Frequency of tetrazepam prescription: estimates for Germany.

Purpose: Authorisation was suspended on 1 August 2013 for tetrazepam-containing medicines. The aim of the study was to assess relevance and pattern of tetrazepam use by estimating the prevalence of prescribing and to analyse prescribing indications and duration. This information is needed to generate baseline data for further evaluation of prescribing muscle relaxants.

Methods: Claims data analysis (Health Insurance Sample AOK Hesse/KV Hesse, 18.75% random sample of insurants from AOK Hesse, Germany).

Study Population: 267 787 insurants continuously insured or deceased in 2011. Prevalence estimates were standardised to the German population. To assess the quantity of prescribed tetrazepam, we applied defined daily dose (DDD) methodology with 125 mg of tetrazepam as 1 DDD. The prescribing indications were analysed with a matched case-control design.

Results: In 2011, 2.6% of the study population received at least one tetrazepam prescription (men, 2.1%; women, 3.0%). The mean prescribed dosage was 15 DDD and increased by age up to 43 DDD in women and 30 DDD in men ≥80 years. The most frequently documented diagnoses were low-back pain (21.3%) and cervicalgia (20.3%). It appeared that the greatest difference in prevalence between tetrazepam recipients and controls was for the diagnosis 'Other specified disorders of muscle' (ICD: M62.8). This diagnosis was five times more prevalent in tetrazepam recipients than in controls.

Conclusion: Tetrazepam was the most widely prescribed muscle relaxant in Germany, hence physicians may seek an alternative after its market withdrawal. However, according to treatment guidelines, muscle relaxants play only a minor role and a multimodal approach should be preferred.