Evaluation of vitamin D prescribing and consumption in Turkiye

Year 2023, , 110 - 117, 30.08.2023

Didem Varımlı , Fatma İşli , Ülkü Ündeğer Bucurgat

https://doi.org/10.26650/IstanbulJPharm.2023.1194407

Abstract

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.

Keywords

Drug, drug consumption, rational drug use, Vitamin D, prescribing

References

• Akılcı İlaç Kullanımı. (2022). Neden Akılcı İlaç Kullanımı. Retrieved from http://www.akilciilac.gov.tr/ google scholar
• Aksoy, M., Alkan, A., İşli, F. (2015). Sağlık Bakanlığı’nın Akılcı İlaç Kullanımını Yaygınlaştırma Faaliyetleri. Türkiye Klinikleri, 3(1), 19-26. google scholar
• 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
• 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
• Balkan, F., Ünal, O. K. (2013). Nadir bir hiperkalsemi sebebi: D vitamini intoksikasyonu. Genel Tıp Dergisi., 23(3), 90-92. google scholar
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• Galior, K., Grebe, S., Singh, R. (2018). Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency. Nutrients, 10(8), 953. google scholar
• 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
• 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
• Holick, M. F. (2007). Vitamin D deficiency. The New England Journal of Medicine , 357(3), 266-81. google scholar
• Holick, M. F. (2009) Vitamin D status: measurement, interpretation, and clinical application. Annals of Epidemiology, 19, 73-78. google scholar
• 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
• Hossein-Nezhad, A., Holick, M. F. (2013). Vitamin D for health: A global perspective. Mayo Clinic Proceedings, 88(7), 720-755. google scholar
• Kara, S., Yıldırım, Baş, F., Öngel, K. (2012). D hipervitaminozu: Olgu sunumu. Türk Aile Hekimliği Dergisi, 16(2), 93-95. google scholar
• Kayaalp O. (2005). Tıbbi Farmakoloji (11th ed). Ankara: Hacettepe-Taş Yayınları. google scholar
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• Taşkesen, M., Gümüş, S., Katar, S. (2009). Latrojenik subklinik D hip-ervitaminozu: Olgu sunumu. Dicle Tıp Dergisi, 36(2),137-139. google scholar
• 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
• 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
• 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
• Türkiye İlaç ve Tıbbi Cihaz Kurumu. (TITCK, 2022b). Küb/Kt Listesi). Retrieved from https://www.titck.gov.tr/kubkt google scholar
• 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
• 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
• 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
• Urbanska, M., tukaszkiewicz, J., Ptudowski, P, Jones, G. (2018). Vitamin D Toxicity-A Clinical Perspective. Frontiers in Endocrinology, 9, 550. google scholar
• 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
• 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
• 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
• Vural, N. (2005). Toksikoloji. Ankara: Ankara Üniversitesi Eczacılık Fakültesi Yayınları. google scholar
• World Health Organization (2022). A11CC Vitamin D and Analogues. Re-trieved from https://www.whocc.no/atc_ddd_index/?code=A11CC google scholar
• World Health Organization (2022). ATC/DDD Index 2022. Re-trieved from https://www.whocc.no/atc_ddd_index/ google scholar
• 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
• 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