Utilización del propacetamol en un hospital de tercer nivel. Actuaciones derivadas de su estudio

Propacetamol is a hydrosoluble prodrug from paracetamol that belongs to the pharmacologic group of paraaminophenols, which is authorized in Spain for its use in the treatment of postoperative pain. Objective: 1) To know the conditions for the use of propacetamol in our hospital and to estimate the extra expenditure derived from the misuse of it after an overall initial analysis. 2) To know the impact per services that a lack of supply of Proefferalgan® could have in order to obtain some parameters of action to minimize its effect. 3) To elaborate a detailed report with the purpose of facilitating the establishment of protocols for the use of propacetamol in moderate-to-severe postoperative pain by the Commission on Pharmacy and Therapeutics. Method: In a prospective manner, all the pharmacotherapeutic prescriptions from patients entered in the hospitalization floors between January 16th and February 16th, 2002 were analyzed. All the data were gathered from the pharmacologic treatment sheet, the medical notes and the nursing staff notes. Alongside, a survey took place among the floors' nursing staff about propacetamol and metamizol magnesium. Results: The number of analyzed treatments was 65 and the doses of 1g-propacetamol administrated were 476. The most frequent purpose of prescription was fever (81.5%), followed by pain (15.4%) and concomitant fever and pain (3.1%). In 80% of patients the oral pathway was available at the moment when propacetamol was patterned. Only 1.3% of the doses administrated within the period of study were patterned for postoperative pain. The cost of the 476 doses of 1g-propacetamol administrated was 329 (54,740 PTA), from which only 4.14 (688.8 PTA) belonged to the 6 doses of propacetamol administrated for the approved indication. 81.2% of the surveyed nursing staff were of the opinion that in order to diminish the fever, the endovenous metamizol magnesium is more efficient than propacetamol. Conclusions: At our center propacetamol is widely used for non-authorized indications. The prescription of oral paracetamol, in cases where the oral pathway was available, and of intravenous metamizol magnesium, when it was not available, instead of patterned propacetamol for non-approved indications, could have supposed savings of 319.90 (53,226.88 PTA) per month or 3,839.00 (638,755.85 PTA) per year. The presentation of a report to the Commission on Pharmacy and Therapeutics originated the creation of protocols for its use