title: Prescribing patterns of the four most commonly used sedatives in endoscopic examination in Korea: propofol, midazolam, diazepam, and lorazepam.
abstract: As the sedative use increases due to the effectiveness and relatively safe profile, the abuse potential is also increasing. This study was conducted to examine the usage of four sedative agents in endoscopic examination and to compare the propofol use with the other three sedatives. Using National Health Insurance claims data from 2008 to 2012, we identified the number of cases of conscious sedation during endoscopy using one or more of the following agents: propofol, midazolam, diazepam, and lorazepam. The general characteristics of patients and medical service providers were analyzed, and the regional and annual distributions of frequency of use were compared. We also identified patient cases with excessive number of endoscopic examinations. Among the total of 3,156,231 sedatives users, midazolam was the most commonly used agent (n=2,845,250, 90.1%). However, the largest increase in patient number, which increased from 11,410 in 2008 to 28,170 in 2012, was observed with propofol. While the majority of patients received an annual endoscopy, we identified several suspected abuse cases of patients receiving endoscopies repetitively as many as 114 times in five years. The rise of sedative use in endoscopic examinations and several patient cases of repeated sedative administration suggest a potential risk for abuse. Medical service providers should be cautious when using sedatives and carefully review each patient's medical history prior to the procedure.
authors: Korea Institute of Drug Safety and Risk Management (KIDS), 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea.
authors: Ju-Young
authors: JY
authors: Shin
authors: Korea Institute of Drug Safety and Risk Management (KIDS), 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea.
authors: Shin Haeng
authors: SH
authors: Lee
authors: Korea Institute of Drug Safety and Risk Management (KIDS), 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea.
authors: Sun Mi
authors: SM
authors: Shin
authors: Korea Institute of Drug Safety and Risk Management (KIDS), 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea.
authors: Mi Hee
authors: MH
authors: Kim
authors: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyeong-dong, Jongno-gu, Seoul 110-746, Republic of Korea.
authors: Sung Geon
authors: SG
authors: Park
authors: Korea Institute of Drug Safety and Risk Management (KIDS), 136 Changgyeonggung-ro, Jongno-gu, Seoul 110-750, Republic of Korea; Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea. Electronic address: bjpark@snu.ac.kr.
authors: Byung-Joo
authors: BJ
authors: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003975:Diazepam / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D004724:Endoscopy / Q000639:trends*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use*; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000209:etiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D008140:Lorazepam; D003975:Diazepam; D008874:Midazolam; D015742:Propofol
keywords: Abuse; Diazepam; Endoscopic examination; Lorazepam; Midazolam; Propofol; Sedatives