Pattern of co-prescription of silymarin and antidiabetics in outpatient, a population based study

Chan, Agnes L. F.; Leung, Henry W. C.; Tsair-Wei Chien; Shun-Jin Lin
July 2009
Journal of Medicinal Food Plants;Jul2009, Vol. 1 Issue 2, p1
Academic Journal
The aim of this study was to analyze the trend of combined use of silymarin and hypoglycemic drugs (anti-diabetics) by elderly outpatient in 7-year period in Taiwan and assess whether the trends may be in line with the preliminary positive outcome. A systematic review analysis was performed to identify the correlation of silymarin to hypoglycemic drugs. A retrospective and descriptive population based study was then performed by using claim database of the National Health Insurance Research Database, which contains all inpatient and outpatient medical claims of approximately 23 million patients in Taiwan between January 2000 and December 2006. Adult patients aged from 18 years to ≧60 years, who had concurrently prescribed silymarin and antidiabetic drugs at outpatient visit were identified. The prescribing trends were described in terms of prescribing patterns of silymarin monotherapy or combination therapy in each study year. The extents to which the co-prescription of two drugs and the association with patients' characteristics, types of hospitals and co-morbid chronic diseases were assessed and statistically analyzed by SPSS for Windows as well as Many-faceted Rasch Model. A total of 3193049 prescriptions, which included silymarin monotherapy and silymarin-antidiabetics combination therapy, were identified over the 7-year period from 2000 to 2006. The total number of prescription of silymarin monotherapy and silymarin-antidiabetics combination therapy increased from 0.17% (860/515765) in 2000 to 0.76% (2335/ 309053) in 2006 and from 0.01% in 2000 to 0.11% in 2006, respectively. Silymarin combined with antidiabetics were mostly prescribed to patients aged 60 years or older. The proportion of prescriptions with silymarin alone increased about 4 folds from 245 in 2000 to 1022 in 2006, among patients over 60 years old. The number of co-prescriptions prescribed to the same aged patients also increased from 15.49% to 58.8 %. Most prescriptions were prescribed for 28 days. Forty-two percent of the co- prescriptions were prescribed at the same visit. The correlation of co-prescription of silymarin-antidiabetics with patients' characteristics, specialty of prescribing physicians, types of antidiabetics and other cofounders showed statistical significance. Silymarin is widely used in Taiwan and Europe as a hepato-protective drug. As it is able to reduce plasma glucose and pancreatic lipid peroxidation reported by some studies, the increased trends of co-prescription of silymarin and hypoglycemic drugs in elderly population found in this study mayimply that some physicians management of diabetic cirrhotic patients had a positive trends towards the positive preliminary outcome that silymarin reduces insulin resistance. Therefore, patients who want to use silymarin may need to be informed about the possibility of drug interaction in order to reduce therapeutic failure or increased toxicity of conventional drug therapy.


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