Drug utilization review of tramadol hydrochloride in a regional hospital in South Africa; findings and implications

ABSTRACT

Background

Drug utilization reviews (DURs) can be used to promote rational prescribing and ensure compliance with standard treatment guidelines. In recent years, the use of tramadol hydrochloride (HCl) for pain has increased significantly across countries. We sought to determine prescribing patterns and the use of tramadol in a regional hospital in South Africa to provide future guidance in view of increasing concerns with the prescribing of tramadol.

Method

A prospective, quantitative and descriptive study was conducted over two months. Outpatient and inpatient prescriptions and ward requisitions where tramadol HCl was prescribed or ordered were identified, which included outpatients collecting antiretroviral treatment. Prescriptions were reviewed and evaluated to determine the level of compliance to the Standard Treatment Guidelines and Essential Medicines List (STGs/EML) for South Africa as a measure of rational prescribing. Quantities issued to the inpatient wards and expenditure incurred by the pharmacy departments were assessed to determine overall usage and total costs.

Results

In total, 415 tramadol HCl prescriptions were collected over a 2-month period. Compliance was 70.1% to the STGs/EML. The outpatient pharmacy department had the highest compliance at 76.4% while the antiretroviral pharmacy compliance was 29.1%. Most prescriptions dispensed at the outpatient pharmacy were from the Surgical Outpatient Department (140; 33.7%) and the Orthopedic Outpatient Department (108; 26.0%). The outpatient pharmacy had the highest tramadol HCl consumption and expenditure at $4,874.13 (R72,054.28), while the inpatient pharmacy’s expenditure was $2,526.63 (R37,351.20), and the antiretroviral pharmacy $590.13 (R8,722.75). The hospital’s tramadol HCl expenditure increased when compared to previous financial years, from $10,576.04 (R156,326.00) in 2014–2015 to $39,584.00 (R585,088.80) in 2016–2017.

Conclusion

This study highlights the need for the implementation of monitoring and evaluation tools to enhance rational prescribing and use of tramadol HCl. These are being implemented and will be evaluated in future projects.

KEYWORDS:

• Tramadol
• drug utilization review
• guidelines
• EML
• hospital
• South Africa

Declaration of interest

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

A reviewer on this manuscript has disclosed that they have consulted for Grunenthal in 2018 and presented at the WHO Expert Committee on Drug Dependence opening meeting during which tramadol HCl was reviewed in 2018. However, they did not participate in the tramadol review or present on behalf of Grunenthal. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Data availability statement

The data described in this article are openly available in the Open Science Framework at DOI:10.17605/OSF.IO/TPA6U.

Supplementary Material

Supplementary data for this article can be accessed here.

Additional information

Funding

The authors declare they have no conflicts of interest although Akhona Fynn works works as a hospital pharmacist for KwaZulu-Natal Department of Health. There was no funding for this research project.