Prescribing Patterns and Guideline Adherence for Meperidine Use in Taiwan

The use of meperidine (Pethidine or Demerol), a Schedule II narcotic analgesic in Taiwan, has become a relevant issue for its high potential of iatrogenic addiction. Evidence has showed that the analgesic potency of meperidine was considered high falsely, with the little-to-none therapeutic advantage offering over other opioid analgesic prescriptions. The long half-life of its neurotoxic metabolite produces severe adverse effects such as anxiety, spasms, and seizure attacks, especially in patients with failure kidney function and elderly. Its euphoria effect increases the risk of addition. Many clinical practice guidelines have been released to decrease its prescription and first-line use in pain management in multiple countries. Taiwan Food and Drug Administration also released its guideline on the use for meperidine in 2011, and the descending trend of meperidine use in Taiwan is similar to the global pattern. However, it is still common practice to prescribe meperidine as the first-line choice in many clinical settings. Studies are warranted to understand the adherence of meperidine practice guideline and prescribing pattern in Taiwan. The present study is aimed for evaluating the meperidine prescribing patterns and adherence rate to clinical practice guidelines in Taiwan by both qualitative and quantitative methods. For qualitative approach, literature review with textual analysis will be used to find evident items to assess from clinical practice guidelines. For quantitative approach, the study will analyze from the Longitudinal Health Insurance Database 2005 (LHID2010) from 2005 to 2014 to evaluate: (1) trend, characteristics and indications, duration of use, dosing of meperidine in Taiwan; and (2) the adherence and difference of meperidine prescribing pattern after the introduction of meperidine practice guideline in 2011. Predictors of meperidine prescribing will be also analyzed by using multi-variate logistic regression model. The result of this study will be expected to level the medicine management in Taiwan with international standard, and become reference for policy making in the future.