TY - JOUR T1 - Evaluation of vitamin D prescribing and consumption in Turkiye AU - Varımlı, Didem AU - İşli, Fatma AU - Ündeğer Bucurgat, Ülkü PY - 2023 DA - August DO - 10.26650/IstanbulJPharm.2023.1194407 JF - İstanbul Journal of Pharmacy JO - iujp PB - Istanbul University WT - DergiPark SN - 2587-2087 SP - 110 EP - 117 VL - 53 IS - 2 LA - en AB - Background and Aims: Vitamin D plays several roles in keeping the body’s cells healthy and functioning the way they should. Most people do not get enough Vitamin D, so supplements are common. However, it is also possible for this vitamin to build up and reach toxic levels in the body. This study investigated the prescription of Vitamin D and Analogues in primary care and outpatient consumption in Türkiye between the years 2015- 2018. Also, the number of protocols created with Hypervitaminosis D was evaluated.Methods: In this study, drug consumption data were evaluated by Prescription Information System (PIS) and ATC/DDD (Anatomical, Therapeutic and Chem- Defined Daily Dose) Methodology. Descriptive statistics were used for evaluation of the data, and numerical values were presented via tables and graphics. Statistical analysis of the data was performed using the SPSS 23 (Statistical Package for the Social Sciences) package program. The Chi-square test was used to evaluate the relationship between the variables, and the P value below 0.05 was accepted as a statistical significance.Results: Between 2015 and 2018, a total of 11.874.898 prescriptions containing drugs with the A11CC (Vitamin D and Analogues) ATC code were created by family physicians. The total number and the percentage of prescriptions containing Vitamin D and Analogues increased over these years. There was a statistically significant difference between the number of prescriptions. While the percentage of prescriptions containing Vitamin D and Analogues was 0.89 in 2015, it was 3.38 in 2018. It was determined that the percentage of prescriptions increased over these years. The consumption of the drugs with the A11CC ATC code in outpatients increased over these years according to the ATC/DDD methodology.Conclusion: The study showed that the prescription of preparations containing Vitamin D by family physicians increased significantly over the years and there was an increase in Vitamin D consumption in outpatients. In addition, it was shown that the number of protocols established for the diagnosis of Hypervitaminosis D increased over the years in Türkiye. KW - Drug KW - drug consumption KW - rational drug use KW - Vitamin D KW - prescribing CR - Akılcı İlaç Kullanımı. (2022). Neden Akılcı İlaç Kullanımı. Retrieved from http://www.akilciilac.gov.tr/ google scholar CR - Aksoy, M., Alkan, A., İşli, F. (2015). Sağlık Bakanlığı’nın Akılcı İlaç Kullanımını Yaygınlaştırma Faaliyetleri. Türkiye Klinikleri, 3(1), 19-26. google scholar CR - Altieri, B., Cavalier, E., Bhattoa, H. P,, Perez-Lopez, F. R., Lopez-Bae-na, M. T., Perez-Roncero, G. R. (2020). Vitamin D testing: advan-tages and limits of the current assays. European Journal of Clinical Nutrition, 74, 231-247. google scholar CR - Aydın, A. E., Dokuzlar, Ö. (2018). Geriatrik Bir Olguda D Vitamini İntoksikasyonuna Bağlı Gelişen Akut Mental Değişiklik. Geriatrik Bilimler Dergisi, 1(2), 73-78. google scholar CR - Balkan, F., Ünal, O. K. (2013). Nadir bir hiperkalsemi sebebi: D vitamini intoksikasyonu. Genel Tıp Dergisi., 23(3), 90-92. google scholar CR - Belaidi, N., Georges, A., Lacroix, I., Croisonnier, A., Ducros, V., Sou-berbielle, J.C. et al. (2016). Hypercalcemia and elevated concen-tration of Vitamin D: A case report too easy to be true. Clinica Chi-mica Acta; International Journal of Clinical Chemistry, 457, 123-124. google scholar CR - Bouillon, R., Carmeliet, G. (2018). Vitamin D insufficiency: Defini-tion, diagnosis and management. Best Practice & Research Clinical Endocrinology & Metabolism, 32(5), 669-684. google scholar CR - Bozacı, İ., Avcı, T., Nalbant, S., Vasi, İ., Soydan, M. (2018). Oral D Vitamin Replasmanına Bağlı Gelişen Hiperkalsemi ve Akut Böbrek Hasarı. Turkish Nephrology Dialysis and Transplantation Journal, 27(2), 221-224. google scholar CR - Buluş, D., İnan, Y., Demet, E., Andıran, N. (2016). D Vitamini İntoksikasyonuna Bağlı Hiperkalsemi: Olgu Sunumu. Türkiye Çocuk Hastalıkları Dergisi/Turkish Journal of Pediatric Disease., 4, 277-279. google scholar CR - Dawson-Hughes, B. (2022). Vitamin D deficiency in adults: defi-nition, clinical manifestations, and treatment. Retrieved from https://www.uptodate.com/contents/vitamin-d-deficiency-in-adults-definition-clinical-manifestations-and-treatment google scholar CR - De, Paula, A. L. T., Gonzaga, W. P. F., Oliveira, L. M., Feibelmann, T. C. M., Markus, J. (2020). Exogenous intoxication by non-prescribed use of Vitamin D, a case report. BMC Geriatrics, 20, 221. google scholar CR - Ertl, D. A., Raimann, A., Csaicsich, D., Patsch, J. M., Laccone, F., Haeusler, G. (2017). A Pediatric Patient with a CYP24A1 Mutation: Four Years of Clinical, Biochemical, and Imaging Follow-Up. Hor-mone Research in Paediatrics, 87, 196-204. google scholar CR - Galior, K., Grebe, S., Singh, R. (2018). Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency. Nutrients, 10(8), 953. google scholar CR - Garbim, B. B., Âvila, L. D., Rigatto, S. Z. P., Quadros, K. R. S., Be-langero, V. M. S., Oliveira, R. B. (2017). Hypercalcemia in children: three cases report with unusual clinical presentations. Brazilian Journal of Nephrology, 39(2), 213-216. google scholar CR - Giustina, A., Adler, R. A., Binkley, N., Bouillon, R., Ebeling, P. R., Laz-aretti-Castro, M., Marcocci, C., Rizzoli, R., Sempos, C. T., Bilezikian, J. P. (2019). Controversies in Vitamin D: Summary Statement From an International Conference. The Journal of Clinical Endocrinology & Metabolism , 104(2), 234-240. google scholar CR - Holick, M. F. (2007). Vitamin D deficiency. The New England Journal of Medicine , 357(3), 266-81. google scholar CR - Holick, M. F. (2009) Vitamin D status: measurement, interpretation, and clinical application. Annals of Epidemiology, 19, 73-78. google scholar CR - Holick, M. F. (2017) The Vitamin D deficiency pandemic: Ap-proaches for diagnosis, treatment and prevention. Reviews in En-docrine and Metabolic Disorders, 18(2), 153-165. google scholar CR - Hossein-Nezhad, A., Holick, M. F. (2013). Vitamin D for health: A global perspective. Mayo Clinic Proceedings, 88(7), 720-755. google scholar CR - Kara, S., Yıldırım, Baş, F., Öngel, K. (2012). D hipervitaminozu: Olgu sunumu. Türk Aile Hekimliği Dergisi, 16(2), 93-95. google scholar CR - Kayaalp O. (2005). Tıbbi Farmakoloji (11th ed). Ankara: Hacettepe-Taş Yayınları. google scholar CR - Ketha, H., Wadams, H., Lteif, A., Singh, R. J. (2015). Iatrogenic Vitamin D toxicity in an infant - a case report and review of literature. The Journal of Steroid Biochemistry and Molecular Biology, 148, 14-18. google scholar CR - Lips, P., Cashman, K. D., Lamberg-Allardt, C., Bischoff-Ferrari, H. A., Obermayer-Pietsch, B. R., Bianchi, M., Stepan, J., El-Hajj, Fuleihan, G., Bouillon, R. (2019). Current Vitamin D status in European and Middle East countries and strategies to prevent Vitamin D defi-ciency; a position statement of the European Calcified Tissue So-ciety. European Journal of Endocrinology, 180(4), 23-54. google scholar CR - Manson, J. E., Brannon, P. M., Rosen, C. J. (2016). Vitamin D defi-ciency. Is there really a pandemic? The New England Journal of Medicine, 375; 1817-1819. google scholar Ozkan, B., Hatun, S., Bereket, A. (2012). Vitamin D intoxication. Turkish Journal of Pediatrics, 54(2), 93-98. google scholar CR - Pilz, S., Zittermann, A., Trummer, C., Theiler-Schwetz, V., Lerch-baum, E., Keppel, M. H. et al. (2019). Vitamin D testing and treat-ment: a narrative review of current evidence. Endocrine Connec-tions, 8(2), 27-43. google scholar CR - Sarı, E., Bülbül, L., Benzer, M., Akçay, T., Özkul, Sağlam, N. (2014). Yüksek Doz D Vitamini Alımı Sonucu Hiperkalsemi Gelişen Olguda Pamidronat Tedavisi. Sami Hatipoğlu Şişli Etfal Hastanesi Tıp Bülteni, 48(4), 322-324. google scholar CR - Scheelings, T. F., Slocombe, R. F., Bayley, C. (2017). Metastatic min-eralisation caused by Vitamin D intoxication in hand-raised short-beaked echidnas (Tachyglossus aculeatus). Australian Veterinary Journal, 95(11), 427-430. google scholar CR - Sempos, C. T., Heijboer, A. C., Bikle, D. D., Bollerslev, J., Bouillon, R., Brannon, P. M., DeLuca, H. F., Jones, G., Munns, C. F., Bilezikian, J. P., Giustina, A., Binkley, N. (2018). Vitamin D assays and the definition of hypovitaminosis D: results from the First International Confer-ence on Controversies in Vitamin D. British Journal of Clinical Phar-macology, 84(10), 2194-2207. google scholar CR - Sharma LK, Dutta D, Sharma N, Gadpayle AK. (2017). The increas-ing problem of subclinical and overt hypervitaminosis D in India: An institutional experience and review. Nutrition, 34:76-81. google scholar CR - Taşkesen, M., Gümüş, S., Katar, S. (2009). Latrojenik subklinik D hip-ervitaminozu: Olgu sunumu. Dicle Tıp Dergisi, 36(2),137-139. google scholar CR - Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD). (2022). Osteoporoz ve Metabolik Kemik Hastalıkları Tanı ve Tedavi Kılavuzu. Retrieved from https://file.temd.org.tr/Uploads/publica-tions/guides/documents/OSTEOPOROZ_MKH2022.pdf google scholar CR - Türkiye İlaç ve Tıbbi Cihaz Kurumu (TITCK. 2020). D vitamini içeren ilaçlar hk. Retrieved from https://titck.gov.tr/storage/ Archive/2020/dynamicModulesAttachment/output_f048c54a-0173-4df2-974b-2a6d589499d7.pdf google scholar CR - Türkiye İlaç ve Tıbbi Cihaz Kurumu. (TITCK, 2016). D Vitamini Sayın Eczacı Mektubu. Retrieved from https://titck.gov.tr/stor-age/dynamicModulesAttachment/Devit3-eczac%C4%B1%20 bilgilendirme%20mektubu.pdf google scholar CR - Türkiye İlaç ve Tıbbi Cihaz Kurumu. (TITCK, 2022b). Küb/Kt Listesi). Retrieved from https://www.titck.gov.tr/kubkt google scholar CR - Türkiye İlaç ve Tıbbi Cihaz Kurumu. (TITCK, 2022a). SKRS 3 E-Reçete İlaç Listesi. Retrieved from https://www.titck.gov.tr/din-amikmodul/43 google scholar CR - Türkmenoğlu, Y., Kök, S., Gülcan, G., Kalçın, S., Kahyaoğlu, H., Adal, S. E. (2014). Vitamin D İntoksikasyonu: İki Olgu Sunumu. Okmeydanı Tıp Dergisi, 30(3), 176-178. google scholar CR - Uğur, K., Artaş, H., Balin, M., Aykut, E., Demircan, S., Orhan, B. et al. (2016). Hiperkalsemiye Neden Olan D Vitamini İntoksikasyonu: Olgu Sunumu. Fırat ÜniversitesiSağlıkBilimleriTıp Dergisi, 30(3), 139-141. google scholar CR - Urbanska, M., tukaszkiewicz, J., Ptudowski, P, Jones, G. (2018). Vitamin D Toxicity-A Clinical Perspective. Frontiers in Endocrinology, 9, 550. google scholar CR - Uytun, S., Ertural, U., Baş, V. N., Torun, Y. A. (2014). Adölesan bir olguda yüksek dozda uzun süreli D vitamini kullanımına bağlı asemptomatik kronik intoksikasyon. Türk Aile Hekimliği Dergisi, 18(4), 206-208. google scholar CR - Ünal, E., Koksal, Y., Keles, S., Artac, H., Reisli, İ., Energin, M. (2007).Iatrogenıc Vitamin D intoxiciation in infancy: three cases. Marmara Medical Journal, 20(1), 47-51. google scholar CR - Vincentis, S. D., Russo, A., Milazzo, M., Lonardo, A., Santis, M. C. D., Rochira, V. (2021). How Much Vitamin D is Too Much? A Case Re-port and Review of the Literature. Endocrine, Metabolic & Immune Disorders - Drug Targets., 21(9); 1653-1659. google scholar CR - Vural, N. (2005). Toksikoloji. Ankara: Ankara Üniversitesi Eczacılık Fakültesi Yayınları. google scholar CR - World Health Organization (2022). A11CC Vitamin D and Analogues. Re-trieved from https://www.whocc.no/atc_ddd_index/?code=A11CC google scholar CR - World Health Organization (2022). ATC/DDD Index 2022. Re-trieved from https://www.whocc.no/atc_ddd_index/ google scholar CR - Yasar, A., Fırat, F., Özer, I., Özer, S., Erdemir, B. F. (2011). Çocukta İki Taraflı Böbrek Taşının Nadir Bir Nedeni: D Vitamini İntoksikasyonu. Gaziosmanpaşa Üniversitesi Tıp Fakültesi Dergisi, 3(3), 19-23. google scholar CR - Yılmaz, R., Gül, A., Çakan, N., Aydın, A. (2014). 36 Günlük Sütçocuğunda Hipervitaminoz D: Olgu Sunumu Hypervitamin-osis D In An 36 Days Old Infant: A case report. Pediatric Practice and Research, 2(1), 1-4. google scholar UR - https://doi.org/10.26650/IstanbulJPharm.2023.1194407 L1 - https://dergipark.org.tr/en/download/article-file/2730307 ER -