Journal of Pharmacoeconomics and Pharmaceutical Management 2015. 1(3/4):56-58.

Economic burden of irrational use of injectable form of Dexamethasone: a warning to health system
Fatemeh Soleymani, Malikeh Haerizadeh, Amir Farshchi


Background: Irrational prescribing of injections is common in Iran. According to the statistics of the National Committee of Rational Use of Drugs (NCRUD), more than 40% of
prescriptions have at least one injectable form, while injectable dosage form of dexamethasone is on the top of the list. Considering the side effects of corticosteroids, the
objective of this study was to investigate the prescribing pattern of dexamethasone in all physicians' prescriptions from 2007 to 2011 in Iran. Method: A cross-sectional
study was carried out on a collection of prescriptions collected from health insurance companies from 2007 to 2011. The inspection was for prescriptions including injectable
form of dexamethasone using special software called Rx Analyst and cost analysis was conducted using NCRUD. Results: Almost 365 million prescriptions were reviewed.
Those prescriptions including at least one injectable form were identified. Among prescriptions including injectable form of medicines, more than 21% had at least one
injectable dosage form of dexamethasone making it the first prescribed medicine by general practitioners. An overall increasing tendency in prescribing pattern and the cost
of injectable dosage form of dexamethasone were evident over the observation period. Prescribing the injectable form of dexamethasone was 12.28% in 2007, 13.11% in
2010 and 12.10% in 2011 by all physicians. All related costs were calculated using governmental prices and finally total costs were adjusted to 2011 fees in USD. Conclusion:
Irrational pattern of prescribing injectable form of dexamethasone was extracted from the results of this study. It seems that general practitioners are trying to substitute
pain relievers’ drugs by injectable dosage form of dexamethasone. Irrational prescriptions of injectable dexamethasone cause not only further costs but also adverse
reactions associated with steroid injections. A robust strategy to promote rational use of medicine is strongly needed to correct the pattern of dexamethasone prescription
in Iran.


Dexamethasone, Drug use pattern, Irrational use of drugs, Cost.

Full Text:



(1) World Health Organization (WHO). Injection safety [online], 2006.

Available from:

(2) World Health Organization (WHO). How to develop and

implement a national drug policy. 2nd ed. 2001.

(3) Iranian Ministry of Health- Department of Pharmaceutical Affairs.

Annual Reports 1996-2003, 2004.

(4) Iranian National Formulary. The medicine hygiene, therapy and

instruction, drug and food assistant, 2010.

(5) Mansoor F. Case definition of traumatic injection neuropathy. .

Pakistan J Med Res. 2004;43(3):1-9.

(6) Central Bank of Iran. 2014. Available from:


(7) Furukawa H. Challenge for preventing medication errors learn

from errors: What is the most effective label display to prevent

medication error for injectable drug? HCI Applications and

Services. 2007;4553:437 - 42.

(8) Iranian Ministry of Health- Food and Drug Organization. Available


(9) Soleymani F, Valadkhani M, Dinarvand R. Challenges and

achievement of promoting rational use of drug in Iran. Iran J

Public Health. 2009;38:166-8.

(10) Karimi A, Haerizadeh M, Soleymani F, Haerizadeh M, Taheri F.

Evaluation of medicine prescription pattern using World Health

Organization prescribing indicators in Iran: A cross-sectional

study. Journal of research in pharmacy practice 2014;3(2):39

(11) Iranian Ministry of Health- Food and Drug Organization. Drug

prescription indexes 2008-2009,2010.

(12) Iranian Ministry of Health- Food and Drug Organization. Drug

prescription indexes, 2006-2007.2008.

(13) Abdollahiasl A, Kebriaeezadeh A, Nikfar S, Farshchi A, Ghiasi G,

Abdollahi M. Patterns of antibiotic consumption in Iran during

-2009. International Journal of Antimicrobial Agents.



  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.