug Description Dosage’ and ‘Total Drug Description Unit’.
Remaining residual has been handled manually
5. Packaging Description Dosage Calculation by programmingThe packaging description dosage would be taking the parsed ‘Factor’ and calculated with reference to the
‘SKU’ or ‘UOM’.
The result of this step is the ‘Total Packaging Description Dosage’
Remaining residual has been handled manually
6. Total Dosage Calculation by programmingTotal Dosage = Total Drug Description Dosage * Total Packaging Description Dosage * Quantity
procured
Total Dosage Unit = Total Drug Description Unit
Statistical report
This statistics on use of medicines in this report are presented using the Anatomical Therapeutic Chemical
(ATC) classifi cation system, and the unit of measurement is expressed in defi ned daily dose (DDD). This is
recommended by the WHO to be used for drug utilization research and for purpose of comparisons of drug
consumption statistics between countries, between regions or population groups within country and to evaluate
trends in drug use over time.
Structure of the ATC Classifi cation system
In this system, medicines are divided into different groups according to the organ or system on which they act,
and on their chemical, pharmacological and therapeutic properties.
Medicines are classifi ed in groups at 5 different levels as follows:
Level Group and subgroups
1. Anatomical main group. There are 14 of these, eg C cardiovascular, M musculo-skeletal, R respiratory,
etc
2. Therapeutic main group
3. Therapeutic subgroup
4. Chemical or Therapeutic subgroup
5. Drug chemical substance
An example should make this clear. Simvastatin is coded C10AA01. The structure of its code is as follows:
Level Code Group and subgroups
1. C Cardiovascular system
2. C10 Serum lipid reducing agents
3. C10A Cholesterol or triglyceride reducers
4. C10AA HMG CoA reductase inhibitors
5. C10AA01 Simvastatin
Refer to the publication Guidelines for ATC Classifi cation and DDD Assignment (WHO Collaborating Centre for
Drug Statistics Methodology 2003; www.whocc.no) for details.
xxv
Concept of the Defi ned Daily Dose (DDD)
The measurement unit for medicines use adopted in this report is the DDD.
The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. The
DDD is simply a technical measure of drug utilization; it does not necessarily agree with the recommended or
prescribed daily dose. Doses for individual patients and patient groups will often differ from the DDD. The DDD
is often a compromise based on review of the available information about doses used in various countries. The
DDD may even be a dose rarely prescribed because it is an average of two or more commonly used doses.
Medicines use statistics in this report are presented for most drugs as numbers of DDDs per 1000 inhabitants per
day. Some interpretative notes as follows:
• The DDDs/1000 inhabitants/day provides a rough estimate of the proportion of population treated daily
with certain drugs. For example, the fi gure 10 DDDs/1000 inhabitants/day indicates that 1% (10/1000) of the
population on average might get a certain drug or group of drugs every day in the year.
• The DDDs/1000 inhabitants/day is most useful for drugs used in the treatment of chronic diseases and
especially when there is a good agreement between the average prescribed daily dose and the DDD.
• For most drugs, their DDDs/1000 inhabitants/day are calculated for the total population including all age
and sex groups. Where a drug use is limited to particular age or sex groups, then it will be more meaningful
to express the fi gure for the relevant age-sex groups only. For example DDDs/1000 children age<12 /day, or
DDDs/1000 women in reproductive age groups/day.
For antiinfectives (or other drugs normally used in short duration), the medicine use statistics are presented
as DDD per inhabitant per year. This gives an estimate of the number of days for which each inhabitant is, on
average, treated annually. For example, 5 DDDs/inhabitant/year indicates that the utilization is equivalent to the
treatment of every inhabitant with a 5-days course in the year.
In interpreting drug utilization statistics expressed using DDD as in this report, readers are caution to bear in
mind the following limitations:
• A medicine may have several indications while the DDD is based on the main indication in adults.
• Medicines procured or prescribed or dispensed, as presented here, may not necessarily be consumed
• DDD may be diffi cult to assign or not assign at all for certain medicines, for examples medicines with
multiple ingredients, topical products, antineoplastic drugs and anaesthetic agents.
• Medicines newly introduced into the market may yet have ATC and DDD assigned to it.
• The DDD assigned to a drug is primarily based on other countries’ experience and may not refl ect the
commonly prescribed adult dose in Malaysia.
Statistical methods
In this report, as explained above, the quantity of use of a medicine is expressed as, depending on the type of
medicine, the number of DDDs per 1000 inhabitants per day or DDDs per inhabitants per year. These statistics
are calculated as follows:
T*1000
DDDs/1000 inhabitants/day =
DDD* P*365
T
DDDs/inhabitant/year =
DDD* P
Where
T is an estimate of the total quantity of the drug utilized in the year under consideration
DDD is the DDD assigned for the drug according to the ATC/DDD system
P is the mid-year population of Malaysia or the relevant area where the survey was conducted
365 refers to the 365 days in a year
In either case, an estimate of the total quantity of the drug being utilized in the year is required, and this must be
expressed in the same unit as the DDD assigned for the drug.
xxvi
The statistical estimation of the totals varies depending on the survey method and the sampling design employed
to collect the data, and if necessary with adjustment for incomplete data. These are described below.
# Surveys Estimation procedure
1. MOH
Pharmaceutical
procurement
No sampling was employed in the survey.
The total is therefore simply estimated by the sum of all the quantities of the drug
procured in all procurement records in the year.
Adjustment is made for the 51 hospitals with incomplete procurement records.
2. Private hospitals’
pharmaceutical
procurement
Data were available for only a sample of hospitals.
The total is estimated by T = Wi T
i
Where;
Wi is the sampling weight of the ith hospital
Ti is the value of the quantity of drug procured of the ith hospital in the year
Since, large hospitals as measured by bed strength was overrepresented in the sample,
a bias correction factor (BCF) was applied to the estimate.
BCF = B / b * Wi
Where B is total number of beds in the population, b the number in the sample and
Wi is the sampling weight of the ith hospital
3. University
and Armed
Forces’ hospital
pharmaceutical
procurement
Data were available for only a sample of hospitals.
The total is estimated by T = Wi T
i
Where;
Wi is the sampling weight of the ith hospital adjusted for non-response
Ti is the value of the quantity of drug procured of the ith hospital in the year
4. Private GP
prescription
Data were collected only for a sample of GPs and for each respondent, data collected
only for a sample of days in a year (working days only).
The total is estimated by T = Wi jT
ij
Where;
Wij is the sampling weight for the ith day of the jth GP
Tij is the value of the quantity of drug prescribed by the jth GP on the ith day
5. Private specialist
practice
prescription
(Nephrology and
dialysis practices
only)
No sampling was employed in the survey.
The total is therefore simply estimated by the sum of all the quantities of the drug
prescribed for all patients dialyzing in the facility.
6. Private pharmacy
dispensing
Data were collected only for a sample of pharmacies and for each respondent, data
collected only for a sample of days in a year (working days only).
The total is estimated by T = Wi jT
ij
Where;
Wij is the sampling weight for the ith day of the jth Pharmacy
Tij is the value of the quantity of drug dispensed by the jth Pharmacy on the ith day
Where there is sampling or where response rate of the survey was less than 100%, the procedures described above incorporate the sampling weight of the sampling unit in the estimation of total.
The sampling weight for each sampling unit or unit of analysis has the following components: 1. Probability of selection. The basic weight is obtained by multiplying the reciprocals of the probability of selection at each step of sampling design. Example, for GP prescription survey, this is GP practice and prescription day.
2. Adjustment for non-response.The response rate was less than 100% for some surveys; an adjustment to the sampling weight is required. The non-response adjustment weight is a ratio with the number of units in the population as the numerator and the number of responding sampling units as the denominator. The adjustment reduces the bias in an estimate to the extent that non-responding units have same characteristics as responding units. Where this is unlikely, some adjustments took into account differences in some relevant characteristics between responding and non-responding units that may infl uence drug utilization, such as bed strength, staff strength, scope of services for hospitals etc.
xxvii
ABBREVIATIONS
ACEI Angiotensin Converting Enzyme Inhibitors
AF Atrial Fibrillation
APPL Approved Product Price List
ARB Angiotensin II Antagonists/ Angiotensin Receptor Blocker
ASR Age Standardized Rate
ATC Anatomical Therapeutic Chemical
BCF Bias Correction Factor
BPFK Biro Pengawalan Farmaseutikal Kebangsaan
CCB Calcium Channel Blockers
CCF Congestive Cardiac failure
COAD Chronic Obstructive Airway Disease
CPG Clinical Practice Guidelines
DALYs Disability Life Years
DDD Defi ned Daily Dose
Dept Department
FDA Food And Drug Administration
GP General Practitioner
HMG CoA 3-hydroxy-3-methylglutaryl coenzyme A
INN International Nonproprietary Name
ISAAC International Study of Asthma and Allergies in Chilldhood
KL Kuala Lumpur
LMWH Low Molecular Weight Heparin
MOH Ministry of Health
NCC National Cancer Centre
NCI National Cancer Institute
NMP National Medicines Policy
NMUS National Medicines Use Survey
NPCB National Pharmaceutical Control Bureau
NSAID Non Steroidal Anti- Infl ammatory Drugs
OTC Over-the-Counter
PCDOM Primary Care Doctors Organisation Malaysia
SDP Source Data Producer
SERM Selective Estrogen Receptor Modulator
SKU Stock Keeping Unit
SSRI Serotonin Selective Reuptake Inhibitor
UOM Unit of Measurement
URTI Upper Respiratory Tract Infection
WHO World Health Organization
WP Wilayah Persekutuan
CHAPTER 1
USE OF MEDICINES IN MALAYSIA Malaysian Statistics on Medicine 2004
1
Edited by:
Sarojini S1, C.M. Lim1, T.O. Lim1, L.S. Lai2, Zaki Morad1
1 Clinical Research Centre MOH, 2 Pharmaceutical Services Division MOH
For the fi rst time in Malaysia, we are able to report national estimates of the use of medicines. This chapter
describes the commonly used medicines by therapeutic groups and by specifi c drugs. Certain medicines however
were deliberately excluded in this chapter for various reasons as follows:
1. OTC medicines, health supplements and traditional complementary medicines are outside the scope of the
NMUS
2. Medicines without DDD assignment such as antineoplastic drugs, anaesthetic agents
3. Predominantly topical medicines (Dermatologicals, Ophthalmologicals, Otologicals, Gynaecologicals, Nasal
and Throat preparations, Stomologicals)
The most commonly used medicines in 2004 in Malaysia were antidiabetic medications (4% of the population were
on this), of which glibenclamide (1.4% of population) and metformin were the most commonly used drugs.
The various antihypertensive medications also fi gured very high on the top 30 list; beta-blockers was second
(2.5% of population on this), followed by agents acting on the renin-angiotensin system (third on list, 2.2%),
calcium channel blockers (seventh on list, 1.8%) and diuretics (tenth on list, 1.5%; though this include high
ceiling diuretics not used for hypertension). Collectively, these antihypertensive medicines were more commonly
used than antidiabetics. Hypertension and diabetes mellitus are the two most prevalent chronic disorders in the
country. In 1996, the prevalence of hypertension was 33% [1] and diabetes mellitus 8% [2]; thus in the light
of known disease epidemiology, such high medicines utilization rates for these conditions are to be expected.
Indeed one may question whether they were suffi ciently high to ensure all in need of therapy were on treatment
and properly controlled.
This utilization pattern is in sharp contrast to Australia (the only country in the region with available medicine
use statistics [3]), where lipid reducers (top) and antiasthmatics (second on list) dominated its top-10 drug list
in year 2000. The latter only ranked fourth on Malaysian top-10 list, which is to be expected considering the
difference in disease prevalence between the 2 countries [4], while the relatively lower use of lipid reducers
(only 2% of population compared with 7% or higher in Australia) defi nitely suggests under-utilization of lipid
reducers, even if past survey has shown lower prevalence of hypercholesterolaemia in Malaysia [5]. Another
interesting contrast is simvastatin (sixth on our list) and lovastatin (twentieth on list) are commonly used here,
while atorvastatin topped the Australian list.
A surprisingly highly used medicine is antihistamines for systemic use (2% of population), mostly chlorpheniramine
and loratadine, which deserve further investigation.
Antibacterial medicines not surprisingly were widely used, amoxicillin, amoxicillin+ enzyme inhibitor,
doxycycline were the most popular items in the group. Similarly, antirheumatic medicines were also commonly
used (1.6% of population; the common drugs were diclofenac and mefenamic acid) and analgesics (1%). Refer to
individual chapters for detailed discussion on these specifi c therapeutic groups.
Certain perhaps surprising levels of medicine utilization observed (in terms of % of population on), whether
expectedly or unexpectedly high or low, were:
• Drugs for acid related disorders such as peptic ulcers 0.7%
• Systemic corticosteroids 0.5%
• Psycholeptics 0.5%
• Antiepileptics 0.2%
• Antigout medicines, 0.2%
• Thyroid therapy (thyroxine and antithyroid medicines) 0.2%
Malaysian Statistics on Medicine 2004
CHAPTER 1
USE OF MEDICINES IN MALAYSIA
2
For the disorders for which these medicines are indicated, little is known about their epidemiology and treatment
in this country to aid interpretation of these medicines use statistics. They deserve further investigation. Refer to
individual chapters for further discussion on some of these specifi c therapeutic groups.
Table 1.1: Top 30 Therapeutic groups by Utilization in DDD/1000 population/day 2004
# ATC Therapeutic group Public Private Total
1. A10 DRUGS USED IN DIABETES 26.7887 15.1461 41.9348
2. C07 BETA BLOCKING AGENTS 17.0781 8.5554 25.6335
3. C09 AGENTS ACTING ON THE RENIN-
ANGIOTENSIN SYSTEM
9.3489 12.8611 22.2100
4. R03 DRUGS FOR OBSTRUCTIVE AIRWAY
DISEASES
11.6735 10.3845 22.0580
5. R06 ANTIHISTAMINES FOR SYSTEMIC USE 4.9574 14.6639 19.6212
6. C10 SERUM LIPID REDUCING AGENTS 5.0703 14.1665 19.2368
7. C08 CALCIUM CHANNEL BLOCKERS 12.3461 6.2281 18.5742
8. J01 ANTIBACTERIALS FOR SYSTEMIC USE 3.8749 13.8439 17.7188
9. M01 ANTIINFLAMMATORY AND
ANTIRHEUMATIC PRODUCTS
4.0256 11.9142 15.9397
10. C03 DIURETICS 8.1171 7.7100 15.8271
11. N02 ANALGESICS 4.2168 5.4568 9.6736
12. A02 DRUGS FOR ACID RELATED DISORDERS 2.3643 4.6592 7.0235
13. C01 CARDIAC THERAPY 2.9101 2.6040 5.5141
14. N05 PSYCHOLEPTICS 3.2487 1.8760 5.1247
15. H02 CORTICOSTEROIDS FOR SYSTEMIC USE 1.4101 3.4475 4.8576
16. C02 OTHER ANTIHYPERTENSIVES 2.9638 0.3169 3.2808
17. B01 ANTITHROMBOTIC AGENTS 2.1520 1.1157 3.2676
18. N03 ANTIEPILEPTICS 1.8314 0.4358 2.2672
19. M04 ANTIGOUT PREPARATIONS 1.0003 1.1924 2.1927
20. H03 THYROID THERAPY 1.2360 0.8220 2.0580
21. N06 PSYCHOANALEPTICS 0.5030 0.8226 1.3256
22. N07 OTHER NERVOUS SYSTEM DRUGS 0.4089 0.7186 1.1274
23. M05 DRUGS FOR TREATMENT OF BONE
DISEASES
0.6809 0.3762 1.0571
24. J02 ANTIMYCOTICS FOR SYSTEMIC USE 0.0371 0.9775 1.0146
25. J04 ANTIMYCOBACTERIALS 0.8336 0.1419 0.9755
26. N04 ANTI-PARKINSON DRUGS 0.7094 0.0368 0.7462
27. M03 MUSCLE RELAXANTS 0.0406 0.5911 0.6318
28. L02 ENDOCRINE THERAPY 0.1697 0.0827 0.2524
29. P01 ANTIPROTOZOALS 0.1981 0.0231 0.2213
30. J05 ANTIVIRALS FOR SYSTEMIC USE 0.1151 0.0875 0.2026
CHAPTER 1
USE OF MEDICINES IN MALAYSIA Malaysian Statistics on Medicine 2004
3
Table 1.2: Top 40 Drugs by Utilization in DDD/1000 population/day 2004
# ATC Drugs Public Private Total
1. A10B B01 GLIBENCLAMIDE 10.9606 3.5307 14.4913
2. C07A B03 ATENOLOL 6.3664 6.7118 13.0782
3. A10B A02 METFORMIN 7.7235 4.0201 11.7436
4. C07A B02 METOPROLOL 10.1242 0.8652 10.9895
5. C08C A05 NIFEDIPINE 8.8336 1.0538 9.8874
6. C10A A01 SIMVASTATIN 1.0938 6.8078 7.9016
7. C08C A01 AMLODIPINE 2.8030 3.7759 6.5788
8. R03A C02 SALBUTAMOL 5.3490 0.9874 6.3364
9. R06A B04 CHLORPHENIRAMINE 2.4555 3.2771 5.7326
10. A10B B09 GLICLAZIDE 2.7913 2.8564 5.6477
11. R03C C02 SALBUTAMOL 0.6634 4.7596 5.4231
12. M01A B05 DICLOFENAC 1.2021 4.1477 5.3498
13. M01A G01 MEFENAMIC ACID 1.4452 3.3449 4.7901
14. R06A X13 LORATADINE 0.5986 4.0112 4.6098
15. C03C A01 FUROSEMIDE 3.3840 1.0876 4.4716
16. A10A D- INSULINS AND ANALOGUES
(INTERMEDIATE-ACTING COMBINED
WITH FAST-ACTING)
2.9303 1.5073 4.4376
17. C03A A04 CHLOROTHIAZIDE 4.0569 0.0284 4.0854
18. C10A A02 LOVASTATIN 2.9441 1.1358 4.0799
19. J01C A04 AMOXICILLIN 0.7732 3.2511 4.0243
20. C09A A04 PERINDOPRIL 3.0035 1.0106 4.0141
21. C10A A05 ATORVASTATIN 0.4129 3.5017 3.9146
22. C09A A01 CAPTOPRIL 3.6115 0.2813 3.8928
23. C09A A02 ENALAPRIL 1.8020 2.0296 3.8315
24. H02A B06 PREDNISOLONE 0.9587 2.6250 3.5837
25. A02B A02 RANITIDINE 1.0864 2.0978 3.1843
26. C03A A03 HYDROCHLOROTHIAZIDE 0.0007 3.0596 3.0603
27. J01C R02 AMOXICILLIN+ENZYME INHIBITOR 0.0984 2.8586 2.9569
28. R06A E07 CETIRIZINE 0.0941 2.5528 2.6469
29. R03B A02 BUDESONIDE 1.7225 0.8771 2.5996
30. C02C A01 PRAZOSIN 2.3022 0.1498 2.4520
31. R06A D02 PROMETHAZINE 0.9011 1.3746 2.2757
32. C03B A11 INDAPAMIDE 0.0925 2.0972 2.1897
33. C01E B15 TRIMETAZIDINE 0.8007 1.2629 2.0636
34. C09C A01 LOSARTAN 0.3466 1.6337 1.9803
35. R03D A04 THEOPHYLLINE 1.2720 0.5879 1.8599
36. A10A B- INSULINS AND ANALOGUES (FAST-
ACTING)
1.0116 0.7592 1.7708
37. J01A A02 DOXYCYCLINE 0.1970 1.5380 1.7350
38. R03B B04 TIOTROPIUM BROMIDE 0.7026 1.0132 1.7158
39. C09A A03 LISINOPRIL 0.0001 1.6353 1.6354
40. M04A A01 ALLOPURINOL 0.6952 0.8834 1.5786
Malaysian Statistics on Medicine 2004
CHAPTER 1
USE OF MEDICINES IN MALAYSIA
4
References
1. Lim TO, Zaki M, Maimunah AH, Rozita H, Ding LM. Prevalence, awareness, treatment and control of
Hypertension in Malaysian adult population. Singapore Medical Journal 2004;45:20-27
2. Lim TO, Ding LM, Zaki M, Suleiman AB et al. Distribution of blood glucose in a national sample of
Malaysian adults. Med J Malaysia 2000;55:65-77
3. Australian Statistics on Medicine 1999-2000.Commonwealth Department of health and ageing Australia
2003
4. International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide
variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in
Childhood (ISAAC) Eur Respir J. 1998; 12:315-35
5. Lim TO, Ding LM, Zaki M, Suleiman AB et al. Distribution of blood total cholesterol in a national sample
of Malaysian adults. Med J Malaysia 2000;55:78-89
CHAPTER 2
EXPENDITURE ON MEDICINES IN MALAYSIA Malaysian Statistics on Medicine 2004
5
Edited by:
Shanthi V1, A. Goh2 , KK Lee2, Leong KC4, Rosminah Mohd Din3, Lim TO2
With contributions from:
Nour Hanah Othman3, Chua KL5
1 Institute for Health Management, 2 Clinical Research Centre MOH, 3 Pharmaceutical Services Division MOH, 4 Klinik Leong, 5 Planning & Development Division MOH
Considering the common chronic diseases in the country, the cost estimates of the commonly used drugs were
not surprising. In the top-10 list by cost, antihypertensive medications took the fi rst, second, sixth and tenth
ranks, while the statins were in the third and fourth rank, and an oral antidiabetics was ranked seventh.
The Malaysian healthcare sector spent about RM 145 million on antihypertensive medicines alone in year 2004.
Among these medicines, losartan, a drug acting on the renin-angiotensin system, tops the list with estimated
expenditure of RM 46.9 million. The private sector alone spent about RM 32 million on losartan in year 2004.
Amlodipine a calcium channel blocker, is the close second with a cost of RM 33 million.
The widely used statins, atorvastatin and simvastatin ranked third and fourth in the list with a 3.9 and 7.9 DDD/1000
population/day presented with a total cost of RM 74 million. Out of which the private sector accounted for RM 63
million. This is similiar to the Australian Statistics on Medicine wherein the statins are ranked fi rst and second.
This is expected in reference to their high utilization for hypercholesterolaemias in both countries.
Diabetes being one of the most prevalent chronic disorders in the country accounted for a total of RM 39 million
in drug expenditure. Presently gliclazide, the more commonly used oral antidiabetic drug in the private sector
is ranked seventh in the list with a cost of RM 16.5 million. The other commonly used oral antidiabetic drugs,
metformin, glibenclamide and insulin, had a total cost of RM 22.7 million.
Estimated Cost of the Top 40 Utilized Drugs, 2004
# ATC Drugs Public Cost/
Year (RM)
PrivateCost/
Year (RM)
Total Cost/
year (RM)
1. C09C A01 LOSARTAN 14,370,813 32,541,686 46,912,499
2. C08C A01 AMLODIPINE 28,330,855 4,759,518 33,090,373
3. C10A A05 ATORVASTATIN 4,368,009 26,428,830 30,796,838
4. C10A A01 SIMVASTATIN 2,910,660 27,269,223 30,179,883
5. J01C R02 AMOXICILLIN+ENZYME
INHIBITOR
849,856 20,387,523 21,237,380
6. C09D A01 LOSARTAN AND DIURETICS 902,534 16,837,071 17,739,605
7. A10B B09 GLICLAZIDE 8,157,546 8,347,800 16,505,346
8. R03A C02 SALBUTAMOL (INHALANT) 11,447,111 2,113,082 13,560,193
9. M01A B05 DICLOFENAC 2,864,376 9,883,180 12,747,555
10. C09A A04 PERINDOPRIL 8,693,567 2,925,160 11,618,727
11. B01A C05 TICLOPIDINE 6,828,453 3,873,663 10,702,116
12. C07A B02 METOPROLOL 9,636,382 823,512 10,459,894
13. A10B A02 METFORMIN 9,807,577 12,463 9,820,041
14. A02B C01 OMEPRAZOLE 888,512 7,232,717 8,121,229
15. C10A B05 FENOFIBRATE 117,373 7,991,129 8,108,503
16. C08C A05 NIFEDIPINE 7,052,004 856,024 7,908,028
Malaysian Statistics on Medicine 2004
CHAPTER 2
EXPENDITURE ON MEDICINES IN MALAYSIA
6
Estimated Cost of the Top 40 Utilized Drugs, 2004
# ATC Drugs Public Cost/
Year (RM)
PrivateCost/
Year (RM)
Total Cost/
year (RM)
17. C01E B15 TRIMETAZIDINE 2,563,485 5,188,363 7,751,848
18. R06A E07 CETIRIZINE 131,792 7,198,341 7,330,133
19. R06A X13 LORATADINE 335,349 6,891,295 7,226,643
20. C08C A02 FELODIPINE 2,079,655 4,792,226 6,871,881
21. R03B A02 BUDESONIDE 6,467,952 8,517 6,476,469
22. C09A A01 CAPTOPRIL 5,563,912 433,374 5,997,285
23. J01F A01 ERYTHROMYCIN 2,934,642 2,631,479 5,566,121
24. C10A A02 LOVASTATIN 3,809,996 1,463,490 5,273,485
25. C03B A11 INDAPAMIDE 587,731 4,405,864 4,993,595
26. A10A D01 INSULIN 3,064,353 1,576,255 4,640,608
27. C07A B03 ATENOLOL 2,229,122 2,350,060 4,579,182
28. A10B B01 GLIBENCLAMIDE 1,842,110 2,614,223 4,456,333
29. A10A B01 INSULIN 2,402,741 1,423,701 3,826,442
30. R06A B04 CHLORPHENAMINE 1,506,309 2,010,313 3,516,622
31. R03D A04 THEOPHYLLINE 442,003 2,860,405 3,302,408
32. H02A B06 PREDNISOLONE 447,570 2,843,125 3,290,696
33. C09A A03 LISINOPRIL 28,317 2,862,908 2,891,225
34. C02C A01 PRAZOSIN 2,303,985 449,748 2,753,733
35. A02B A02 RANITIDINE 2,525,793 104,008 2,629,801
36. C09A A02 ENALAPRIL 1,236,661 1,392,857 2,629,518
37. C03A A04 CHLOROTHIAZIDE 2,500,040 18,695 2,518,734
38. M04A A01 ALLOPURINOL 689,874 1,512,194 2,202,068
39. J01C A04 AMOXICILLIN 2,165,817 9,107 2,174,924
40. R03C C02 SALBUTAMOL (SYSTEMIC) 21,162 2,096,135 2,117,297
7
CHAPTER 3: USE OF DRUGS FOR ACID RELATED DISORDERS [RESERVE]
CHAPTER 4: USE OF ANTIOBESITY MEDICINES [RESERVE]
CHAPTER 5
USE OF ANTIDIABETICS Malaysian Statistics on Medicine 2004
9
Edited by:
G.R. Letchuman Ramanathan1, Yap Piang Kian2, Muruga Vadivale3, SP Chan10 , Oiyammal Chelliah4, Loh Kiaw Moi5, Ariza Zakaria6, Ernieda Md Hatah7
With contributions from:
Selva Malar8, Zanariah Hussein7, Badrulnizam7
1 Ipoh Hospital MOH, 2 Subang Jaya Medical Centre, 3 Sanofi Aventis Group, 4 Penang Hospital MOH, 5 Xepa-Soul Pattinson, 6 Clinical Research Centre MOH, 7 Putrajaya Hospital MOH, 8 Kuantan Health Clinic MOH, 10 Faculty of Medicine, University Malaya
Among antidiabetic medicines, the sulfonylureas were the most widely used (21.157 DDD/1000 population/day),
followed by biguanides, insulin, thiazolidinediones and alpha-glucosidase inhibitors. 2.1% of the population was
on sulfonylureas, translating to about 5% of population aged 30 and above (about 40% of population was aged
>=30 in 2004). This is consistent with the known high prevalence of diabetes in Malaysia (prevalence of 8.3% in
1996), taking into account substantial number of patients were not on drug therapy or had undiagnosed diabetes
[1,2].
The most popular sulphonylurea was glibenclamide. Chlorpropamide usage was low. This is rightly so as it tends
to cause serious prolonged hypoglycaemia. The Australian data (2000) showed that the use of chlorpropamide in
Australia was almost non-existent [3]. The use of chlorpropamide locally should also be discouraged.
The biguanides only accounted for 11.7436 DDD/1000 population/day in 2004. Metformin has been recommended
in recent guidelines to be fi rst line therapy for most type 2 patients. It is also cheap and hence cost effective.
The other oral agents, the alpha-glucosidase inhibitors and thiazolidinediones had lower usage. This was probably
because of their prohibitive cost.
The fi xed-dose combination drugs were new on the market in 2004 and hence thier observed low usage. We
expect a rise in the use of these drugs in the future because of their cost advantage. It is anticipated that fi xed
dose combinations will also improve compliance. As expected, the newer oral agents like glipizide, gliclazide,
glimepiride, rosiglitazone, repaglinide and nateglinide were more commonly used in the private sector as these
drugs were either not available in the Government formulary or their usage was only limited to specialists
(gliclazide, rosiglitazone and repaglinide).
It is a fact that most patients with type 2 diabetes will eventually require insulin for optimal glycaemic control.
Intermediate-acting insulin combined with fast-acting insulin seems to be the preferred regime. Although three
injections pre-meal of a fast-acting insulin and a basal dose of either an intermediate-acting insulin or long-
acting insulin(glargine) is more physiological; patients and doctors in general prefer the less intensive regime
using combinations (usually 30% short-acting and 70% long-acting) requiring only two injections a day. In
terms of public/private use, the only category where the DDD was higher in the private category was the long-
acting insulins. This is probably due to the fact that the new insulin analogue (glargine) was not available in the
Government formulary in 2004.
Comparing insulin use in Australia (2000), Finland (2002) and Malaysia (2004), the fi gures were 10.58, 18.62
and 7.78 DDD/1000 persons respectively [3,4]. Even if we take into consideration the lower prevalence of type
1 diabetes in Malaysia, the overall usage of insulin in Malaysia was low. The need for more stringent diabetic
control in type 2 diabetics (and hence the use of insulin when beta-cell failure ensues) has to be emphasised.
Malaysian Statistics on Medicine 2004
CHAPTER 5
USE OF ANTIDIABETICS
10
Table 5.1: Use of Antidiabetics by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
A10A INSULIN AND ANALOGUES 7.7762
A10B A BIGUANIDES 11.7436
A10B B SULFONAMIDES, UREA DERIVATIVES 21.1569
A10B D COMBINATIONS OF ORAL BLOOD GLUCOSE LOWERING
DRUGS
0.0545
A10B F ALPHA GLUCOSIDASE INHIBITORS 0.3861
A10B G THIAZOLIDINEDIONES 0.5741
A10B X OTHER ORAL BLOOD GLUCOSE LOWERING DRUGS 0.2433
Table 5.2: Use of Antidiabetics by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
A10A INSULIN AND ANALOGUES A10A B INSULINS AND ANALOGUES, FAST-ACTING Total 1.7708
Public 1.0116
Private 0.7592
A10A C INSULINS AND ANALOGUES,
INTERMEDIATE-ACTING
Total 0.9099
Public 0.8
Private 0.1099
A10A D INSULINS AND ANALOGUES,
INTERMEDIATE-ACTING COMBINED WITH
FAST-ACTING
Total 4.4376
Public 2.9303
Private 1.5073
A10A E INSULINS AND ANALOGUES, LONG-ACTING Total 0.6579
Public 0.1327
Private 0.5251
A10B A BIGUANIDES A10B A02 METFORMIN Total 11.7436
Public 7.7235
Private 4.0201
A10B B SULFONAMIDES, UREA DERIVATIVESA10B B01 GLIBENCLAMIDE Total 14.4913
Public 10.9606
Private 3.5307
A10B B02 CHLORPROPAMIDE Total 0.0448
Public 0.0225
Private 0.0223
A10B B07 GLIPIZIDE Total 0.1075
Public 0.0013
Private 0.1062
A10B B09 GLICLAZIDE Total 5.6477
Public 2.7913
Private 2.8564
A10B B12 GLIMEPIRIDE Total 0.8657
Public 0.0607
Private 0.805
CHAPTER 5
USE OF ANTIDIABETICS Malaysian Statistics on Medicine 2004
11
Table 5.2: Use of Antidiabetics by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
A10B D COMBINATIONS OF ORAL BLOOD GLUCOSE LOWERING DRUGS
A10B D03 METFORMIN AND ROSIGLITAZONE Total 0.0545
Public
Private 0.0545
A10B F ALPHA GLUCOSIDASE INHIBITORS A10B F01 ACARBOSE Total 0.3861
Public 0.2456
Private 0.1404
A10B G THIAZILIDINEDIONES A10B G02 ROSIGLITAZONE Total 0.5741
Public 0.0176
Private 0.5565
A10B X OTHER ORAL BLOOD GLUCOSE LOWERING DRUGS
A10B X02 REPAGLINIDE Total 0.2186
Public 0.0818
Private 0.1368
A10B X03 NATEGLINIDE Total 0.0247
Public 0.0091
Private 0.0157
References
1. The National Health Morbidity Survey 1, Institute of Public Health, Ministry of Health Malaysia 1985.
2. The National Health Morbidity Survey 2, Institute of Public Health, Ministry of Health Malaysia 1996.
3. Australian Statistics on Medicine 1999-2000. Commonwealth Department of Health and Ageing Australia
2003
4. Medicines consumption in the Nordic countries 1999-2003. Nordic Medico Statistical Committee 2004;
2004: Copenhagen
13
CHAPTER 6: USE OF ANTIANAEMIC DRUGS [RESERVE]
CHAPTER 7: USE OF ANTIHAEMORRHAGIC DRUGS [RESERVE]
CHAPTER 8
USE OF DRUGS FOR CARDIOVASCULAR DISORDERS Malaysian Statistics on Medicine 2004
15
Edited by:
Tamil Selvan Muthusamy1, Sim Kui Hian2 , Khoo Kah Lin3
With contributions from:
Mohd. Husni B Jamal4, Chai Swee Chin5, David KL Quek6, Noraini bt. Mohamad7
1 Damansara Specialist Hospital, 2 Sarawak General Hospital MOH, 3 Klinik Dr Khoo Kah Lin, 4 Governance Board, 5 Clinical Research Centre, 6 D Quek Specialist Heart Clinic, 7 Putra Jaya Hospital MOH
The only Vitamin K antagonist used in the country is warfarin. Warfarin is used by 0.0033 % of the population
everyday in a year (or a DDD of 0.33). The common indications for warfarin use are: for stroke prevention among
patients with Atrial Fibrillation (AF); valvular heart disease especially those with valve replacements; venous
thrombosis-embolism; intra-cardiac thrombi [1]. It is well-known that the incidence of AF increases with age;
therefore increased warfarin use in this subset should confer benefi t among the elderly. 2.5% of the population
of Malaysia are above 70 years of age [2], therefore approximately 0.25% of the population are in AF (10 % of
population above 70 years of age are in AF). In comparison, the DDD for warfarin in Australia for the year 2003
is 4.840. Based on this, there appears to be gross underuse of the drug in Malaysia.
Low molecular weight heparin (LMWH) is more commonly used than unfractionated heparin (DDD 0.59563 and
0.1794 respectively). This shows a rapid clinical acceptance and adaptation of use of LMWH as an antithrombotic
in our country. Similar increased use was recorded in Australia in the year 2003 (DDD LMWH 0.612, Heparin
0.035) [3]. Regarding commonly used antithrombotics, there are no data available for the use of aspirin, the
most widely used anti-platelet agent. Because aspirin is the anchor medication for most coronary heart disorders,
its prevalence of use and costs would have been very instructive as to how Malaysian physicians utilize this
important drug. The failure to capture the use of aspirin should be corrected in the next NMUS. Regarding other
antiplatelet drugs, the use of clopidogrel and ticlopidine are comparable. The use of glycoprotein 2B3A receptor
blockers is very small and is likely to be appropriate.
Fibrinolytic agents are a fi rst line therapy for most ST-Elevation Myocardial Infarction in Malaysia (the less
available superior therapy is direct percutaneous coronary intervention or PCI). The use of streptokinase as
thrombolytic agent (for ST-Elevation Myocardial Infarction, and some pulmonary embolism) is 0.0009, which
appears to be low. The use of the more expensive lytic agents is even lower, most likely due to cost-constraints.
Digoxin is mainly used in patients with congestive cardiac failure and Atrial Fibrillation and the DDD fi gure
of 0.5724 is acceptable. The use should increase in future due to increase in our ageing population resulting in
possibly higher incidence of AF and congestive cardiac failure. However, it should be noted that the dose of
digoxin used in the elderly should be carefully monitored and appropriately lower, based on their renal function
and lower lean body weight. The DDD for digoxin in Australia for example is 5.599, which refl ects a larger
prevalence of heart failure problems in that subset of the population.
Antiarrhythmic drugs are generally used in specialized units. Amiodarone is the commonest drug used. The use
of other antiarrhythmic drugs is limited, and mirrors the declining norm as well as international use. Vasodilators
(especially nitrates) are used mainly in the treatment of coronary artery disease. The long acting forms (isorsorbide
mononitrate) are not widely used in public institution due to their cost and lower availability.
Diuretics are very widely used in Malaysia especially in the public sector. Hydrochlorothiazide and chlorothiazide
are widely used antihypertensive drugs (DDD 3.0603 and 4.0854 respectively). Indapamide on the other hand is
a weak diuretic with a potent antihypertensive effect, but with possible signifi cant longer-term adverse events. Its
use is surprisingly wide (DDD 2.1897). A similar pattern is also seen in Australia (DDD 7.535).
Spironolactone (an aldosterone inhibitor) on the other hand appears to be underused, although not totally
unexpected. Previously when fi rst used, its higher doses were associated with potassium retention as well as
CHAPTER 8
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR CARDIOVASCULAR DISORDERS
16
gynaecomastia, hence it has never been endorsed as a fi rst line diuretic for hypertensive use. Therefore, because
antihypertensive drugs are the most prescribed, its use should be appropriately lower. However, of recent years,
this drug has been shown to reduce mortality in Congestive Cardiac failure (CCF) [4]. The Government hospital
discharge rate for CCF is 41.78 per 100 000 population (0.04178 % of Malaysian population) and the death rate
from CCF is 3.63 per 100 000 population (0.00363% of the population)[5]. Spironolactone DDD in the public
sector is 0.2176 (0.02176% of the population take this drug everyday in a year).
Furosemide is a potent loop-diuretic principally used for correcting water and salt retention. It use as an
antihypertensive is not recommended as it has only a short duration of action and severe metabolic-electrolyte
effects. Furosemide’s DDD is 4.4716; thus it is widely used. (However, furosemide use is less than that of the
thiazides combined (3.0603+4.0854=7.1457). Furosemide is usually and appropriately used in CCF, but it is also
commonly used in renal diseases and perhaps less appropriately in general practice when given rather freely for
short term treatment of episodic water retention in outpatients.
In summary NMUS shows that the cardiovascular drug use in Malaysia appears to be very similar to
international data. The use of some very benefi cial drug should increase with wider application of clinical practice
guidelines.
Table 8.1: Use of Drugs for Cardiovascular disorders, in DDD/1000 population/day 2004
# Drug Class 2004
B01 ANTITHROMBOTIC DRUGS 3.2676
C01A CARDIAC GLYCOSIDES 0.5724
C01B ANTIARRHYTHMICS 0.1721
C01C CARDIAC STIMULANTS 0.2959
C01D VASODILATORS IN CARDIAC DISEASES 2.3971
C03 DIURETICS 15.8271
C04 PERIPHERAL VASODILATORS 0.0606
Table 8.2.1: Use of Antithrombotic drugs by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
B01AA VITAMIN K ANTAGONISTS 0.3344
B01AB HEPARIN GROUP 0.7886
B01AC PLATELET AGGREGATION INHIBITORS 2.143
B01AD ENZYMES 0.0016
Table 8.2.2: Use of Antithrombotic drugs by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
B01AA VITAMIN K ANTAGONISTS B01A A03 WARFARIN Total 0.3344
Public 0.2299
Private 0.1045
B01AB HEPARIN GROUP B01A B01 HEPARIN Total 0.1794
Public 0.1392
Private 0.0402
B01A B05 ENOXAPARIN Total 0.5202
Public 0.4825
Private 0.0377
CHAPTER 8
USE OF DRUGS FOR CARDIOVASCULAR DISORDERS Malaysian Statistics on Medicine 2004
17
Table 8.2.2: Use of Antithrombotic drugs by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
B01A B06 NADROPARIN Total 0.0747Public 0.0709Private 0.0038
B01A B10 TINZAPARIN Total 0.0014Public 0.001Private 0.0005
B01A B11 SULODEXIDE Total 0.0129Public 0.0009
Private 0.012
B01AC PLATELET AGGREGATION INHIBITORS B01A C04 CLOPIDOGREL Total 0.7623
Public 0.3329
Private 0.4293
B01A C05 TICLOPIDINE Total 1.3231
Public 0.8442
Private 0.4789
B01A C07 DIPYRIDAMOLE Total 0.0573
Public 0.049
Private 0.0083
B01A C11 ILOPROST Total 0.0002
Public <0.0001
Private 0.0002
B01A C13 ABCIXIMAB Total 0.0001
Public 0.0001
Private <0.0001
B01A C16 EPTIFIBATIDE Total <0.0001
Public 0
Private <0.0001
B01A C17 TIROFIBAN Total 0.0001
Public 0
Private 0.0001
B01AD ENZYMES B01A D01 STREPTOKINASE Total 0.001
Public 0.0008
Private 0.0001
B01A D02 ALTEPLASE Total 0.0006
Public 0.0006
Private <0.0001
B01A D04 UROKINASE Total <0.0001
Public <0.0001
Private <0.0001
B01A D10 DROTRECOGIN ALFA (ACTIVATED) Total <0.0001
Public <0.0001
Private <0.0001
CHAPTER 8
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR CARDIOVASCULAR DISORDERS
18
Table 8.3.1: Use of Cardiac Glycosides by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C01A A05 DIGOXIN Total 0.5724
Public 0.3645
Private 0.2079
Table 8.4.1: Use of Anti-Arrhythmics by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C01B B01 LIDOCAINE Total 0.019
Public 0.0157
Private 0.0034
C01B C03 PROPAFENONE Total 0.0058
Public 0.002
Private 0.0038
C01B C04 FLECAINIDE Total 0.012
Public 0.0053
Private 0.0068
C01B D01 AMIODARONE Total 0.1353
Public 0.0427
Private 0.0926
Table 8.5.1: Use of Cardiac stimulants by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C01C A02 ISOPRENALINE Total <0.0001
Public <0.0001
Private <0.0001
C01C A03 NOREPINEPHRINE Total 0.0327
Public 0.0319
Private 0.0008
C01C A04 DOPAMINE Total 0.007
Public 0.0042
Private 0.0029
C01C A06 PHENYLEPHRINE Total 0.0057
Public 0.003
Private 0.0026
C01C A07 DOBUTAMINE Total 0.015
Public 0.013
Private 0.0021
C01C A09 METARAMINOL Total 0.0001
Public 0.0001
Private 0
C01C A24 EPINEPHRINE Total 0.2346
Public 0.1257
Private 0.1089
CHAPTER 8
USE OF DRUGS FOR CARDIOVASCULAR DISORDERS Malaysian Statistics on Medicine 2004
19
Table 8.5.1: Use of Cardiac stimulants by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C01C E02 MILRINONE Total 0.0008
Public 0.0004
Private 0.0005
C01C X08 LEVOSIMENDAN Total <0.0001
Public 0
Private <0.0001
Table 8.6.1: Use of Vasodilators in Cardiac diseases by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C01D A02 GLYCERYL TRINITRATE Total 0.179
Public 0.1122
Private 0.0669
C01D A08 ISOSORBIDE DINITRATE Total 1.3881
Public 1.2368
Private 0.1513
C01D A14 ISOSORBIDE MONONITRATE Total 0.83
Public 0.1392
Private 0.6908
Table 8.7.1: Use of Diuretics by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C03A A03 HYDROCHLOROTHIAZIDE Total 3.0603
Public 0.0007
Private 3.0596
C03A A04 CHLOROTHIAZIDE Total 4.0854
Public 4.0569
Private 0.0284
C03B A04 CHLORTALIDONE Total 0.0001
Public 0
Private 0.0001
C03B A11 INDAPAMIDE Total 2.1897
Public 0.0925
Private 2.0972
C03C A01 FUROSEMIDE Total 4.4716
Public 3.384
Private 1.0876
C03C A02 BUMETANIDE Total 0.0928
Public 0.0785
Private 0.0143
C03D A01 SPIRONOLACTONE Total 0.3084
Public 0.2176
Private 0.0908
CHAPTER 8
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR CARDIOVASCULAR DISORDERS
20
Table 8.7.1: Use of Diuretics by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C03D B01 AMILORIDE Total 0.2857
Public 0.2857
Private
C03E A01 HYDROCHLOROTHIAZIDE AND POTASSIUM-
SPARING AGENTS
Total 1.3331
Public 0.0011
Private 1.332
Table 8.8.1: Use of Peripheral vasodilators by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C04A D03 PENTOXIFYLLINE Total 0.0568
Public 0.0427
Private 0.014
C04A E01 ERGOLOID MESYLATES Total 0.0038
Public 0.0003
Private 0.0036
References:
1. Ezekowitz, Bridgers, et al Warfarin in the prevention of stroke associated with non rheumatic atrial
fi brillation. N Engl J Med. 327:1406,1992.
2. Vital Statistics Malaysia 2004
3. Australian Statistics on Medicine 1999-2000.Commonwealth Department of Health and Ageing Australia
2003
4. Pitt B, Zannad F, Remme WJ, et al. N Engl J Med 1999; 341: 709-717
5. Petunjuk petunjuk Indicators for Monitoring and Evaluation of Strategy for Health for All. Ministry Of
Health Malaysia – December 2004
CHAPTER 9
USE OF ANTIHYPERTENSIVES Malaysian Statistics on Medicine 2004
21
Edited by:
Zaki Morad1, Rozina Ghazalli2, Lim TO3
With contributions from:
Sahida bt Said4, Siti Shahida Md. Shariffudin1
1 Kuala Lumpur Hospital MOH, 2 Penang Hospital MOH, 3 Clinical Research Centre MOH, 4 Primary Health Care Division MOH
Beta blockers were the most commonly prescribed antihypertensive medications, followed by Calcium Channel
Blockers (CCB), Angiotensin Converting Enzyme Inhibitors (ACEI), diuretics and Angiotensin II Antagonists
(ARB). In total, utilization of these drugs amounted to about 75 DDD/1000 population/day. That is, about 7.5%
of the population was on antihypertensive (assuming no combination among these classes), which translates into
18.7% of population aged 30 and above (about 40% of population was aged >=30 in 2004). This is consistent with
the known high prevalence of hypertension in Malaysia (prevalence of 33% in 1996), taking into account substantial
number of patients were not on drug therapy or had undiagnosed hypertension [1]. The utilization pattern is also
somewhat consistent with local clinical practice guideline [2], which recommended beta blockers and diuretics
as drugs of fi rst choice for control of uncomplicated hypertension. Diuretics however could be more widely used.
In other Asian countries (Taiwan, China, India), CCBs appear to be the most popular antihypertensives, while in
Australia the ARBs were the most widely used [3].
Among the beta blockers we noted that the most popular are atenolol and metoprolol, They are favoured over the
older generation of beta blockers like esmolol probably due to the single daily dosing. Carvedilol, a relatively new
drug has gained increased usage.
Nifedipine is the most commonly used CCB in the public sector because of its low cost but in the private sector
the more expensive drugs such as amlodipine and felodipine are favoured because of the convenient daily dosing.
In addition the dihydropyridine group appears to be favored. In Australia [3] the dihydropyridine usage also
far outweighs the non-dihydropyridine usage for hypertension perhaps because of usage in cardiac associated
reasons.
Amongst the ACEIs, perindopril leads the way followed by captopril then enalapril. In the public sector, perindopril
is now relatively cheap and because of daily dosing convenience has overtaken captopril as the main prescribed
ACEI. In the private sector enalapril is the most commonly used followed by lisinopril.
The most commonly used ARB is losartan in the public sector and telmisartan in private. However with every
ARB the private sector overtakes the MOH due to the cost factor. In Australia [3] irbesartan was the top ARB
used.
Table 9.1: Use of Antihypertensives by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004C02A CENTRALLY ACTING ADRENERGIC BLOCKERS 0.6164C02C-A ALPHA BLOCKERS 2.6571
C02D ARTERIOLAR SMOOTH MUSCLE RELAXANTS 0.0071
C02K OTHER ANTIHYPERTENSIVES 0.0001
C03A LOW-CEILING DIURETICS, THIAZIDES 7.1457
C03B LOW-CEILING DIURETICS, EXCL. THIAZIDES 2.1897
C07 BETA BLOCKERS 25.6335
C08 CALCIUM CHANNEL BLOCKERS 18.5742
C09A ANGIOTENSIN CONVERTING ENZYME INHIBITORS,
PLAIN
14.5902
C09B ANGIOTENSIN CONVERTING ENZYME INHIBITORS,
COMBINATIONS
0.0043
C09C ANGIOTENSIN II ANTAGONISTS, PLAIN 4.7457
C09D ANGIOTENSIN II ANTAGONISTS, COMBINATIONS 2.8697
Malaysian Statistics on Medicine 2004
CHAPTER 9
USE OF ANTIHYPERTENSIVES
22
Table 9.2: Use of Antihypertensives by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
C02A CENTRALLY ACTING ADRENERGIC BLOCKERS C02A B METHYLDOPA Total 0.5865
Public 0.5621
Private 0.0244
C02A C05 MOXONIDINE Total 0.03
Public
Private 0.03
C02C-A ALPHA BLOCKERS C02C A01 PRAZOSIN Total 2.452
Public 2.3022
Private 0.1498
C02C A04 DOXAZOSIN Total 0.2052
Public 0.094
Private 0.1111
C02D ARTERIOLAR SMOOTH MUSCLE RELAXANTS C02D A01 DIAZOXIDE Total 0
Public 0
Private 0
C02D B01 DIHYDRALAZINE Total 0.0034
Public 0.0031
Private 0.0003
C02D B02 HYDRALAZINE Total 0
Public 0
Private 0
C02D C01 MINOXIDIL Total 0.0014
Public 0.0008
Private 0.0007
C02D D01 NITROPRUSSIDE Total 0.0023
Public 0.0017
Private 0.0006
C02K OTHER ANTIHYPERTENSIVES C02K D01 KETANSERIN Total <0.0001
Public 0
Private <0.0001
C02K X01 BOSENTAN Total 0.0001
Public 0
Private 0.0001
C03A LOW-CEILING DIURETICS, THIAZIDES C03A A03 HYDROCHLOROTHIAZIDE Total 3.0603
Public 0.0007
Private 3.0596
CHAPTER 9
USE OF ANTIHYPERTENSIVES Malaysian Statistics on Medicine 2004
23
Table 9.2: Use of Antihypertensives by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
C03A A04 CHLOROTHIAZIDE Total 4.0854
Public 4.0569
Private 0.0284
C03B LOW-CEILING DIURETICS, EXCL. THIAZIDES C03B A04 CHLORTALIDONE Total 0.0001
Public 0
Private 0.0001
C03B A11 INDAPAMIDE Total 2.1897
Public 0.0925
Private 2.0972
C07 BETA BLOCKERS C07A A05 PROPRANOLOL Total 0.6566
Public 0.3736
Private 0.2829
C07A A07 SOTALOL Total 0.0208
Public 0.0002
Private 0.0206
C07A B02 METOPROLOL Total 10.9895
Public 10.1242
Private 0.8652
C07A B03 ATENOLOL Total 13.0782
Public 6.3664
Private 6.7118
C07A B04 ACEBUTOLOL Total 0.0006
Public
Private 0.0006
C07A B05 BETAXOLOL Total 0.0756
Public 0.0134
Private 0.0622
C07A B07 BISOPROLOL Total 0.2735
Public 0.0085
Private 0.265
C07A B09 ESMOLOL Total <0.0001
Public <0.0001
Private <0.0001
C07A G01 LABETALOL Total 0.1286
Public 0.1163
Private 0.0123
C07A G02 CARVEDILOL Total 0.4101
Public 0.0753
Private 0.3348
Malaysian Statistics on Medicine 2004
CHAPTER 9
USE OF ANTIHYPERTENSIVES
24
Table 9.2: Use of Antihypertensives by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
C08 CALCIUM CHANNEL BLOCKERS C08C A01 AMLODIPINE Total 6.5788
Public 2.803
Private 3.7759
C08C A02 FELODIPINE Total 1.3333
Public 0.4035
Private 0.9298
C08C A03 ISRADIPINE Total 0.0103
Public
Private 0.0103
C08C A04 NICARDIPINE Total 0.0089
Public 0
Private 0.0089
C08C A05 NIFEDIPINE Total 9.8874
Public 8.8336
Private 1.0538
C08C A06 NIMODIPINE Total 0.0017
Public 0.0005
Private 0.0012
C08C A09 LACIDIPINE Total 0.0027
Public <0.0001
Private 0.0027
C08C A13 LERCANIDIPINE Total 0.1344
Public
Private 0.1344
C08D A01 VERAPAMIL Total 0.0795
Public 0.0245
Private 0.0551
C08D B01 DILTIAZEM Total 0.5371
Public 0.2811
Private 0.256
C09A ANGIOTENSIN CONVERTING ENZYME INHIBITORS, PLAIN C09A A01 CAPTOPRIL Total 3.8928
Public 3.6115
Private 0.2813
C09A A02 ENALAPRIL Total 3.8315
Public 1.802
Private 2.0296
C09A A03 LISINOPRIL Total 1.6354
Public 0.0001
Private 1.6353
CHAPTER 9
USE OF ANTIHYPERTENSIVES Malaysian Statistics on Medicine 2004
25
Table 9.2: Use of Antihypertensives by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
C09A A04 PERINDOPRIL Total 4.0141
Public 3.0035
Private 1.0106
C09A A05 RAMIPRIL Total 1.0647
Public 0.1961
Private 0.8686
C09A A06 QUINAPRIL Total 0.0488
Public 0
Private 0.0488
C09A A09 FOSINOPRIL Total 0.1028
Public 0.0047
Private 0.0981
C09B ACE INHIBITORS, COMBINATIONS C09B A04 PERINDOPRIL AND DIURETICS Total 0.0043
Public 0.0008
Private 0.0035
C09C ANGIOTENSIN II ANTAGONISTS, PLAIN C09C A01 LOSARTAN Total 1.9803
Public 0.3466
Private 1.6337
C09C A03 VALSARTAN Total 0.7344
Public 0.1017
Private 0.6327
C09C A04 IRBESARTAN Total 0.5115
Public 0.074
Private 0.4374
C09C A06 CANDESARTAN Total 0.3311
Public 0.001
Private 0.3301
C09C A07 TELMISARTAN Total 1.1884
Public 0.1111
Private 1.0773
C09D ANGIOTENSIN II ANTAGONISTS, COMBINATIONS C09D A01 LOSARTAN AND DIURETICS Total 1.2717
Public 0.0647
Private 1.207
C09D A03 VALSARTAN AND DIURETICS Total 0.8293
Public 0.0213
Private 0.8081
C09D A04 IRBESARTAN AND DIURETICS Total 0.343
Public 0.0095
Private 0.3335
Malaysian Statistics on Medicine 2004
CHAPTER 9
USE OF ANTIHYPERTENSIVES
26
Table 9.2: Use of Antihypertensives by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
C09D A06 CANDESARTAN AND DIURETICS Total 0.2053
Public 0.0002
Private 0.2051
C09D A07 TELMISARTAN AND DIURETICS Total 0.2204
Public 0.0001
Private 0.2203
References:
1. Lim TO, Zaki M, Maimunah AH, Rozita H, Ding LM. Prevalence, awareness, treatment and control of
Hypertension in Malaysian adult population. Singapore Medical Journal 2004;45:20-27
2. Clinical Practice Guidelines on management of Hypertension. Available at: http://www.acadmed.org.my/
html/index.shtml
3. Australian Statistics on Medicine 2003.Commonwealth Department of health and ageing Australia 2005
CHAPTER 10
USE OF LIPID LOWERING MEDICINES Malaysian Statistics on Medicine 2004
27
Edited by:
Sim Kui Hian1, Tamil Selvan Muthusamy2, Khoo Kah Lin3
With contributions from:
Mohd. Husni B Jamal4, Chai Swee Chin5, David KL Quek6, Noraini bt. Mohamad7, Selvarajah Sathaya7
1 Sarawak General Hospital MOH, 2 Damansara Specialist Hospital, 3 Klinik Dr Khoo Kah Lin, 4 Governance Board, 5 Clinical Research Centre, 6 D Quek Specialist Heart Clinic, 7 PutraJaya Hospital MOH, 8 Klinik Prime Care
Lipid lowering medicines has been proven beyond doubt as one of the most cost effective treatments in the
primary and secondary prevention of coronary artery disease [1].
Similar to worldwide trend, the HMG CoA reductase inhibitors (or statins) were the most commonly used lipid
lowering agents in Malaysia. Compared to Nordic countries (in 2003, Greenland, lowest in the group, had a 29.9
DDD/1000 population/day while Norway, highest in the group, had a 97.8 DDD/1000 population/day) [2], the
usage of HMG CoA reductase inhibitors in Malaysia was only 17.0 DDD/1000 population/day (despite population
adjustment for age). Therefore, given the fact that coronary artery disease was the number one cause of death in
Malaysia during the corresponding period, statin use as a class of drugs, is still severely underutilised despite the
strong recommendation by the Malaysian CPG on the Management of Dyslipidaemia in 2004 [3].
In 2004 in Malaysia, simvastatin was the most commonly used HMG CoA reductase inhibitor with 7.9 DDD/1000
population/day. In an earlier comparable period (in 2000) in Australia, simvastatin was also the most commonly
used HMG CoA reductase inhibitor with 29.7 DDD/1000 population/day [4]. The second most common HMG
CoA reductase inhibitor used in Malaysia, in 2004, was atorvastatin at 3.9 DDD/1000 population/day. In Australia,
in 2003, however, atorvastatin had become the most common HMG CoA reductase inhibitor used [5].
All the HMG CoA reductase inhibitors used in Malaysia in 2004 were more commonly used by the private health
care providers apart from the generic Lovastatin which was the most common HMG CoA reductase inhibitor
used by the public health care providers.
In Malaysia in 2004, fi brates had the same level of utilization as in Australia (in 2002-2003) at around 1.9
DDD/1000 population/day [5]. The public health care providers had greater usage of this class of medicine than
the private sector. Generic gemfi brozil was the most commonly used medicine in this class.
Similar to the Nordic countries and Australia, all the other class of lipid lowering medicines such as bile acid
sequestrants, nicotinic acid derivatives and newer agents such as ezetimibe only had negligible usage in NMUS
Malaysia 2004.
Table 10.1: Use of Lipid Lowering Medicines by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
C10A A HMG COA REDUCTASE INHIBITORS 17.0099
C10A B FIBRATES 1.9141
C10A C BILE ACID SEQUESTRANTS 0.0034
C10A D NICOTINIC ACID AND DERIVATIVES 0.0001
C10A X OTHER CHOLESTEROL AND TRIGLYCERIDE REDUCERS 0.3093
Malaysian Statistics on Medicine 2004
CHAPTER 10
USE OF LIPID LOWERING MEDICINES
28
Table 10.2: Use of Lipid Lowering Medicines by Drug Class and Agents, in DDD/1000 population/day
2004
ATC Drug Class and Agents 2004
C10A A HMG COA REDUCTASE INHIBITORS C10A A01 SIMVASTATIN Total 7.9016
Public 1.0938
Private 6.8078
C10A A02 LOVASTATIN Total 4.0799
Public 2.9441
Private 1.1358
C10A A03 PRAVASTATIN Total 0.5667
Public 0.1032
Private 0.4635
C10A A04 FLUVASTATIN Total 0.5469
Public 0.0026
Private 0.5443
C10A A05 ATORVASTATIN Total 3.9146
Public 0.4129
Private 3.5017
C10A A07 ROSUVASTATIN Total 0.0001
Public 0.0001
Private
C10A B FIBRATES C10A B02 BEZAFIBRATE Total 0.0045
Public 0
Private 0.0045
C10A B04 GEMFIBROZIL Total 0.5271
Public 0.4671
Private 0.0599
C10A B05 FENOFIBRATE Total 1.2838
Public 0.0362
Private 1.2476
C10A B08 CIPROFIBRATE Total 0.0987
Public 0.0093
Private 0.0894
CHAPTER 10
USE OF LIPID LOWERING MEDICINES Malaysian Statistics on Medicine 2004
29
Table 10.2: Use of Lipid Lowering Medicines by Drug Class and Agents, in DDD/1000 population/day
2004
ATC Drug Class and Agents 2004
C10A C HMG COA REDUCTASE INHIBITORS C10A C01 COLESTYRAMINE Total 0.0034
Public 0.0003
Private 0.0032
C10A D NICOTINIC ACID AND DERIVATIVES C10A D02 NICOTINIC ACID Total <0.0001
Public <0.0001
Private 0
C10A D06 ACIPIMOX Total 0.0001
Public 0
Private 0.0001
C10A X OTHER CHOLESTEROL AND TRIGLYCERIDE REDUCERSC10A X09 EZETIMIBE Total 0.3093
Public 0.0006
Private 0.3086
References:
1. Kastelein JJP. Atherosclerosis. 1999;143(suppl 1):S17-S21
2. Medicines consumption in the Nordic countries 1999-2003.Nordic Medico Statistical Committee 2004;
2004: Copenhagen.
3. Third Malaysia CPG on Management of dyslipidaemia 2004.
4. Australian Statistics on Medicine 1999-2000.Commonwealth Department of Health and Ageing Australia
2003
5. Australian Statistics on Medicine 2003.Commonwealth of Australia 2005.
31
CHAPTER 11: USE OF DERMATOLOGICALS [RESERVE]
CHAPTER 12: USE OF GYNAECOLOGICALS, SEX HORMONES AND HORMONAL
CONTRACEPTIVES [RESERVE]
CHAPTER 13: USE OF UROLOGICALS [RESERVE]
CHAPTER 14: USE OF DRUGS FOR ENDOCRINE DISORDERS [RESERVE]
CHAPTER 15
USE OF ANTIINFECTIVES Malaysian Statistics on Medicine 2004
33
Edited by:
Tan Kah Kee1
With contributions from:
Victor Chuang Tuan Giam2, Sameerah bt Shaikh Abdul Rahman3, Usha Rajasingam4, Rahela bt Ambaras Khan3, Sharmini Selvarajah5, Zuhaila bt Muhamad Ikbar6, Rohaizan bt Mohd Hanafi ah6, Yuen Shalyn5
1 Seremban Hospital MOH, 2 Universiti Kebangsaan Malaysia, 3 Pharmacy Services Division, 4 Bio Collagen Tech Sdn Bhd, 5 Clinical Research Centre MOH, 6 Penang Hospital MOH
The most commonly used antiinfectives in 2004 were antibacterials, followed by antimycotics, antimycobacterials,
antivirals and antimalarials. Among all classes of antibacterials, penicillins were most used, which was four times
more frequent than macrolides, lincosamides and streptogramins, other beta-lactams such as cephalosporins
and carbapenems, and tetracyclines. Amongst penicillins, usage of amoxicillin was the highest, followed
by amoxicillin and enzyme inhibitor, and cloxacillin. Amoxicillin, amoxicillin and enzyme inhibitor were
predominantly prescribed in the private sector whilst cloxacillin was more commonly prescribed in the public
sector. Heavy consumption of penicillins could be due to widespread usage for common infections such as Upper
Respiratory Tract Infection (URTI) and skin infections.
The most commonly used macrolides were erythromycin and clarithromycin. In the cephalosporin group,
cephalexin was most used followed by cefuroxime. The private sector prescribed mostly cephalexin, while the
public sector used twice as much cefuroxime than private. Among the tetracyclines class, doxycycline was the
most used and predominantly prescribed by the private sector. The private used eight times more doxycycline
than the public sector.
This could be due to widespread usage of doxycycline for the treatment of acne, although no defi nitive data on
indications for prescription could be obtained to verify it.
More quinolones were being prescribed in the private sector in a range of two fold (ciprofl oxacin) to 24 fold
(ofl oxacin), while the public sector hardly use norfl oxacin. In the use of sulphamethoxazole and trimethoprim,
private sector used two times more (0.4) than the public sector (0.2)
The use of antibacterials in Malaysia (17.7) is higher than Denmark (15.0/1000 inhabitants/day) and Sweden
(16.3), comparable to Norway (17.0) but lower than Finland (22.3) and Iceland (20.3). Pattern of consumption of
the penicillin group (J01 C) is similar to the Nordic countries (1999-2003) where it is the dominant antimicrobial
group in both regions. Consumption of combinations of amoxicillin and enzyme inhibitor (J01C R02) was
signifi cantly higher in Malaysia (15 times more) compared to most Nordic countries. Consumption of macrolides
(2.2) was similar to Norway (1.9) and Denmark (2.2) but far higher than Sweden (0.9). Quinolone consumption
was more frequent in Malaysia compared to Nordic regions, except in Finland, which was higher (2.3 times
more). In contrast, consumption of antibacterial of class sulfonamides and trimethoprim was generally lower in
Malaysia compared to most Nordic countries, except in Finland and Iceland, which was higher (3 times more).
Table 15.1: Use of Antiinfectives, in DDD/1000 population/day 2004
# Drug Class 2004
J01 ANTIBACTERIALS 17.7188
J02 ANTIMYCOTICS 1.0146
J04 ANTIMYCOBACTERIALS 0.9756
J05 ANTIVIRALS 0.2026
P01B ANTIMALARIALS 0.1203
Malaysian Statistics on Medicine 2004
CHAPTER 15
USE OF ANTIINFECTIVES
34
Table 15.2.1: Use of Antibacterials by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
J01A TETRACYCLINES 2.0082
J01B AMPHENICOLS 0.0064
J01C BETA-LACTAMS, PENICILLINS 8.8538
J01D OTHER BETA-LACTAMS 2.1925
J01E SULFONAMIDES AND TRIMETHOPRIM 0.657
J01F MACROLIDES, LINCOSAMIDES AND STREPTOGRAMINS 2.2027
J01G AMINOGLYCOSIDES 0.3632
J01M QUINOLONES 0.6823
J01X OTHER ANTIBACTERIALS 0.7527
Table 15.2.2: Use of Antibacterials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J01A TETRACYCLINES J01A A02 DOXYCYCLINE Total 1.735
Public 0.197
Private 1.538
J01A A06 OXYTETRACYCLINE Total 0
Public 0
Private 0
J01A A07 TETRACYCLINE Total 0.2167
Public 0.0561
Private 0.1606
J01A A08 MINOCYCLINE Total 0.0565
Public 0.0005
Private 0.0559
J01B ANPHENICOLS J01B A01 CHLORAMPHENICOL Total 0.0064
Public 0.0027
Private 0.0037
J01C BETA-LACTAMS, PENICILLINS J01C A01 AMPICILLIN Total 0.1816
Public 0.0717
Private 0.1099
J01C A04 AMOXICILLIN Total 4.0243
Public 0.7732
Private 3.2511
J01C A06 BACAMPICILLIN Total 0.3568
Public 0.2211
Private 0.1357
J01C A12 PIPERACILLIN Total 0.0012
Public 0.0012
Private 0
CHAPTER 15
USE OF ANTIINFECTIVES Malaysian Statistics on Medicine 2004
35
Table 15.2.2: Use of Antibacterials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J01C E01 BENZYLPENICILLIN Total 0.0282
Public 0.0234
Private 0.0048
J01C E02 PHENOXYMETHYLPENICILLIN Total 0.1949
Public 0.1707
Private 0.0242
J01C E08 BENZATHINE BENZYLPENICILLIN Total 0.0013
Public 0.0012
Private 0.0001
J01C E09 PROCAINE BENZYLPENICILLIN Total 0.0001
Public 0.0001
Private <0.0001
J01C F02 CLOXACILLIN Total 0.9678
Public 0.6695
Private 0.2983
J01C F05 FLUCLOXACILLIN Total 0.0379
Public 0.0008
Private 0.0371
J01C R01 AMPICILLIN AND ENZYME INHIBITOR Total 0.033
Public 0.0227
Private 0.0103
J01C R02 AMOXICILLIN AND ENZYME INHIBITOR Total 2.9569
Public 0.0984
Private 2.8586
J01C R03 TICARCILLIN AND ENZYME INHIBITOR Total 0
Public
Private 0
J01C R04 SULTAMICILLIN Total 0.0666
Public 0.0305
Private 0.0361
J01C R05 PIPERACILLIN AND ENZYME INHIBITOR Total 0.0032
Public 0.0025
Private 0.0008
J01D OTHER BETA-LACTAMS J01D B01 CEFALEXIN Total 1.1906
Public 0.0428
Private 1.1478
J01D B04 CEFAZOLIN Total 0.0028
Public 0
Private 0.0028
Malaysian Statistics on Medicine 2004
CHAPTER 15
USE OF ANTIINFECTIVES
36
Table 15.2.2: Use of Antibacterials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J01D B05 CEFADROXIL Total 0.0569
Public
Private 0.0569
J01D C02 CEFUROXIME Total 0.3745
Public 0.2545
Private 0.12
J01D C04 CEFACLOR Total 0.1213
Public 0.0026
Private 0.1187
J01D C10 CEFPROZIL Total 0.0261
Public 0.0006
Private 0.0255
J01D D01 CEFOTAXIME Total 0.1007
Public 0.0045
Private 0.0962
J01D D02 CEFTAZIDIME Total 0.0137
Public 0.0115
Private 0.0022
J01D D04 CEFTRIAXONE Total 0.0294
Public 0.0205
Private 0.009
J01D D10 CEFETAMET Total 0
Public 0
Private 0
J01D D12 CEFOPERAZONE Total 0.0165
Public 0.016
Private 0.0005
J01D D14 CEFTIBUTEN Total 0.0616
Public 0.0004
Private 0.0612
J01D E01 CEFEPIME Total 0.0507
Public 0.0467
Private 0.004
J01D H02 MEROPENEM Total 0.1359
Public 0.011
Private 0.1249
J01D H03 ERTAPENEM Total 0.0018
Public 0.0006
Private 0.0011
J01D H51 IMIPENEM AND ENZYME INHIBITOR Total 0.0099
Public 0.0066
Private 0.0034
CHAPTER 15
USE OF ANTIINFECTIVES Malaysian Statistics on Medicine 2004
37
Table 15.2.2: Use of Antibacterials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J01E SULFONAMIDES AND TRIMETHOPRIM J01E A01 TRIMETHOPRIM Total 0.0423
Public 0.0014
Private 0.0409
J01E C01 SULFAMETHOXAZOLE Total <0.0001
Public <0.0001
Private 0
J01E E01 SULFAMETHOXAZOLE AND TRIMETHOPRIM Total 0.6071
Public 0.2032
Private 0.4039
J01E E02 SULFADIAZINE AND TRIMETHOPRIM Total 0.0076
Public <0.0001
Private 0.0075
J01F MACROLIDES, LINCOSAMIDES AND STREPTOGRAMINS J01F A01 ERYTHROMYCIN Total 1.3734
Public 0.5767
Private 0.7967
J01F A02 SPIRAMYCIN Total 0.0007
Public <0.0001
Private 0.0006
J01F A06 ROXITHROMYCIN Total 0.2004
Public 0
Private 0.2004
J01F A09 CLARITHROMYCIN Total 0.3289
Public 0.0397
Private 0.2892
J01F A10 AZITHROMYCIN Total 0.2446
Public 0.0131
Private 0.2316
J01F A13 DIRITHROMYCIN Total 0
Public 0
Private 0
J01F F01 CLINDAMYCIN Total 0.0409
Public 0.0023
Private 0.0386
J01F F02 LINCOMYCIN Total 0.0138
Public 0
Private 0.0138
J01G AMINOGLYCOSIDES J01G A01 STREPTOMYCIN Total 0.0497
Public 0.0493
Private 0.0004
Malaysian Statistics on Medicine 2004
CHAPTER 15
USE OF ANTIINFECTIVES
38
Table 15.2.2: Use of Antibacterials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J01G B03 GENTAMICIN Total 0.3017
Public 0.0119
Private 0.2898
J01G B04 KANAMYCIN Total 0.0034
Public 0.0002
Private 0.0032
J01G B06 AMIKACIN Total 0.0055
Public 0.0048
Private 0.0007
J01G B07 NETILMICIN Total 0.003
Public 0.0021
Private 0.0009
J01M QUINOLONES J01M A01 OFLOXACIN Total 0.1475
Public 0.0058
Private 0.1417
J01M A02 CIPROFLOXACIN Total 0.3347
Public 0.1197
Private 0.215
J01M A03 PEFLOXACIN Total 0.0136
Public 0.0069
Private 0.0067
J01M A04 ENOXACIN Total 0.0024
Public 0
Private 0.0024
J01M A06 NORFLOXACIN Total 0.107
Public <0.0001
Private 0.1069
J01M A12 LEVOFLOXACIN Total 0.0061
Public 0
Private 0.0061
J01M A14 MOXIFLOXACIN Total 0.0187
Public 0.0015
Private 0.0172
J01M A16 GATIFLOXACIN Total 0.0217
Public 0.0007
Private 0.021
J01M B04 PIPEMIDIC ACID Total 0.0306
Public <0.0001
Private 0.0306
CHAPTER 15
USE OF ANTIINFECTIVES Malaysian Statistics on Medicine 2004
39
Table 15.2.2: Use of Antibacterials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J01X OTHER ANTIBACTERIALS J01X A01 VANCOMYCIN Total 0.0055
Public 0.0042
Private 0.0012
J01X A02 TEICOPLANIN Total 0.002
Public 0.0017
Private 0.0003
J01X B02 POLYMYXIN B Total 0.0001
Public 0.0001
Private 0
J01X C01 FUSIDIC ACID Total 0.0194
Public 0.0129
Private 0.0065
J01X D01 METRONIDAZOLE Total 0.7106
Public 0.0464
Private 0.6643
J01X D02 TINIDAZOLE Total 0.0009
Public 0
Private 0.0009
J01X E01 NITROFURANTOIN Total 0.0091
Public 0.0086
Private 0.0005
J01X X01 FOSFOMYCIN Total 0.0003
Public 0
Private 0.0003
J01X X04 SPECTINOMYCIN Total 0
Public 0
Private 0
J01X X08 LINEZOLID Total 0.0049
Public 0.0001
Private 0.0048
Table 15.3.1: Use of Antimycotics by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
J02A A ANTIBIOTICS 0.0036
J02A B IMIDAZOLE DERIVATIOVES 0.8942
J02A C TRIAZOLE DERIAVTIVES 0.1168
J02A X OTHER ANTIMYCOTICS FOR SYSTEMIC USE 0.0001
Malaysian Statistics on Medicine 2004
CHAPTER 15
USE OF ANTIINFECTIVES
40
Table 15.3.2: Use of Antimycotics by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J02A A ANTIBIOTICS J02A A01 AMPHOTERICIN B Total 0.0036
Public 0.0034
Private 0.0001
J02A B IMIDAZOLE DERIVATIOVES J02A B01 MICONAZOLE Total 0.0158
Public 0.0011
Private 0.0147
J02A B02 KETOCONAZOLE Total 0.8784
Public 0.0073
Private 0.871
J02A C TRIAZOLE DERIAVTIVES J02A C01 FLUCONAZOLE Total 0.0576
Public 0.0142
Private 0.0435
J02A C02 ITRACONAZOLE Total 0.0591
Public 0.011
Private 0.0481
J02A X OTHER ANTIMYCOTICS FOR SYSTEMIC USE J02A X01 FLUCYTOSINE Total <0.0001
Public <0.0001
Private 0
J02A X04 CASPOFUNGIN Total 0.0001
Public <0.0001
Private <0.0001
Table 15.4.1: Use of Antimycobacterials by Drug Class, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J04A B01 CYCLOSERINE Total 0.0004
Public 0.0004
Private 0
J04A B02 RIFAMPICIN Total 0.2387
Public 0.1954
Private 0.0433
J04A B30 CAPREOMYCIN Total 0
Public 0
Private 0
J04A C01 ISONIAZID Total 0.4357
Public 0.3881
Private 0.0476
CHAPTER 15
USE OF ANTIINFECTIVES Malaysian Statistics on Medicine 2004
41
Table 15.4.1: Use of Antimycobacterials by Drug Class, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J04A D03 ETHIONAMIDE Total 0
Public 0
Private 0
J04A K01 PYRAZINAMIDE Total 0.129
Public 0.1043
Private 0.0247
J04A K02 ETHAMBUTOL Total 0.075
Public 0.0569
Private 0.018
J04A M02 RIFAMPICIN AND ISONIAZID Total 0.0082
Public
Private 0.0082
J04A M05 RIFAMPICIN, PYRAZINAMIDE AND
ISONIAZID
Total 0.0001
Public 0
Private 0.0001
J04B A01 CLOFAZIMINE Total <0.0001
Public <0.0001
Private 0
J04B A02 DAPSONE Total 0.0884
Public 0.0884
Private 0
Table 15.5.1: Use of Antimalarials by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
P01B A AMINOQUINOLINES 0.1143
P01B B BIGUANIDES 0
P01B C METHANOLQUINOLINES 0.003
P01B D DIAMINOPYRIMIDINES 0.003
Table 15.5.2: Use of Antimalarials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
P01B A AMINOQUINOLINES P01B A01 CHLOROQUINE Total 0.0052
Public 0.0048
Private 0.0004
P01B A02 HYDROXYCHLOROQUINE Total 0.0434
Public 0.0366
Private 0.0068
P01B A03 PRIMAQUINE Total 0.0657
Public 0.0653
Private 0.0004
Malaysian Statistics on Medicine 2004
CHAPTER 15
USE OF ANTIINFECTIVES
42
Table 15.5.2: Use of Antimalarials by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
P01B B BIGUANIDES P01B B01 PROGUANIL Total 0
Public 0
Private 0
P01B C METHANOLQUINOLINES P01B C01 QUININE Total 0.0029
Public 0.0019
Private 0.0011
P01B C02 MEFLOQUINE Total 0.0001
Public <0.0001
Private <0.0001
P01B D DIAMINOPYRIMIDINES P01B D01 PYRIMETHAMINE Total 0.0001
Public 0
Private 0.0001
P01B D51 PYRIMETHAMINE, COMBINATIONS Total 0.003
Public 0.0007
Private 0.0023
Table 15.6.1: Use of Antivirals by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
J05A B NUCLEOSIDES AND NUCLEOTIDES, EXCLUDING
REVERSE TRANSCRIPTASE INHIBITORS
0.0664
J05A E PROTEASE INHIBITORS 0.017
J05A F NUCLEOSIDES AND NUCLEOTIDES REVERSE
TRANSCRIPTASE INHIBITORS
0.095
J05A G NON-NUCLEOSIDE REVERSE TRANSCRIPTASE
INHIBITORS
0.0241
J05A H NEURAMINIDASE INHIBITORS <0.0001
Table 15.6.2: Use of Antivirals by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J05A B NUCLEOSIDES AND NUCLEOTIDES, EXCLUDING REVERSE TRANSCRIPTASE INHIBITORS
J05A B01 ACICLOVIR Total 0.0623
Public 0.0043
Private 0.058
J05A B04 RIBAVIRIN Total 0.002
Public 0.0017
Private 0.0002
J05A B06 GANCICLOVIR Total 0.0001
Public 0.0001
Private <0.0001
CHAPTER 15
USE OF ANTIINFECTIVES Malaysian Statistics on Medicine 2004
43
Table 15.6.2: Use of Antivirals by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J05A B09 FAMCICLOVIR Total <0.0001
Public 0
Private <0.0001
J05A B11 VALACICLOVIR Total 0.002
Public 0
Private 0.002
J05A B14 VALGANCICLOVIR Total 0.0001
Public 0.0001
Private 0
J05A E PROTEASE INHIBITORS J05A E02 INDINAVIR Total 0.0148
Public 0.0147
Private 0.0001
J05A E03 RITONAVIR Total 0.0021
Public 0.0021
Private <0.0001
J05A E04 NELFINAVIR Total <0.0001
Public <0.0001
Private 0
J05A F NUCLEOSIDES AND NUCLEOTIDES REVERSE TRANSCRIPTASE INHIBITORS
J05A F01 ZIDOVUDINE Total 0.0145
Public 0.0143
Private 0.0002
J05A F02 DIDANOSINE Total 0.011
Public 0.0105
Private 0.0005
J05A F03 ZALCITABINE Total <0.0001
Public <0.0001
Private 0
J05A F04 STAVUDINE Total 0.0113
Public 0.0109
Private 0.0005
J05A F05 LAMIVUDINE Total 0.0437
Public 0.0233
Private 0.0204
J05A F08 ADEFOVIR DIPIVOXIL Total 0.0031
Public 0.0001
Private 0.003
J05A F30 COMBINATIONS Total 0.0114
Public 0.0099
Private 0.0015
Malaysian Statistics on Medicine 2004
CHAPTER 15
USE OF ANTIINFECTIVES
44
Table 15.6.2: Use of Antivirals by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
J05A G NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS J05A G01 NEVIRAPINE Total 0.0039
Public 0.0038
Private 0.0001
J05A G03 EFAVIRENZ Total 0.0202
Public 0.0193
Private 0.0009
J05A H NEURAMINIDASE INHIBITORS J05A H02 OSELTAMIVIR Total <0.0001
Public <0.0001
Private 0
References:
1. Medicines consumption in the Nordic countries 1999-2003.Nordic Medico Statistical Committee 2004;
2004: Copenhagen
2. Monnet DL, Molstad S, Cars O. Defi ned daily doses of antimicrobials refl ect antimicrobial prescriptions in
ambulatory care. Journal of Antimicrobial Chemotherapy 2004; 53: 1109-11
CHAPTER 16:
USE OF ANTINEOPLASTIC AGENTS Malaysian Statistics on Medicine 2004
45
Edited by:
Lim Yeok Siew1, Beena Devi2
With contributions from:
S Visalachy PuruShotaman1, Sujatha Suthandiram3, Kamarun Neasa1, Yuzlina Muhamad Yunus1, Kananathan Ratnavelu4, Nik Nuradlina Nik Adnan1, Tajunisah Mohamad Eusoff5, Gucharan Singh6
1 Kuala Lumpur Hospital MOH, 2 Sarawak General Hospital MOH, 3 Hospital Tengku Ampuan Rahimah MOH, 4 NCI cancer Hoapital, 5 Penang Hospital MOH, 6 Damansara Specialist Centre.
Antineoplastics are agents used in the treatment of cancer. Treatment of cancer using antineoplastic agents is
complex and is usually under the care of oncologists. Cancer is still a major problem in Malaysia causing high
morbidity and mortality. In 2003 there were 21,464 cancer cases diagnosed in West Malaysia. The cumulative
lifetime risk of cancer in the Malaysian population is 1:4. The age-standardized rate (ASR) for overall cancer
incidence in West Malaysia in 2003 is 143.2 per 100,000. Malaysia has a population of 25 million in 2004.
The top 5 cancers are breast cancer, lung cancer, colorectal, cervix and leukemia. According to the report
prepared by Dr G. Lim on NCC, it states that there are 5 government hospitals and 14 private centres treating
cancer cases and Malaysia has 1 oncologist per 800,000 population (NCC report). Based on the recommendation
given by the Royal College of Radiologists in 1998, the norm for UK is 1:250,000. Funding for antineoplastic
agents for Government hospitals comes from Ministry of Health (MOH) and in the 23 private hospitals, the drug
cost is borne by patients themselves. 54% of the total cancer patients are seen in Government hospitals while
46% are seen in private hospitals.
The National Medicine Use Survey (NMUS) identifi ed 44 antineoplastic drugs used in Malaysia. The top 15
antineoplastics are as in table 1. The top 5 antineoplastic agents used for solid tumours and hematological cancers
are shown in table 2 .The low usage drugs are gemtuzumab, cladribine, alemtuzumab, thiotepa and topotecan.
Usage of trastuzumab for breast cancer in the country was 0.05 mg/1000 population. Usage of imatinib for
chronic myeloid leukemia and gastro-intestinal stromal tumour was 23.297 mg/1000 population. Gefi tinib was
used for lung cancer as much as 26.24 mg/1000 population. Temozolomide usage for glioblastoma multiforme
was 4.28 mg/1000 population .
This is the fi rst attempt at preparing a report which is descriptive in nature on antineoplastic agents used nationwide
and hence should not be interpreted as being wholly conclusive. In addition to the government hospitals which
participated in this study, only 29 private hospitals contributed their data. There are limitations in our data
presentation because of the following reasons:
1. Other classes of drugs such as antibacterials can be in daily defi ned dose (DDD) but antineoplastic agents can
not be calculated (DDD) even for study purposes. The reason for this is because some antineoplastic agents
are used for different types of cancers at varying doses and even for the same indication there are different
treatment regimes using different doses in mg/m2.
2. Note that the indications for the drugs were not captured in the present format of data collection.
In order to have meaningful interpretation of the usage of antineoplastic agents nationwide, we recommend that
there is more information of indications of the usage, the number of patients who had been on those agents, the
number of trained personnel and facilties. With additional information, we hope to be able to produce a report
which would help policy makers to be able to make the right decisions that would help cancer patients in the country.
In addiction in future, we will be able to produce reports, which can be made comparable internationally.
46
Malaysian Statistics on Medicine 2004
CHAPTER 16
USE OF ANTINEOPLASTIC AGENTS
Table 1: Use of Antineoplastic Drugs in total dosage/1000 population 2004
ATC Drug Name Unit Route 2004
L01X X05 HYDROXYCARBAMIDE MG o 5236.53
L01B C02 FLUOROURACIL MG p 3077.589
L01B C06 CAPECITABINE MG o 1004.578
L01X X24 PEGASPARGASE U p 994.8829
L01X X02 ASPARAGINASE U p 899.4993
L01B C01 CYTARABINE MG p 872.9756
L01A A01 CYCLOPHOSPHAMIDE MG p 681.2297
L01A A06 IFOSFAMIDE MG p 447.4823
L01B B02 MERCAPTOPURINE MG o 297.6244
L01B C05 GEMCITABINE MG p 153.169
L01C B01 ETOPOSIDE MG p 123.4749
L01B A01 METHOTREXATE MG p 120.5313
L01A X04 DACARBAZINE MG p 116.9271
L01X A02 CARBOPLATIN MG p 83.3364
L01B C02 FLUOROURACIL MG o 67.8944
Table 2. Top 5 Antineoplastic drugs for solid tumours and hematological malignancies
No ANTINEOPLASTICS USED IN
SOLID TUMOURS
ANTINEOPLASTICS USED IN HEMATOLOGICAL
MALIGNANCIES
1. FLUROURACIL INJECTION HYDROXYCARBAMIDE ORAL
2. CAPECITABINE ORAL PEGASPARGASE INJECTION
3. CYCLOPHOSPHAMIDE INJECTION ASPARAGINASE INJECTION
4. IFOSFAMIDE INJECTION CYTARABINE INJECTION
5. GEMCITABINE INJECTION MERCAPTOPURINE ORAL
References
1. First Databank. Min/Max Dosing Modules. 2005
2. GLCC. Presentations for RMK 9. 2005
3. Katherine Blake. UK Government moves to tackle lottery of cancer drugs. BMJ 2004
4. Manitoba Centre for Health Policy. Dose Intensity. May 2004
5. Norwegian Institute of Public Health WHO collaborating Centre for Drug Statistics Methodology Norway.
Guidelines for ATC classifi cation and DDD assignment 2005
6. Variations in usage of cancer drugs approved by NICE Report of the Review undertaken by the National
Cancer Director.
47
CHAPTER 17: USE OF SYSTEMIC CORTICOSTEROIDS AND IMMUNOSUPPRESSIVE
AGENTS [RESERVE]
CHAPTER 18: USE OF DRUGS FOR
RHEUMATOLOGICAL AND BONE DISORDERS Malaysian Statistics on Medicine 2004
49
Edited by:
R. Ramanathan1, Lee Chee Kuan1, Manmohan Singh1, Jennifer Tan2, Suhadah Ahad3
1 Ipoh Hospital MOH, 2 Farmasi Alychem, 3 Melaka Hospital MOH
In the year 2004, diclofenec in all its forms was the most commonly used Non Steroidal Anti Infl ammatory
Drugs (NSAID) in public and private sectors in Malaysia. This is followed by mefenamic acid, coxibs, propionic
acid derivatives, oxicams and others in that order. Diclofenac is available in oral, parental, and as suppository.
The reason for its high usage is likely due to its cost effectiveness and easy availability. In the public sector, its
prescription does not need to be countersigned by a specialist. It is also sold widely by the private clinics and
pharmacies. Comparing our usage to that in Australia and Finland, their most used NSAID is ibuprofen [1,2].
These NSAIDs must be used with great caution as they can cause severe gastric side effects on prolonged and
uncontrolled usage.
Mefenamic acid is the second most commonly used NSAID. This drug is also widely used by gynaecologists to
treat dysfunction uterine bleeding and dysmenorrhoea.
COX-2 inhibitors made their appearance in our market in the late 90’s and gradually become a popular medication
to treat pain. COX-2 inhibitors have gastric protective function, hence can be used with less caution in patients
with history of gastric ulcer. Nevertheless the usage is still low due to its high cost. This is also the main reason
why this drug is used more in the private sector. The most commonly used coxib is etoricoxib followed by
celecoxib, valdecoxib, rofecoxib, and parecoxib. Rofecoxib was withdrawn from the world market in the second
half of 2004 because it was found to be associated with higher incidence of cardic events and transient increase in
blood pressure. Injectable valdecoxib was also withdrawn in early 2005 due to it side effect; skin allergy reaction.
Nevertheless the other coxibs still need to be used with great caution as large-scale studies are underway to
determine the safety of these coxibs.
In the propionic acid group, ibuprofen has the highest usage in Malaysia and it seems to be the most popular
propionic derivative used in Finland and Australia also. The other members of this group is ketoprofen which is
not commonly used orally or parenteraly but usually applied topically.
Nimesulide was banned by FDA since 1985 but is still being used in our private sector. The sales may be from
the GP clinics or the pharmacies. In view of the severe side effects, this drug should be withdrawn from our
market.
The antigout preparations used are mainly allopurinol for chronic gout control and colchicines in the treatment
of acute gout attacks. This trend is similar to the Finland and Australian studies but their usage is much higher
compared to ours. This may be due to lack of awareness in our population that gout can be treated with this
medication.
Osteoporosis is the commonest bone disease treated in our clinical practice. Alendronate acid is the most
commonly used bisphosphanate in the management of bone disease in Malaysia. This is due to the fact that
alendronte can prevent a second vertebral and non-vertebral fractures in 50 % of individuals with osteoporotic
bones [3,4,5].
The other bisphosphonates are not widely used due to cost and availability. We would like to see other classes of
anti osteoporotic agents such as alfacalcidiol, SERMs, parathyroid hormones and the latest, strontium, be used
too.
CHAPTER 18: USE OF DRUGS FOR
Malaysian Statistics on Medicine 2004 RHEUMATOLOGICAL AND BONE DISORDERS
50
Table 18.1: Use of Drugs for Rheumatological and Bone disorders, in DDD/1000 population/day 2004
# Drug Class 2004
M01 NON-STEROIDAL ANTIINFLAMMATORY AGENTS 15.9397
M03 MUSCLE RELAXANTS 0.6318
M04 ANTIGOUT PREPARATIONS 2.1927
M05 BONE DISEASES THERAPY 1.0571
Table 18.2.1: Use of Non-Steroidal Antiinfl ammatory drugs by Drug Class, in DDD/1000 population/day
2004
# Drug Class 2004
M01A A BUTYLPYRAZOLIDINES 0
M01A B ACETIC ACID DERIVATIVES 6.0663
M01A C OXICAMS 1.1485
M01A E PROPIONIC ACID DERIVATIVES 1.4998
M01A G FENAMATES 4.7901
M01A H COXIBS 2.3982
M01A X OTHER NON-STEROIDAL ANTI-INFLAMMATORY
AGENTS
0.0332
M01C C PENICILLAMINE 0.0037
Table 18.2.2: Use of Non-Steroidal Antiinfl ammatory drugs by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
M01A A BUTYLPYRAZOLIDINES M01A A01 PHENYLBUTAZONE Total 0
Public 0
Private
M01A B ACETIC ACID DERIVATIVES M01A B01 INDOMETACIN Total 0.6929
Public 0.4138
Private 0.2791
M01A B02 SULINDAC Total 0.0187
Public
Private 0.0187
M01A B05 DICLOFENAC Total 5.3498
Public 1.2021
Private 4.1477
M01A B15 KETOROLAC Total 0.0049
Public 0.0045
Private 0.0003
M01A C OXICAMS M01A C01 PIROXICAM Total 0.3457
Public 0.0557
Private 0.29
CHAPTER 18: USE OF DRUGS FOR
RHEUMATOLOGICAL AND BONE DISORDERS Malaysian Statistics on Medicine 2004
51
Table 18.2.2: Use of Non-Steroidal Antiinfl ammatory drugs by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
M01A C02 TENOXICAM Total 0.0336
Public
Private 0.0336
M01A C06 MELOXICAM Total 0.7692
Public 0.2765
Private 0.4927
M01A E PROPIONIC ACID DERIVATIVES M01A E01 IBUPROFEN Total 0.9071
Public 0.1955
Private 0.7116
M01A E02 NAPROXEN Total 0.5771
Public 0.0505
Private 0.5266
M01A E03 KETOPROFEN Total 0.0156
Public 0.0058
Private 0.0098
M01A G FENAMATES M01A G01 MEFENAMIC ACID Total 4.7901
Public 1.4452
Private 3.3449
M01A H COXIBS M01A H01 CELECOXIB Total 0.6874
Public 0.2245
Private 0.4629
M01A H02 ROFECOXIB Total 0.3498
Public 0.1369
Private 0.2129
M01A H03 VALDECOXIB Total 0.3884
Public 0.0061
Private 0.3823
M01A H04 PARECOXIB Total 0.0008
Public 0.0001
Private 0.0007
M01A H05 ETORICOXIB Total 0.9718
Public 0.0047
Private 0.9671
M01A X OTHER NON-STEROIDAL ANTIINFLAMMATORY AGENTS M01A X17 NIMESULIDE Total 0.0332
Public
Private 0.0332
CHAPTER 18: USE OF DRUGS FOR
Malaysian Statistics on Medicine 2004 RHEUMATOLOGICAL AND BONE DISORDERS
52
Table 18.2.2: Use of Non-Steroidal Antiinfl ammatory drugs by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
M01C C PENICILLAMINE M01C C01 PENICILLAMINE Total 0.0037
Public 0.0036
Private 0.0001
Table 18.3.1: Use of Muscle relaxants by Drug Class, in DDD/1000 population/day 2004
# Drug Class and Agents 2004
M03B C01 ORPHENADRINE (CITRATE) Total 0.2289
Public 0.0056
Private 0.2233
M03B C51 ORPHENADRINE, COMBINATIONS Total 0.3652
Public
Private 0.3652
M03B X01 BACLOFEN Total 0.0377
Public 0.035
Private 0.0027
Table 18.4.1: Use of Antigout preparations by Drug Class, in DDD/1000 population/day 2004
# Drug Class and Agents 2004
M04A A01 ALLOPURINOL Total 1.5786
Public 0.6952
Private 0.8834
M04A B01 PROBENECID Total 0.0032
Public 0
Private 0.0032
M04A C01 COLCHICINE Total 0.6108
Public 0.3051
Private 0.3058
CHAPTER 18: USE OF DRUGS FOR
RHEUMATOLOGICAL AND BONE DISORDERS Malaysian Statistics on Medicine 2004
53
Table 18.5.1: Use of Bone diseases therapy by Drug Class, in DDD/1000 population/day 2004
# Drug Class and Agents 2004
M05B A02 CLODRONIC ACID Total 0.0041
Public 0.002
Private 0.0022
M05B A03 PAMIDRONIC ACID Total 0.0012
Public 0.0012
Private 0.0001
M05B A04 ALENDRONIC ACID Total 1.0433
Public 0.6693
Private 0.3739
M05B A07 RISEDRONIC ACID Total 0.0083
Public 0.0083
Private
M05B A08 ZOLEDRONIC ACID Total 0.0002
Public 0.0001
Private 0.0001
References:
1. Medicines consumption in the Nordic countries 1999-2003.Nordic Medico Statistical Committee 2004;
2004: Copenhagen
2. Australian Statistics on Medicine 1999-2000.Commonwealth Department of health and ageing Australia
2003
3. Black DM, Thompson De, Bauer DC et al, for the FIT Research group. Fracture risk reduction with alendronate
in women with osteoporosis; The Fracture Intervention Trial. J Clin Endocrinol Metab 2000:85(11):4118-
4124.
4. Quandt S, Thompson D, Hocberg M. Consistency of effect of alendronate on reduction in risk of hip and
forearm fractures: A meta-analysis. Poster presented at: 5th Workshop on Bisphosphonates; April 5-7 2000;
Dayos Switzerland.
5. Lees B, Garland SW, Walton C et al. Role of oral pamidronate in prevention of bone loss in postmenopausal
women. Osteoporos Int 1996;6(6):480-485
55
CHAPTER 19: USE OF ANALGESICS AND ANAESTHETICS [RESERVE]
CHAPTER 20: USE OF DRUGS FOR NEUROLOGICAL DISORDERS [RESERVE]
CHAPTER 21
USE OF DRUGS FOR PSYCHIATRIC DISORDERS Malaysian Statistics on Medicine 2004
57
Edited by:
Suraya Yusoff1, Suarn Singh2, Syed Fadzli Syed Sailuddin3
With contributions from:
Benjamin Chan Teck Ming4, Ahmad Hatim Sulaiman5, Zoriah bt Aziz6, Tg Malini Tg Mohd Noor Izam7, Noor Ratna Naharuddin4, Mariam Bintarty Rushdi7
1 Sultanah Aminah Hospital MOH, 2 Bahagia Hospital MOH, 3 Pharmaceutical Services Division MOH, 4 Permai Hospital MOH, 5 Department of Psychological Medicine, Faculty of Medicine,University of Malaya, 6 Department of Pharmacy Faculty of Medicine,University of Malaya, 7 Kuala Lumpur Hospital MOH
The prevalence of mental health disorders in Malaysia is about 10.7% [1] and was responsible for 8.6% of the
total Disability Life Years (DALYs). Mental disorders ranked fourth as the leading cause of burden of disease by
disease categories and unipolar major depression accounts for 45% of this burden [2]. The biopsychosocial model
is used in the management of mental disorder. However psychopharmacology still remains one of the mainstay
of treatment of most mental disorders. The cost of psychiatric medications however, has increased over the years
with the introduction of newer generation of both antipsychotic and antidepressant medications.
Among the psychiatric medications, antipsychotics form 37.9% of consumption, antidepressants 32.1%, followed
by anxiolytics, sedatives and hypnotics 30%. This may be because the majority of patients with psychotic
symptoms are treated at the public facilities.
The consumption of antipsychotic medication is still low in Malaysia compared to other countries. It may indicate
that a proportion of population with schizophrenia did not come forward for treatment due to the stigma of
the illness. It may also mean that default rate is high. Most of the consumption is at public facilities (54.3%).
Among the conventional antipsychotic medication, phenothiazines showed the highest consumption followed by
the thioxanthenes. We can safely imply from the data that the usage of depot medication is about 28.7%. Atypical
antipsychotics form only 10.3% of consumption. In Australia, it contributes to 35% of consumption in 2002 [3].
The main reason may be due to the high cost of the atypical. Among the atypicals, risperidone (6%) shows the
highest consumption, at both the private and public facilities.
Lithium is coded among the antipsychotic medication group. However its use in psychiatry is as a mood
stabilizer, and so should not be in this group. Spain actually excluded lithium from the total DDD calculations for
antipsychotic medication [4].
The consumption of antidepressant is still low compared to other countries. Depression is probably under-
diagnosed and under-treated. Among the antidepressant groups, the Serotonin Selective Reuptake Inhibitor
(SSRI), non-selective monoamine reuptake inhibitors and other antidepressant group are used in equal amount.
The use of SSRI in other countries far exceeds that of other types of antidepressants. The non-selective monoamine
reuptake inhibitors are still highly used despite the recommendation in the guidelines. The private facilities are
the main consumers of antidepressant. It is encouraging to see that most depressed patients prefer to see private
practitioners.
Anxiolytics, sedative and hypnotics use are still very low in Malaysia. Like Australia, the use of benzodiazepines
related hypnotics is much lower compared to the benzodiazepine derivatives [5]. Of the anxiolytics, the
benzodiazepines were the most commonly used, forming 83.5% of the total consumption. Among the hypnotics,
the benzodiazepine derivatives are more commonly used when compared to the benzodiazepines related group,
62.4% and 37.48% respectively. The consumption of these 2 groups of drugs is much higher in the private
facilities (66.3% versus 33.7%). This is expected as most patients with anxiety and insomnia seek treatment from
private practitioners fi rst.
The anti-dementia medication consumption in Malaysia is still very low. They are mainly used in the public
facilities. The consumption in other countries is equally low.
CHAPTER 21
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR PSYCHIATRIC DISORDERS
58
Table 21.1.1: Use of Antipsychotics by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
N05A A/B/C PHENOTHIAZINES 1.4295
N05A D BUTYROPHENONE DERIVATIVES 0.615
N05A E INDOLE DERIVATIVES 0.0017
N05A F THIOXANTHENE DERIVATIVES 0.1896
N05A H DIAZEPINES, OXAZEPINES AND THIAZEPINES 0.1217
N05A K NEUROLEPTICS, IN TARDIVE DYSKINESIA 0
N05A L BENZAMIDES 0.2661
N05A N LITHIUM 0.03
N05A X OTHER ANTI-PSYCHOTICS 0.1722
Table 21.1.2: Use of Antipsychotics by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
N05A A/B/C PHENOTHIAZINES N05A A01 CHLORPROMAZINE Total 0.5486
Public 0.5273
Private 0.0213
N05A B02 FLUPHENAZINE Total 0.6028
Public 0.5905
Private 0.0123
N05A B03 PERPHENAZINE Total 0.0634
Public 0.0119
Private 0.0515
N05A B04 PROCHLORPERAZINE Total 0.0604
Public 0.0578
Private 0.0027
N05A B06 TRIFLUOPERAZINE Total 0.1311
Public 0.1266
Private 0.0045
N05A C02 THIORIDAZINE Total 0.0231
Public 0.0205
Private 0.0026
N05A D BUTYROPHENONE DERIVATIVES N05A D01 HALOPERIDOL Total 0.615
Public 0.611
Private 0.004
N05A E INDOLE DERIVATIVES N05A E04 ZIPRASIDONE Total 0.0017
Public 0.0003
Private 0.0014
CHAPTER 21
USE OF DRUGS FOR PSYCHIATRIC DISORDERS Malaysian Statistics on Medicine 2004
59
Table 21.1.2: Use of Antipsychotics by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
N05A F THIOXANTHENE DERIVATIVES N05A F01 FLUPENTIXOL Total 0.1521
Public 0.1232
Private 0.029
N05A F02 CLOPENTHIXOL Total 0.0078
Public 0.0078
Private
N05A F05 ZUCLOPENTHIXOL Total 0.0297
Public 0.0291
Private 0.0006
N05A H DIAZEPINES, OXAZEPINES AND THIAZEPINES N05A H02 CLOZAPINE Total 0.031
Public 0.0306
Private 0.0004
N05A H03 OLANZAPINE Total 0.0829
Public 0.0747
Private 0.0083
N05A H04 QUETIAPINE Total 0.0077
Public 0.0072
Private 0.0006
N05A K NEUROLEPTICS, IN TARDIVE DYSKINESIA N05A K01 TETRABENAZINE Total 0
Public 0
Private
N05A L BENZAMIDES N05A L01 SULPIRIDE Total 0.2661
Public 0.2628
Private 0.0033
N05A N LITHIUM N05A N01 LITHIUM Total 0.03
Public 0.0257
Private 0.0043
N05A X OTHER ANTIPSYCHOTICS N05A X08 RISPERIDONE Total 0.1722
Public 0.1498
Private 0.0225
CHAPTER 21
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR PSYCHIATRIC DISORDERS
60
Table 21.2.1: Use of Antidepressants by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
N06A A NON-SELECTIVE MONOAMINE REUPTAKE INHIBITORS 0.5696
N06A B SELECTIVE SEROTONIN REUPTAKE INHIBITORS 0.4654
N06A G MONOAMINE OXIDASE A INHIBITORS 0.0229
N06A X OTHER ANTIDEPRESSANTS 0.114
Table 21.2.2: Use of Antidepressants by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
N06A A NON-SELECTIVE MONOAMINE REUPTAKE INHIBITORS N06A A02 IMIPRAMINE Total 0.0415
Public 0.0256
Private 0.0159
N06A A04 CLOMIPRAMINE Total 0.0114
Public 0.0091
Private 0.0023
N06A A09 AMITRIPTYLINE Total 0.0966
Public 0.0349
Private 0.0617
N06A A16 DOSULEPIN Total 0.4108
Public 0.0476
Private 0.3632
N06A A21 MAPROTILINE Total 0.0093
Public 0.0056
Private 0.0038
N06A B SELECTIVE SEROTONIN REUPTAKE INHIBITORS N06A B03 FLUOXETINE Total 0.1004
Public 0.0609
Private 0.0395
N06A B04 CITALOPRAM Total 0.0186
Public 0.0044
Private 0.0141
N06A B05 PAROXETINE Total 0.0272
Public 0.0021
Private 0.0251
N06A B06 SERTRALINE Total 0.1528
Public 0.105
Private 0.0478
N06A B08 FLUVOXAMINE Total 0.1659
Public 0.1156
Private 0.0504
N06A B10 ESCITALOPRAM Total 0.0004
Public 0.0004
Private
CHAPTER 21
USE OF DRUGS FOR PSYCHIATRIC DISORDERS Malaysian Statistics on Medicine 2004
61
Table 21.2.2: Use of Antidepressants by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
N06A G MONOAMINE OXIDASE A INHIBITORS N06A G02 MOCLOBEMIDE Total 0.0229
Public 0.0133
Private 0.0097
N06A X OTHER ANTIDEPRESSANTS N06A X03 MIANSERIN Total 0.0201
Public 0.0199
Private 0.0002
N06A X06 NEFAZODONE Total 0.0007
Public 0.0007
Private
N06A X11 MIRTAZAPINE Total 0.0775
Public 0.0093
Private 0.0682
N06A X14 TIANEPTINE Total 0
Public 0
Private 0
N06A X16 VENLAFAXINE Total 0.0158
Public 0.0041
Private 0.0117
Table 21.3.1: Use of Anxiolytics, Hypnotics and Sedatives by Drug Class, in DDD/1000 population/day
2004
# Drug Class 2004
N05B A, N05C D BENZODIAZEPINE DERIVATIVES 1.6085
N05B B DIPHENYLMETHANE DERIVATIVES 0.2861
N05C C ALDEHYDES AND DERIVATIVES <0.0001
N05C F BENZODIAZEPINE RELATED DRUGS 0.3966
N05C M OTHER HYNOPTICS AND SEDATIVES 0.0077
CHAPTER 21
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR PSYCHIATRIC DISORDERS
62
Table 21.3.2: Use of Anxiolytics, Hypnotics and Sedatives by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
N05B A, N05C D BENZODIAZEPINE DERIVATIVES N05B A01 DIAZEPAM Total 0.3126
Public 0.0565
Private 0.2561
N05B A02 CHLORDIAZEPOXIDE Total 0.0057
Public
Private 0.0057
N05B A05 POTASSIUM CLORAZEPATE Total 0.0063
Public
Private 0.0063
N05B A06 LORAZEPAM Total 0.1794
Public 0.0159
Private 0.1634
N05B A08 BROMAZEPAM Total 0.0241
Public 0.005
Private 0.0192
N05B A09 CLOBAZAM Total 0.0388
Public 0.0003
Private 0.0385
N05B A12 ALPRAZOLAM Total 0.3976
Public 0.0888
Private 0.3088
N05C D02 NITRAZEPAM Total 0.0046
Public 0.0002
Private 0.0044
N05C D05 TRIAZOLAM Total 0.2315
Public
Private 0.2315
N05C D08 MIDAZOLAM Total 0.4079
Public 0.184
Private 0.2239
N05B B DIPHENYLMETHANE DERIVATIVES N05B B01 HYDROXYZINE Total 0.2861
Public 0.0295
Private 0.2565
N05C C ALDEHYDES AND DERIVATIVES N05C C05 PARALDEHYDE Total <0.0001
Public <0.0001
Private 0
CHAPTER 21
USE OF DRUGS FOR PSYCHIATRIC DISORDERS Malaysian Statistics on Medicine 2004
63
Table 21.3.2: Use of Anxiolytics, Hypnotics and Sedatives by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
N05C F BENZODIAZEPINE RELATED DRUGS N05C F01 ZOPICLONE Total 0.0699
Public
Private 0.0699
N05C F02 ZOLPIDEM Total 0.3266
Public 0.2119
Private 0.1147
N05C M OTHER HYNOPTICS AND SEDATIVES N05C M05 SCOPOLAMINE Total 0.0077
Public
Private 0.0077
Table 21.4.1: Use of Anti-Dementia by Drug Class, in DDD/1000 population/day 2004
# Drug Class 2004
N06D ANTI-DEMENTIA DRUGS 0.0274
Table 21.4.2: Use of Anti-Dementia by Drug Class and Agents, in DDD/1000 population/day 2004
ATC Drug Class and Agents 2004
N06D ANTI-DEMENTIA DRUGS N06D A02 DONEPEZIL Total 0.0114
Public 0.0087
Private 0.0028
N06D A03 RIVASTIGMINE Total 0.0155
Public 0.0152
Private 0.0003
N06D A04 GALANTAMINE Total 0.0004
Public 0.0001
Private 0.0003
References:
1. The National Health Morbidity Survey, 1996.
2. Division of Burden of Disease Institute for Public Health, Malaysian Burden of Disease and Injury Study, in
Health Prioritization: Burden of Disease Approach. 2004, Ministry of Health Malaysia.
3. Martin BG, Stephen Miller L, Icotzan JA, Antipsychotic prescription use and costs for persons with
schizophrenia in the 1990’s: current trends and 5 year time series forecasts, Schizophrenia Research 47(2001):
281-292.
4. Santamaria B, Perez M, Montero D, Madurga M, de Abajo FJ. Use of antipsychotic agents in Spain through
1985-2000. Europsychiatry 2002: 17: 471-476.
5. Australian Statistics on Medicine 1999-2000.Commonwealth Department of Health and Ageing Australia
2003
CHAPTER 22
USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES Malaysian Statistics on Medicine 2004
65
Edited by:
Norzila Mohamed Zainudin1, Molly Cheah2
With contributions from:
Aziah Ahmad Mahayiddin1, Rahayu Shahperi1, Nurdita Hisham3, Sarina Anim bt. Mohd Hidzir4
1 Kuala Lumpur Hospital MOH, 2 NMUS Governance Board (PCDOM), 3 Seremban Hospital MOH, 4 Sungei Buluh Health Clinic MOH
The drugs used in treating asthma are divided into two groups; the fi rst being corticosteroids which is used for
basic treatment of airway infl ammation. The other group is the bronchodilating agents, which are used for acute
symptoms. The bronchodilating agents include the beta-2 adrenoreceptors, the anticholinergics and xanthines.
However in the late 90s two more new drugs were introduced into asthma management therapy. These are the
combination of inhaled glucocorticoids with long acting beta 2 agonists and the antileukotrienes, which is an oral
medication. Both medications are used as antiinfl ammatory and for asthma prophylaxis.
The prevalence of asthma in children in Malaysia is 10%[1]. While in the adult population the prevalence of
asthma is 5 % from the National Health Morbidity Survey[2]. Based on the Malaysian Consensus Guidelines on
Asthma[3,4], the mainstay therapy of inhaled corticosteroids. However the combination therapy is advocated in
the moderate to severe persistent asthmatic. Antileukotrienes however can be prescribed as a fi rst line therapy in
mild persistent group.
The data shows that the usage of inhaled beta-2 agonists is very high, 6 times more commonly used as compared
to inhaled glucocorticoids alone. Specifi cally, the usage of inhaled salbutamol is 5 times higher than inhaled
budesonide. In Australia the use of salbutamol is only 1.7 times higher compared to budesonide in 2000. These
fi ndings supported the community survey in Malaysia, which showed there is an underutilization of inhaled
steroids [5]. Only one third of chronic asthmatics were on inhaled steroids.
The consensus recommended the use of bronchodilator in powdered or aerosol formulation as these are delivered
directly to the lung and the required dosages were smaller and with less side effects. The data showed that the oral
forms are more commonly used compared to the inhalational agents. Reasons may be due to the easy delivery
[6]. Inhalational therapy requires longer time spent by the doctor due to the need of teaching patients the way of
using it. Oral bronchodilator is cheaper compared to inhalational agents.
In terms of steroids prophylaxis, fl uticasone is much more prescribed in the private practice. Both budesonide and
beclomethasone are listed as B drugs in the public while fl uticasone is a list A drug that can only be prescribed
by a specialist.
Antileukotrienes are more commonly prescribed in the private practice. Again this drug is an A list drug in
public hospitals. Its usage is limited to the mild persistent asthma or as an add-on therapy if asthma is not well
controlled on inhaled corticosteroids. Since it is an oral medication, it is being used more in the private sector
although it is more expensive compared to inhalational glucorticosteroids.
The anticholinergics are commonly used for COAD. The newer agent tiatropium bromide is much more commonly
used than compared to iatropium bromide. The tiotropium bromide is a long acting anti-cholinergic prescribed
for severe COAD.
Compared to the Australian and the Nordic countries, the prescription of inhaled bronchodilators and inhaled
steroids are higher than in Malaysia [7,8]. The reasons may be due to that Australia has a higher prevalence of
asthma than in Malaysia. The other reason is that there may be more awareness among medical practitioners
about asthma management as well as an active Australia Asthma Foundation.
CHAPTER 22
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
66
Table 22.1: Use of Medicines for Obstructive Airway Diseases by Drug Class, in DDD/1000 population/
day 2004
# Drug Class 2004
R03A C INHALATIONAL SELECTIVE BETA-2-ADRENORECEPTOR AGONISTS 6.8083
R03A K ADRENERGICS AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY
DISEASES
0.8801
R03B A INHALATIONAL GLUCOCORTICOIDS 3.2641
R03B B INHALATIONAL ANTICHOLINERGICS 2.2498
R03B C INHALATIONAL ANTIALLERGIC AGENTS, EXCLUDING
CORTICOSTEROIDS
0.0001
R03C A ALPHA- AND BETA-ADRENORECEPTOR AGONISTS FOR SYSTEMIC USE 0.0073
R03C C SELECTIVE BETA-2-ADRENORECEPTOR AGONISTS FOR SYSTEMIC USE 6.7596
R03D A XANTHINES 1.869
R03D C LEUKOTRIENE RECEPTOR ANTAGONISTS 0.2197
Table 22.2: Use of Medicines for Obstructive Airway Diseases by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
R03A C INHALATIONAL SELECTIVE BETA-2-ADRENORECEPTOR AGONISTS
R03A C02 SALBUTAMOL Total 6.3364
Public 5.349
Private 0.9874
R03A C03 TERBUTALINE Total 0.0125
Public 0.0014
Private 0.0111
R03A C04 FENOTEROL Total 0.0017
Public 0
Private 0.0017
R03A C12 SALMETEROL Total 0.1029
Public 0.1017
Private 0.0012
R03A C13 FORMOTEROL Total 0.3549
Public 0.1957
Private 0.1592
R03A K ADRENERGICS AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
R03A K03 FENOTEROL AND OTHER DRUGS FOR
OBSTRUCTIVE AIRWAY DISEASES
Total 0.0213
Public 0
Private 0.0213
R03A K04 SALBUTAMOL AND OTHER DRUGS FOR
OBSTRUCTIVE AIRWAY DISEASES
Total 0.466
Public 0.4197
Private 0.0464
R03A K06 SALMETEROL AND OTHER DRUGS FOR
OBSTRUCTIVE AIRWAY DISEASES
Total 0.3182
Public 0.1725
Private 0.1457
CHAPTER 22
USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES Malaysian Statistics on Medicine 2004
67
Table 22.2: Use of Medicines for Obstructive Airway Diseases by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
R03A K07 FORMOTEROL AND OTHER DRUGS FOR
OBSTRUCTIVE AIRWAY DISEASES
Total 0.0745
Public 0.019
Private 0.0555
R03B A INHALATIONAL GLUCOCORTICOIDS R03B A01 BECLOMETASONE Total 0.422
Public 0.3875
Private 0.0345
R03B A02 BUDESONIDE Total 2.5996
Public 1.7225
Private 0.8771
R03B A05 FLUTICASONE Total 0.2425
Public 0.0273
Private 0.2152
R03B B INHALATIONAL ANTICHOLINERGICS R03B B01 IPRATROPIUM BROMIDE Total 0.5339
Public 0.29
Private 0.2439
R03B B04 TIOTROPIUM BROMIDE Total 1.7158
Public 0.7026
Private 1.0132
R03B C INHALATIONAL ANTIALLERGIC AGENTS, EXCLUDING CORTICOSTEROIDS
R03B C01 CROMOGLICIC ACID Total 0.0001
Public 0.0001
Private 0
R03C A ALPHA- AND BETA-ADRENORECEPTOR AGONISTS FOR SYSTEMIC USE
R03C A02 EPHEDRINE Total 0.0073
Public 0.0059
Private 0.0014
R03C C SELECTIVE BETA-2-ADRENORECEPTOR AGONISTS FOR SYSTEMIC USE
R03C C02 SALBUTAMOL Total 5.4231
Public 0.6634
Private 4.7596
R03C C03 TERBUTALINE Total 0.532
Public 0.3095
Private 0.2225
R03C C04 FENOTEROL Total 0.79
Public 0
Private 0.79
CHAPTER 22
Malaysian Statistics on Medicine 2004 USE OF DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
68
Table 22.2: Use of Medicines for Obstructive Airway Diseases by Drug Class and Agents, in DDD/1000
population/day 2004
ATC Drug Class and Agents 2004
R03C C08 PROCATEROL Total 0.0099
Public 0
Private 0.0099
R03C C12 BAMBUTEROL Total 0.0047
Public 0
Private 0.0047
R03D A XANTHINESR03D A04 THEOPHYLLINE Total 1.8599
Public 1.272
Private 0.5879
R03D A05 AMINOPHYLLINE Total 0.0091
Public 0.0047
Private 0.0044
R03D C LEUKOTRIENE RECEPTOR ANTAGONISTSR03D C03 MONTELUKAST Total 0.2197
Public 0.0289
Private 0.1908
References:
1. International Study of Asthma and Allergies in Chilldhood (ISAAC) Steering Committee. Worldwide
variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in
Childhood (ISAAC) Eur Respir J. 1998; 12:315-35
2. Rugayah B. Public Health Institute. Ministry Of Health Malaysia. Report on Second National Health and
Morbidity survey 1997; 11:94-8.
3. Guidelines for the management of childhood asthma. A Consensus Statement prepared for the Academy of
Medicine of Malaysia 2004.
4. Clinical Practice Guidelines for Management of Adult Asthma. A joint statement of the Malaysian Thoracic
Society, Ministry of Health Malaysia., Academy Of Medicine Malaysia 2002.
5. Lai CK, De Guia TS, Kim YY Kiuo SH, Mukhodpadhyyay A, Soriano JB, Trung PL, Zhong NS, Zainudin
N, Zainudin BM. The asthma insights and reality in Asia Pacifi c Steering committee. Asthma Control in the
Asia Pacifi c Region: the Asthma Insights and Reality in Asia-Pacifi c Study. J Allergy Clin Immunol 2003
111: 263-8.
6. Chan PWK, Norzila MZ. Prescribing pattern for childhood asthma treatment in general practice Med Journal
Malaysia 2003;58:475-81.
7. Australian Statistics on Medicine 1999-2000. Commonwealth Department of Health and Ageing Australia
2003
8. Medicines consumption in the Nordic countries 1999-2003. Nordic Medico Statistical Committee 2004;
2004: Copenhagen
69
CHAPTER 23: USE OF ANTIHISTAMINES & NASAL DECONGESANTS [RESERVE]
CHAPTER 24: USE OF OPHTHALMOLOGICALS [RESERVE]
CHAPTER 25: USE OF OTOLOGICALS [RESERVE]
71
72
Malaysian Statistics On Medicine2004
A publication of the Pharmaceutical Services Division and the Clinical Research Centre
Ministry of Health Malaysia
