Prescribing in Taiwan: insight
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Drug groups for glaucoma
2025 05 05 Owen Yang
Anti-glaucoma prostaglandins analogue (#S01EE)
are used in non-acute glaucoma but not the first line in Taiwan.
For acute angle closure glaucoma Mannitol is likey used in the emergency setting, but in Prescribing in Taiwan there is no specific code for mannitol, and it is under
Blood substitutes and perfusion solutions (#B05).
In acute condition this will be added with
carbonic anhydrase inhibitors (#S01EC),
ocular beta-blocking agents (#S01ED),
and ocular sympathomimetics. They are also used as first few lines of treatment in non-acute glaucoma, and only when insufficient can prostaglandin analogues usually be prescribed.
Note that there are two ATC codes for ocular sympathomemetics,
anti-glaucoma sympathomimics (#S01EA) and
ophthalmological sympathomimetics used as decongestants (#S01GA).
Anti-VEGF for age-related macular degeneration
2025 05 02 Owen Yang
Anti-VEGF ocular injection, under the drug group
Ophthalmological anti-neovascularisation agents (#S01L)
in Prescribing in Taiwan, has been funded under the Taiwan National Health Insurance for age-related macular degenetation since 2011.
It is important to be aware that only up to 14 doses in a lifetime can be funded for each eye, equivalent to approximately 2 years of treatment. Treatment beyond this, if needed, is not funded and therefore unlikely to be recorded.
Anti-VEGF ocular injection can also be used in other diseases such as diabetic macular oedema.
Note that similar anti-VEGF (Bevacizumab) has also been used as an anti-neoplastic agent with ATC code #L01FG under a different drug group
Antineoplastic agents, Monoclonal antibodies and antibody drug conjugates (#L01F)
Indications of Coxibs under the Taiwan National Health Insurance
2025 04 30 Owen Yang
There is a visible increase in the prescribing of
Coxib Drugs (#M01AH)
. Coxibs are indicated under the Taiwan National Health Insurance for individuals at age >60 years with osteoarthritis or individuals at any age with immune arthritis, acute severe trauma, acute stroke or acute coronary artery events, liver cirrhosis, history of peptic ulcer, or use of corticosteroids or anticoagulants.
In 2017 some lower-cost Coxibs can be prescribed additionally for individuals at age >50 years with osteoarthritis.
Reduction of Tubercolusis 肺結核 in Taiwan
2025 04 27 Owen Yang
The
2023 Taiwan Tuberculosis Control Report,
the Tuberculosis incidence rate in Taiwan has decreased from 72.5 cases per 100,000 population in 2005 to 28.2 cases in 2023.
This is also reflected in the reduction of
Single (#J04AK)
and
Combination (#J04AM)
Drugs for Tuberculosis in Prescribing in Taiwan.
Potentially contraversial prescribing-only drugs for cough 咳嗽
2025 04 24 Owen Yang
Cough is notoriously difficult to treat, and in many occasions the over-the-counter medication does not offer desired effect. In Taiwan there have been very high prescribing rates of oral
Selective beta-2-adrenoreceptor agonists (#R03CC)
(mainly procaterol) and
Theophylline and its derivatives (#R03DA).
There has not been official reports of the use and this indication for these drugs that I can identify, but anecdotally we know that some doctors in Taiwan prescribe them for a short period of time simply for cough. There seems to be a subtle trend that fewer patients have been prescribed with these drugs.
Treatment of hepatitis C virus (HIV) C型肝炎 in Taiwan
2025 04 21 Owen Yang
Anti-virals for Hepatitis C virus (HCV) infections (#J05AP)
was initially prescribed under the National Health Insurance since 2003 as an
Interferon (#L03AB)
-based therapy, which can be with or without ribavirin as the main antiviral, and this was only used in patients with evidence of liver fibrosis. In 2017 this was replaced with other high efficacy oral Direct Acting Antivirals for HCV, and is available for anyone who has a detectable level of HCV.
More infomation can be found
here.
Most vaccines 疫苗 are not prescribed under the National Health Insurance in Taiwan
2025 04 18 Owen Yang
Most vaccines are not prescribed under National Health Insurance (NHI) in Taiwan, and therefore not expected to be complete in Prescribing in Taiwan.
The
Influenza Vaccines #J07BB
here does not reflect the immunisation rate in Taiwan, but reflects a short period of time in which some hospitals recorded its use under the NHI, possibly for the convenience of being paid for via the NHI channel.
The
Tetanus Vaccine #J07AM
here reflects the use of this vaccine after injuries.
One in four Taiwanese access dental care for caries 蛀牙 in 2020
2025 04 15 Owen Yang
I was wondering whether the data for
A01 Stomatological preparations for local oral treatment (usually for dental use)
may represent the dental care in Taiwan, but this is likely to be a huge underestimation.
This
report suggests every 1 in 4 people accessed dental care for caries, much much higher than just a few percents seen in this ATC drug group.
Prescribing of dementia drugs 失智藥物
2025 04 12 Owen Yang
The main stream of Antidementia drugs,
Anticholinesterases (or acetylcholinesterase inhibitors [ACEI], #N06DA),
has been around since before 2000, and therefore the increasing of prescribing over time (2005-2020) should mainly reflect the increase in diagnosis and prevalence.
The second line drug, Memantine (#N06DX01), has been classified in Prescribing in Taiwan under another group
Other antidementia drugs (#N06DX),
but this group also includes another drug Ginkgo folium (#N06DX02). They are grouped without we knowing the fact that Ginkgo folium has been precribed for
peripheral artery diseases.
The relatively high prescribing rates and the age distribution of this ATC drug group could be the mix between Ginkgo folium and Memanatin.
This is labelled as one of the hindsights and the two drugs will be treated separately when there is an update of Precribing in Taiwan.
Antivirals available for most with zoster 帶狀皰疹 since 2018/2019
2025 04 09 Owen Yang
The increase in prescribing of
oral antivirals (#J05AB),
mainly acyclovir
, seems to reflect the new availbility for zoster (shingles) for all ages and conditions since 2018/2019.
Prior to this it was only prescribed under the National Health Insurance for immunocompromise individuals or for critical skin areas.
Oral antivirals can also be prescribed for varicella (chicken pox).
Prescribing for Helicobacter pylori 幽門螺旋桿菌 in Taiwan
2025 04 06 Owen Yang
Following the report of a still high Helicobacter pylori prevalence in Taiwan (
28%,
declining), one would expect a high number of eradication therapy.
There has not been mush change of Helicobacter eradication regimes during 2005-2020, typically involving
Amoxicillin (#J01CA04),
Clarithromycin (#J01FA09),
Metronidazole (currently under 'Anti-protozoals', #P01),
and a
Proton-pump inhibitor (#A02BC). There are other indications of these medications, but judging from the prescribing of
Clarithromycin (#J01FA09),
prescribing for this indication may not be high.
Vonoprazon (#A02BC08), a potassium-competitive acid blocker, is a new drug in line to potentially replace PPIs. In Prescribing in Taiwan it will technically be under the same category with PPIs,
but so far it is not prescribed under the National Health Insurance.
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.
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.
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.