Review of medicine utilization for Parkinson’s disease management: the Bulgarian perspective

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  • Zornitsa Mitkova
    Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Bulgaria.
  • Maria Kamusheva
    Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Bulgaria.
  • Dobrinka Kalpachka
    Department of Neurology, “Saint Anna” Hospital, Sofia , Bulgaria.
  • Desislava Ignatova
    Department of Psychiatry and Medical Psychology, Medical University of Sofia, Bulgaria.
  • Konstantin Tachkov
    Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Bulgaria.
  • Guenka Petrova
    Department of Organisation and Economy of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Bulgaria.


Background: Parkinson’s disease (PD), which occurs in 1% of the population, is the second most common neurodegenerative disorder. Despite the broad spectrum of PD manifestations and high disease prevalence, there are insufficient data on medicine utilization and prescription strategies. The purpose of the current study was to analyze published data concerning treatment approaches and to compare them with Bulgarian therapeutic practice.

Design and methods: 
We conducted a systematic review of the PubMed and Google Scholar databases, and we calculated medicine utilization in Bulgaria during 2018 and 2019 using the WHO methodology.

The literature search identified a total of 311 publications, but only 12 met the inclusion criteria. Eleven studies pointed out that levodopa-containing medicine are the most frequently used, followed by dopamine agonists. The highest rate was found for levodopa-containing products and decarboxylase inhibitor (1.06 and 1.33 DDD/1000 inh/day), followed by anticholinergic Biperiden (0.494 and 0.455 DDD/1000 inh/day) during 2018 and 2019 in Bulgaria.

Overall, the treatment approaches used in the last decade comply with guideline recommendations, despite variations in levodopa and dopamine agonist utilization. Even though new medicines have been approved for PD management, levodopa-containing products are still most often prescribed and used worldwide.


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