Korea’s DUR fails to contraindicate antiemetic in Parkinson’s
The recent conviction of a Korean doctor for prescribing metoclopramide, an antiemetic, to a Parkinson’s disease patient has exposed the failure of the nation’s Drug Utilization Review system to contraindicate metoclopramide with Parkinson’s disease treatments like levodopa.
Korea Biomedical Review has learned that the DUR, designed to check for contraindicated medications, did not warn against prescribing metoclopramide to patients with Parkinson's disease.
Although the Ministry of Food and Drug Safety (MFDS) has banned metoclopramide for use in these patients, this restriction was not reflected in the DUR system.
“Even if the patient hadn't told the doctor he had Parkinson's, it would have made a difference if the DUR had warned the doctor that metoclopramide was contraindicated with Parkinson's medications,” a primary practitioner at a clinic said. “Furthermore, metoclopramide is the only medication that can be prescribed for vomiting and nausea, with health insurance coverage”
Recently, the Changwon District Court convicted a doctor for causing adverse reactions in a Parkinson’s disease patient after prescribing metoclopramide.
After the ruling, the Health Insurance Review and Assessment Service (HIRA) said it considered updating the DUR system. Including Parkinson's disease medications in the list of contraindicated drugs for metoclopramide combinations could enable the DUR to warn against prescribing both drugs together. In response, the HIRA suggested that the MFDS should take action.
"When the MFDS notifies us of contraindicated drugs, we reflect the information in the DUR system," said a HIRA official. "Currently, Parkinson's disease drugs and metoclopramide are not contraindicated (in the DUR system)," he said.
"We have requested the MFDS to review and reflect the idea of including Parkinson's disease drugs as contraindicated drugs in combination with metoclopramide due to the recent court ruling.”
In the long term, HIRA is also looking to link the DUR to provide information such as contraindicated medications by condition.
"By law, the DUR is limited to the medications you're taking, it doesn't match up with medications you've taken in the past," the HIRA official said. "It doesn't capture all of the information about what conditions you have had."
The MFDS said it would review updating the DUR.
"In principle, the designation of DUR combination contraindications is based on a comprehensive review of domestic and foreign licenses, other literature, and expert advice," said an MFDS official.
"Even if a drug has an upgraded contraindication in its license, not all of them are reflected in the DUR."
The ministry plans to review the need for a DUR designation for the combination of metoclopramide and levodopa and dopamine agonists," he said.