The Utilization of Non-Essential Medicines in the Treatment of Ischemic Stroke in Indonesian Hospitals
Keywords:
Ischemic stroke, non-essential medicines, prescribing, hospital
Abstract
Stroke ranks as the second leading cause of mortality and the third leading cause of disability on a global scale. This has a significant impact, especially in developing countries, places a considerable financial burden on healthcare services, including medicine expenses. Prescribing more generic and essential medicines lowers costs, but prescribing many medicines directly increases overall medication expenses. This study aims to identify commonly prescribed non-essential medicines by internists and neurologists for patients with ischemic stroke. The study adopts a cross-sectional approach, utilizing both quantitative and qualitative methodologies. It involves individuals diagnosed with ischemic stroke. Quantitative data collection encompasses patient characteristics, length of hospitalization, prescribing patterns, secondary diagnoses, number and names of consumed medicines, and therapeutic classes. Retrospectively collected data gained from medical records and admission records between January and September 2019, with a maximum sample size of 30 patients. Qualitative data is obtained through in-depth interviews with internal medicine specialists and neurologists to understand their prescribing practices. The five most prescribed non-essential medicines by specialists in internal medicine and neurology are citicoline, mecobalamin, piracetam, herbal mixtures, and insulin analogs. The use of non-essential medicines aims to achieve enhanced therapeutic effects, expedite post-stroke recovery, and address cognitive impairment and speech difficulties.
References
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Kristin, E., Dinarti, L. K., Febrinasari, R., Pratiwi, W. R., Yasmina, A., & Jaya, S. I. (2023). Persistence to Antihypertensive and Clinical Outcomes in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention. Indonesian Journal of Pharmacy, 34(3), 482–490.
Li, Y., Zheng, J., Zhu, Y., Qu, Y., Suo, R., & Zhu, Y. (2021). Neuroprotective effects of methylcobalamin in cerebral ischemia/reperfusion injury through activation of the ERK1/2 signaling pathway. International Immunopharmacology, 99. https://doi.org/10.1016/j.intimp.2021.108040
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Minalloh, R. H., Machin, A., Mardiana, W., Suansanae, T., Chulavatnatol, S., & Nathisuwan, S. (2022). Pre-Hospital and In-Hospital Delay in Acute Ischemic Stroke Patients in Indonesia: A Multi-center Study. Indonesian Journal of Pharmacy, 33(2), 299–306.
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Ministry of Health of the Republic of Indonesia. (n.d.-c). Decree of the Minister of Health Number HK.01.07 /MENKES/688/2019 Regarding the National Essential Drug List 2019. 2019.
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Mosawi, A. Al. (2020). Recent Uses of Piracetam in Pediatric Neurology. SunKrist Neurology, Neurosurgery and Stroke Journal, 2(1), 1–5. https://doi.org/10.46940/snnsj.02.1002
Norouzi, S., Jafarabadi, M. A., Shamshirgaran, S. M., Farzipoor, F., & Fallah, R. (2021). Modeling survival in patients with brain stroke in the presence of competing risks. Journal of Preventive Medicine and Public Health, 54(1), 55–62. https://doi.org/10.3961/JPMPH.20.463.
Ospel, J., Singh, N., Ganesh, A., & Goyal, M. (2023). Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care. Journal of Stroke, 25(1), 16–25. https://doi.org/10.5853/jos.2022.04077.
Overgaard, K. (2014). The effects of citicoline on acute ischemic stroke: A review. Journal of Stroke and Cerebrovascular Diseases, 23(7), 1764–1769. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.020.
PINZON, R., & SANYASI, R. (2018). Is There Any Benefit of Citicoline for Acute Ischemic Stroke ? Systematic Review of Current Evidences. Journal of Critical Reviews, 5(3), 11–14. https://doi.org/10.22159/jcr.2018v5i3.24568.
Puspitasari, A. D., Salean, D. D. C., Hasmono, D., Hartono, R., & Ardiana, M. (2021). A study of anticoagulant therapy in patients with coronary artery disease. Journal of Basic and Clinical Physiology and Pharmacology, 32(4), 473–478. https://doi.org/10.1515/jbcpp-2020-0486.
Rumi, A., Atthobari, J., Pinzon, R., & Nugroho, A. E. (2014). Predictors of unachieved LDL levels in ischemic stroke patients treated with statins in Yogyakarta Indonesia. Journal of Applied Pharmaceutical Science, 4(4), 97–102. https://doi.org/10.7324/JAPS.2014.40417.
Singh, Mannat M and Parsekar, Shradha S and Ravishankar, N and Nair, S. N. (2015). Disabilities caused due to stroke. International Journal of Advanced Research. International Journal of Advanced Research, 3(5), 328-31.
Specialists, A. of N. (2016). Reference Guide for Clinical Practice in Neurology.
Venkateswaramurthy, N., Krishnaveni, K., Mercy Freeda, R., & Sambath Kumar, R. (2016). Assessment of potential drug–drug interaction in stroke patients. International Journal of Pharmacy and Pharmaceutical Sciences, 8(12), 221–224. https://doi.org/10.22159/ijpps.2016v8i12.13878
Vyas, M. V., Silver, F. L., Austin, P. C., Yu, A. Y. X., Pequeno, P., Fang, J., Laupacis, A., & Kapral, M. K. (2021). Stroke Incidence by Sex Across the Lifespan. Stroke, 52(2), 447–451. https://doi.org/10.1161/STROKEAHA.120.032898
Yuniar, Y., Handayani, R. S., Prayitno, L., Leny, A., & Susyanty. (2023). Medicines Cost Analysis for Inpatient Ischemic Stroke in Indonesia. Proceedings of the 1st International Conference for Health Research – BRIN (ICHR 2022), 1, 611–620. https://doi.org/10.2991/978-94-6463-112-8_56
Zhang, J., Wei, R., Chen, Z., & Luo, B. (2016). Piracetam for Aphasia in Post-stroke Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. CNS Drugs, 30(7), 575–587. https://doi.org/10.1007/s40263-016-0348-1
Aleksic, D. Z., Jankovic, S. M., Mlosavljevic, M. N., Toncev, G. L., Miletic Drakulic, S. D., & Stefanovic, S. M. (2020). Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit. Open Medicine (Poland), 14(1), 813–826. https://doi.org/10.1515/med-2019-0093
Alvarez-Sabín, J., Ortega, G., Jacas, C., Santamarina, E., Maisterra, O., Ribo, M., Molina, C., Quintana, M., & Román, G. C. (2013). Long-term treatment with citicoline may improve poststroke vascular cognitive impairment. Cerebrovascular Diseases, 35(2), 146–154. https://doi.org/10.1159/000346602
Basuliman, A. S., Malabarey, M. A., Abousamak, F. W., Alyousef, B. Y., Alrabea, S. S., Alshabibi, R. A., & Aseri, Z. A. A. (2023). Predictive value of triglycerides to high density lipoprotein ratio in patients with first attack of acute coronary syndrome. Saudi Medical Journal, 44(4), 379–384. https://doi.org/10.15537/smj.2023.44.4.20220928
Bettger, J. P., & Cadilhac, D. A. (2022). Stroke Care Costs and Cost-Effectiveness to Inform Health Policy. Stroke, 53(6), 2078–2081. https://doi.org/10.1161/STROKEAHA.122.037451
Blumberg, J. B., Cena, H., Barr, S. I., Biesalski, H. K., Dagach, R. U., Delaney, B., Frei, B., Moreno González, M. I., Hwalla, N., Lategan-Potgieter, R., McNulty, H., van der Pols, J. C., Winichagoon, P., & Li, D. (2018). The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report. Clinical Therapeutics, 40(4), 640–657. https://doi.org/10.1016/j.clinthera.2018.02.014
Boehme, A. K., Esenwa, C., & Elkind, M. S. V. (2017). Stroke Risk Factors, Genetics, and Prevention. Circulation Research, 120(3), 472–495. https://doi.org/10.1161/CIRCRESAHA.116.308398
BPJS Kesehatan. (2020). INFO BPJS Edisi 104. BPJS Kesehatan, 6–9.
Eledrisi, M. (2020). Insulin analogs versus human insulins for the management of diabetes: An evidence-based review. Libyan Journal of Medical Sciences, 4(4), 164. https://doi.org/10.4103/ljms.ljms_96_20
Gareri, P., Castagna, A., Cotroneo, A. M., Putignano, S., De Sarro, G., & Bruni, A. C. (2015). The role of citicoline in cognitive impairment: Pharmacological characteristics, possible advantages, and doubts for an old drug with new perspectives. Clinical Interventions in Aging, 10, 1421–1429. https://doi.org/10.2147/CIA.S87886
Göz, E., Kahraman, T., Genç, A., Kaya, Ö., Öztürk, V., & Kutluk, K. (2017). Akut inme hastalarinda hastanede kaliş süresini etkileyen etkenler. Journal of Neurological Sciences, 34(2), 143–152. https://doi.org/10.24165/jns.9472.16
Haque, M., Islam, S., Abubakar, A. R., Sani, I. H., Opanga, S., Kamal, Z. M., Akter, F., & Godman, B. (2021). Utilization and expenditure on long-acting insulin analogs among selected middle-income countries with high patient co-payment levels: Findings and implications for the future. Journal of Applied Pharmaceutical Science, 11(7), 172–182. https://doi.org/10.7324/JAPS.2021.110720
Hasan, M., Atiqur-Rahman, M., Chowdhury, S., Esteak, T., Naznin, J., & Shahi, M. S. (2023). Efficacy and Safety of Analog Insulin in Comparison With Human Insulin for Hyperglycemia in Hospitalized Patients With Acute Stroke: A Randomized, Open-Label, Single-Center Trial. Endocrine Practice, 29(1), 18–23. https://doi.org/10.1016/j.eprac.2022.10.180
Jasielski, P., Piędel, F., Piwek, M., Rocka, A., Petit, V., & Rejdak, K. (2020). Application of citicoline in neurological disorders: A systematic review. Nutrients, 12(10), 1–20. https://doi.org/10.3390/nu12103113
Julio J. Secades, P. G. (2022). Citicoline: pharmacological and clinical review, 2022 update. Rev Neurol, 75(Supl X), SX-SX. https://doi.org/10.33588/rn.75S05.2022311.
Kristin, E., Dinarti, L. K., Febrinasari, R., Pratiwi, W. R., Yasmina, A., & Jaya, S. I. (2023). Persistence to Antihypertensive and Clinical Outcomes in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention. Indonesian Journal of Pharmacy, 34(3), 482–490.
Li, Y., Zheng, J., Zhu, Y., Qu, Y., Suo, R., & Zhu, Y. (2021). Neuroprotective effects of methylcobalamin in cerebral ischemia/reperfusion injury through activation of the ERK1/2 signaling pathway. International Immunopharmacology, 99. https://doi.org/10.1016/j.intimp.2021.108040
Lin, K. H., Lin, H. J., & Yeh, P. S. (2022). Determinants of Prolonged Length of Hospital Stay in Patients with Severe Acute Ischemic Stroke. Journal of Clinical Medicine, 11(12), 0–7. https://doi.org/10.3390/jcm11123457
Martí-Carvajal, A. J., Valli, C., Martí-Amarista, C. E., Solà, I., Martí-Fàbregas, J., & Bonfill Cosp, X. (2020). Citicoline for treating people with acute ischemic stroke. Cochrane Database of Systematic Reviews, 2020(8). https://doi.org/10.1002/14651858.CD013066.pub2
Minalloh, R. H., Machin, A., Mardiana, W., Suansanae, T., Chulavatnatol, S., & Nathisuwan, S. (2022). Pre-Hospital and In-Hospital Delay in Acute Ischemic Stroke Patients in Indonesia: A Multi-center Study. Indonesian Journal of Pharmacy, 33(2), 299–306.
Ministry of Health of the Republic of Indonesia. (n.d.-a). Decree of the Minister of Health Number HK.01.07/MENKES/394/2019 Regarding the National Guidelines for Stroke Medical Services. 2019.
Ministry of Health of the Republic of Indonesia. (n.d.-b). Decree of the Minister of Health Number HK.01.07/MENKES/813/2019 Regarding the National Formulary. 2019.
Ministry of Health of the Republic of Indonesia. (n.d.-c). Decree of the Minister of Health Number HK.01.07 /MENKES/688/2019 Regarding the National Essential Drug List 2019. 2019.
Ministry of Health of the Republic of Indonesia. (n.d.-d). National Basic Health Research. 2018.
Ministry of Health of the Republic of Indonesia. (2019a). Decree of the Minister of Health Number HK.01.07/MENKES/813/2019 Regarding the National Formulary.
Ministry of Health of the Republic of Indonesia. (2019b). Decree of the Minister of Health Number HK.01.07/MENKES/813/2019 Regarding the National Formulary.
Mosawi, A. Al. (2020). Recent Uses of Piracetam in Pediatric Neurology. SunKrist Neurology, Neurosurgery and Stroke Journal, 2(1), 1–5. https://doi.org/10.46940/snnsj.02.1002
Norouzi, S., Jafarabadi, M. A., Shamshirgaran, S. M., Farzipoor, F., & Fallah, R. (2021). Modeling survival in patients with brain stroke in the presence of competing risks. Journal of Preventive Medicine and Public Health, 54(1), 55–62. https://doi.org/10.3961/JPMPH.20.463.
Ospel, J., Singh, N., Ganesh, A., & Goyal, M. (2023). Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care. Journal of Stroke, 25(1), 16–25. https://doi.org/10.5853/jos.2022.04077.
Overgaard, K. (2014). The effects of citicoline on acute ischemic stroke: A review. Journal of Stroke and Cerebrovascular Diseases, 23(7), 1764–1769. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.01.020.
PINZON, R., & SANYASI, R. (2018). Is There Any Benefit of Citicoline for Acute Ischemic Stroke ? Systematic Review of Current Evidences. Journal of Critical Reviews, 5(3), 11–14. https://doi.org/10.22159/jcr.2018v5i3.24568.
Puspitasari, A. D., Salean, D. D. C., Hasmono, D., Hartono, R., & Ardiana, M. (2021). A study of anticoagulant therapy in patients with coronary artery disease. Journal of Basic and Clinical Physiology and Pharmacology, 32(4), 473–478. https://doi.org/10.1515/jbcpp-2020-0486.
Rumi, A., Atthobari, J., Pinzon, R., & Nugroho, A. E. (2014). Predictors of unachieved LDL levels in ischemic stroke patients treated with statins in Yogyakarta Indonesia. Journal of Applied Pharmaceutical Science, 4(4), 97–102. https://doi.org/10.7324/JAPS.2014.40417.
Singh, Mannat M and Parsekar, Shradha S and Ravishankar, N and Nair, S. N. (2015). Disabilities caused due to stroke. International Journal of Advanced Research. International Journal of Advanced Research, 3(5), 328-31.
Specialists, A. of N. (2016). Reference Guide for Clinical Practice in Neurology.
Venkateswaramurthy, N., Krishnaveni, K., Mercy Freeda, R., & Sambath Kumar, R. (2016). Assessment of potential drug–drug interaction in stroke patients. International Journal of Pharmacy and Pharmaceutical Sciences, 8(12), 221–224. https://doi.org/10.22159/ijpps.2016v8i12.13878
Vyas, M. V., Silver, F. L., Austin, P. C., Yu, A. Y. X., Pequeno, P., Fang, J., Laupacis, A., & Kapral, M. K. (2021). Stroke Incidence by Sex Across the Lifespan. Stroke, 52(2), 447–451. https://doi.org/10.1161/STROKEAHA.120.032898
Yuniar, Y., Handayani, R. S., Prayitno, L., Leny, A., & Susyanty. (2023). Medicines Cost Analysis for Inpatient Ischemic Stroke in Indonesia. Proceedings of the 1st International Conference for Health Research – BRIN (ICHR 2022), 1, 611–620. https://doi.org/10.2991/978-94-6463-112-8_56
Zhang, J., Wei, R., Chen, Z., & Luo, B. (2016). Piracetam for Aphasia in Post-stroke Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. CNS Drugs, 30(7), 575–587. https://doi.org/10.1007/s40263-016-0348-1
Published
2025-11-18
How to Cite
Handayani, R. S., Siahaan, S., Agus, T. P., Hendarwan, H., Hasugian, A. R., Raharni, R., Isakh, B. M., Prihatini, N., & Manik, C. G. (2025). The Utilization of Non-Essential Medicines in the Treatment of Ischemic Stroke in Indonesian Hospitals. Indonesian Journal of Pharmacy. https://doi.org/10.22146/ijp.19714
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