The study of the Ukrainian pharmaceutical market of laxatives

Constipation is one of the most common reasons for visiting a doctor in the world. In different countries every third or fourth adult has constipation continuously or periodically. Laxatives (L) are OTC-drugs. Therefore, to simplify the choice of a laxative by patients, pharmacists and doctors the study of the pharmaceutical market of L is of current interest. Aim. To analyze the pharmaceutical market of laxatives in Ukraine. Material and methods. Data of ATC/DDD-indexes of the WHO Center on methodology of statistical studies of drugs, doses for L recommended by the manufacturer, data on the average retail price of medicines in Ukraine in August 2016 were used in the study. The methods of research were frequency analysis and ATC/DDD-methodology. Results and discussion. As the result of the structural analysis of the ATC classification and the presence of L at the pharmaceutical market of Ukraine it was found that the following drugs of group A06A were available to treat constipation: softeners (emollients), contact L, bulk-forming L, osmotically acting L, L in enemas and other drugs. The frequency analysis showed that there were 18 INN and 76 TN of L at the pharmaceutical market of Ukraine in 2016; among them domestic drugs were 55 %, and foreign – 45 %. Laxatives were supplied in Ukraine by such manufacturing countries as Portugal, Italy, Spain, Poland, France, Germany, India, Netherlands, Bulgaria, Latvia, Russian Federation and United Kingdom. The cost of the defined daily dose (DDD) for softeners (Vaseline oil) ranged from 2.94 to 3.39 UAH. The cost of DDD for contact L was from 0.60 to 3.90 UAH: for bisacodyl – from 0.60 to 2.82 UAH, for castor oil – 2.505.13 UAH, for senna glycosides – 0.84-3.20 UAH, for sodium picosulfate – 1.35-3.90 UAH, for combination of sodium picosulfate with a dry extract of senna leaves – 1.34-1.55 UAH. The cost of DDD of bulk-forming L ranged from 1.75 to 129.03 UAH: for L with Plantago ovata seeds ranged from 3.58 to 28.92 UAH, for laminaria – 1.75-1.97 UAH. The cost of DDD for osmotically acting L varied from 2.51 to 112.59 UAH: for magnesium sulfate – 2.15-2.51 UAH., and the cost for combination of inorganic salts – 112.59 UAH, for macrogol – 51.01 UAH, for lactulose – 3.75-18.74 UAH, for combinations with macrogol – 54,88-127,32 UAH. The cost of DDD for L in enemas varied from 33.39 to 129.03 UAH. The cost of DDD for other drugs for treatment of constipation was from 1.37 to 48.15 UAH: for glycerol – 3.44-36.49 UAH, for pruсalopride – 31.72-48.15 UAH, for others – 1.37-1.49 UAH. Conclusions. In 2016 there were 18 INN and 76 TN of laxatives at the pharmaceutical market of Ukraine; drugs of domestic manufacture prevailed, the ratio between domestic and foreign drugs was 1.2 : 1. The cost of DDD for L in the context of the minimum and maximum cost of generics ranged from 0.60 tо 129.03 UAH.


Ключевые слова: запор; слабительные лекарственные средства; стоимость средней суточной дозы; АТС/DDD-методология
Constipation is a chronic problem for many people in the world.Treatment of constipation is complex and requires the use of laxatives (L) [1][2][3].It is very important to study the diversity of the pharmaceutical market of L by manufacturers, international nonproprietary names (INN), trade names (TN), and prices.Thus, to simplify the choice of a laxative by patients, pharmacists and doctors the study of the pharmaceutical market of L is of current interest [4].In works of V. Iakovenko (2011), K. Shchokina (2007) the results of marketing analysis of L and peculiarities of pharmacotherapy of constipation were given.But this study complements and deepens the previous studies of the problem in Ukraine [4][5][6][7].
The aim of the study was to analyze the pharmaceutical market of L in Ukraine.

Materials and Methods
Data of ATC/DDD-indexes of the WHO Center on methodology of statistical studies of drugs, doses for L recommended by the manufacturer, data on the average retail price of medicines in Ukraine in August 2016 were used in the study.The methods of research were frequency analysis and ATC/DDD-methodology providing the study of the cost of the defined daily dose (DDD) [8].DDD was determined according to the WHO data.DDDs of L that were not determined by the WHO were calculated as the average dose recommended by the manufacturer.

Results and Discussion
The frequency analysis of the presence of L at the pharmaceutical market of Ukraine by INN and TN, manufacturing countries in 2016 was performed on the basis of data of "Apteka" (Pharmacy) weekly journal.The weighted average retail value for L in Ukraine was calculated as of August, 2016.
As the result of the structural analysis of the ATC classification and the presence of L at the pharmaceutical market of Ukraine it was found that the following drugs of group A06A were available to treat constipation: softeners (emollients), contact L, bulk-forming L, osmotically acting L, L in enemas and other drugs.
The frequency analysis showed that there were 18 INN and 76 TN of L at the pharmaceutical market of Ukraine in 2016; among them domestic drugs were 55 %, and foreign drugs -45 % (Fig. 1).
Laxatives were supplied in Ukraine by such manufacturing countries as Portugal, Italy, Spain, Poland, France, Germany, India, Netherlands, Bulgaria, Latvia, Russian Federation and United Kingdom (Fig. 2).
The group of softeners (emollients) (A06A A) was represented with Vaseline oil at the pharmaceutical market of Ukraine in 2016.The recommended DDD was 15 ml.The cost of DDD for Vaseline oil ranged from 2.94 to 3.39 UAH (Таb.1).The group of contact L (A06A B) consisted of 5 INN and 33 TN at the pharmaceutical market of Ukraine in 2016 (Таb.2).
The cost of DDD for contact L was from 0.60 to 3.90 UAH: for bisacodyl -from 0.60 to 2.82 UAH, for castor oil -2.50-5.13UAH, for senna glycosides -0.84-3.20 UAH, for sodium picosulfate -1.35-3.90UAH, for combination of sodium picosulfate with a dry extract of senna leaves -1.34-1.55UAH.
The group of bulk-forming L (A06A C) consisted of 2 INN and 4 TN at the pharmaceutical market of Ukraine in 2016 (Таb.3).
The cost of DDD of bulk-forming L ranged from 1.75 to 129.03 UAH: for L with Plantago ovata seeds ranged from 3.58 to 28.92 UAH, for laminaria -1.75-1.97UAH.
The group of osmotically acting L (A06A D) consisted of 5 INN and 13 TN at the pharmaceutical market of Ukraine in 2016 (Таb.4).
The group of L in enemas (A06A G) was represented with docusate sodium and combinations of sodium di-hydrogen phosphate dihydrate and sodium hydrogen phosphate dodecahydrate (Таb.5).
The cost of DDD for L in enemas varied from 33.39 to 129.03 UAH.The group of other L (A06A X) was represented with glycerol, prucalopride and various LM (Таb.6).

Fig. 1 .
Fig. 1.The ratio of domestic and foreign manufacturers of laxatives at the pharmaceutical market of Ukraine in 2016.

Fig. 2 .
Fig. 2. The ratio of manufacturing countries of laxatives at the pharmaceutical market of Ukraine in 2016.

Table 1
The group of softeners (emollients)

Table 3
The group of bulk-forming L Notes: * -DDDs of L that were not determined by the WHO.

Table 4
The group of osmotically acting L Notes: * -DDDs of L that were not determined by the WHO.

Table 5
The group of L in enemas Notes: * -DDDs of L that were not determined by the WHO.

Table 6
The group of other L