Prescribing in Taiwan: insight
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Discrepancy in ATCs for gabapentinoids between Taiwan and the WHO
Update 2025 04 02 Owen Yang
Since its approval in the US in 1999, Levetiracetam gradually gained its place into clinical medicine, from being the first-line focal seizure and an adjunctive tonic-clonic seizure therapy, to the first-line treatment for
more refractory or maintanence medication for status epilepticus. A
recent report also suggest a substantial use of Levetiracetam in Taiwan.
In Prescribing in Taiwan, Levetiracetam is grouped under
Other anti-epileptics (Oral, Injections) (#N03AX)
, which includes levetiracetam, lamotrigine, but also gabapentin and pregabalin that could be used in seizure but more for pain. Different from this Taiwan source, in the updated WHO ATC there is a separate category for gabapentinoid (#N02BF) and the old category #N03AX does not include gabapentinoids.
It is probably better to separate these drugs in future updates, but for now this drug group has included a few drugs together and all could be of separate interest.
High prescribing rates of systemic corticosteroids 全身性類固醇 in Taiwan
2025 04 03 Owen Yang
The high prescribing rate of
systemic corticosteroid (#H02AB)
in Taiwan, near 20% in all ages, has been
reported in CTS in 2023
. This is reported to be substantially higher than the US (7%) and Denmark (2%), and possibly mainly driven by short-term prescribing in otherwise healthy individuals.
I think this difference is higher than what could be explained by most demographic-driven disease prevalence, and most likely linked to the practice and patient expectation in Taiwan.
Aspirin 阿斯匹靈 is not an OTC drug in Taiwan
2025 03 28 Owen Yang
Unlike most other countries, aspirin is not an OTC drug in Taiwan and has never been a major drug for non-cardiac use. This makes it interesting to look at prescribing of
Aspirin (or Acetylsalicylic acid #B01AC06)
in Taiwan because aspirin use would probably be almost all captured in the Taiwan Health Databases. The practice in Taiwan largely follows the guidelines released by the US (ACC/AHA),
and so there could be some discretionary use for primary prevention in middle age. It is not possible to know how much it is by simply looking at the analysis here.
Note that there is another ATC drug category in Prescribing in Taiwan for
Aspirin in combination with anti-platelets (#B01AC30)
but comparably they are very rarely prescribed.
Iron supplementation 鐵劑
2025 03 25 Owen Yang
Iron deficiency is not uncommon in younger women during reproductive ages when menstruation periods are the main reason of losing blood and losing iron.
Iron deficiency can also be seen in older ages with increasing co-morbidities and polypharmacies that could lead to iron deficiency.
The Prescribing in Taiwan reflects this well in iron supplement, or
Iron preparations (#B03A).
However, iron supplement can be obtained over the counter (OTC) and commonly seen in health products marketing towards women in Taiwan, and therefore the prescribing rates here may not reflect the true level of iron supplementation.
Changing precribing rates in psoriasis 乾癬 medications in Taiwan
2025 03 22 Owen Yang
The recorded prevalence of psoriasis in Taiwan, or perhaps in Asia in general, is extremely low compared to other countries (also see
here
). In the Prescribing in Taiwan analysis, the use of
Antipsoriatics (#D05)
has decreased in the 2010s. It looks to me that the prescribing rates in the 2015 and 2020, below 1%, reflect the true recorded prevalence of psoriasis more accurately.
There could have been other indications or older uses of these medications prior to 2010.
Phasing out of Allopurinol for gout 痛風 in Taiwan
2025 03 19 Owen Yang
A BMJ report in 2015
confirmed that near 20% of Taiwanese carry HLA-B*58:01, a genetic variant associated with allopurinol-induced severe cutaneous adverse reactions (SCARs).
This has caused the shifting of prescribing medication for gout from
Allopurinol (#M04AA01)
to
Febuxostat (#M04AA03)
in the 2010s.
How many people do we expect to receive tetanus vaccine 破傷風疫苗 in a typical year?
2025 03 16 Owen Yang
Tetanus vaccine (#J07AM) is used to prevent tenanus when there is open wound. Although tetanus vaccine is also a component in routine childhood vaccine, the childhood vaccine is not expected to be recorded in the National Health Insurance becauese it belongs to a different reimbursement scheme.
Therefore, the tetanus vaccine recorded in the Taiwan National Health Insurance should mainly be presribed from the tetanus prevention after injury.
In the Prescribing in Taiwan analysis we found at least 1 in 20 teenagers or adults were prescribed tetanus vaccine each year (see
graph
here). I do not know what to expect, but this rate is really higher than I could have imagined.
there is also a consistent age gap, higher in males and lower in females, receiving tetanus vaccine across all of these age groups. This could be due to gender roles but I find it interesting how consistent the age gap is to the entire age range.
Why are the contraception drugs 避孕藥 not prescribed in Taiwan?
2025 03 13 Owen Yang
The main contraception drugs, according to the Prescribing in Taiwan classification system, should have been under #G02B (intrauterine) and #G03AA (fixed combined), #G03AB (sequential combined), and
#G03AC (progestgens only). However, contraception for typical use has not been prescribed under the National Health Insurance in Taiwan, and so it is not recorded in its database. The number here therefore does not reflect the actual use of contraception in Taiwan.
What is Bromelain 鳳梨酵素? The rise of Bromelain use in Taiwan
2025 03 10 Owen Yang
Bromelain 鳳梨酵素 is approved in the European Union for the debridement in conditions like severe burn. In Taiwan we see high prescribing rate of medication with shared drug code (ATC #M09AB). In 2020 it has been precribed in >10% of young adults in their age 20s and 30s
(see
graph
here.)
Bromelain is derived from pineapples and is manufactured in a few countries including Taiwan and is prescribed for breaking up phlegm.