Prescribing Advice for GPs

New Observational Smoking Data

May 9, 2008 on 3:09 pm | In Prescribing Extra - Other |  Print | No Comments

The Journal of the American Medical Association has published the results of an analysis of data from the Nurses’ Health Study that aimed to assess the relationship between cigarette smoking and smoking cessation on mortality.

The Nurses’ Health Study is a prospective observational study of 104,519 American female nurses. The data were analysed for mortality from all causes and also categorised into vascular and respiratory diseases, lung cancer, other cancers and other causes. Comparisons were made between never smokers, current smokers and past smokers.

Compared to never smokers:

• Smokers were at 2.81 times higher risk of all-cause mortality (95% CI 2.68-2.95)
• Smokers were at 7.25 times higher risk of smoking-related cancers (95% CI 6.43-8.18)
• Smokers were are 1.58 times higher risk of other cancers (95% CI 1.45-1.73)

The study also found that risk was higher in people who started smoking at an earlier age and that risk declined to baseline over a period of 20 years for lung diseases with a more rapid decline for vascular mortality.

Action: These data contribute to what is already known about the harms of smoking and the benefits of smoking cessation. Clinicians may find the numerical risk data useful when encouraging abstinence from smoking.

MeReC Bulletin - Drug Management of Obesity

May 8, 2008 on 10:33 am | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) discussing the drug management of obesity.

The bulletin describes the increasing incidence of obesity and the impact that this has on health. The article also discusses non-pharmacological and pharmacological methods for loosing weight with a more detailed examination of when drugs are appropriate, how effective they are likely to be and the side effects and safety concerns associated with use.

The article concludes that, “it is worth encouraging people to eat a little less and move a little more“. It is also noted that all anti-obesity drugs are associated with modest weight loss of 3 to 5kg and that prescribing should consider the overall benefit in relation to safety warnings, national guidance and licensed product indications. Finally, the bulletin provides a table of the three currently available anti-obesity drugs with detail given for Safety, Tolerability, Efficacy, Price and Simplicity of use (STEPS) that will aid clinicians in making an informed decision about which drug is most appropriate to use.

Action: Clinicians who are involved in the management of patients who are overweight or obese will find this bulletin to be useful and informative. It is of the usual high standard expected from the NPC.

Management of Asthma guideline updated

May 7, 2008 on 11:10 am | In Prescribing Extra - Other |  Print | No Comments

The Scottish Intercollegiate Guidelines Network (SIGN) has published an update to the British Guideline on the Management of Asthma (PDF).

SIGN and the British Thoracic Society jointly produce the guideline. This update includes:

• A rewritten section on diagnosis for both adults and children
• A section on special situations including occupational asthma, asthma in pregnancy and the new topic of difficult asthma
• Updated sections on pharmacological and non-pharmacological management
• An amalgamated section on patient education and compliance
• An amalgamated section on organisation of care and audit

The guideline is also available as a Quick Reference Guide that covers the key areas of diagnosis, chronic and acute management in adults and children, special cases (pregnancy and occupational asthma), care delivery and patient education.

Action: All clinicians who diagnose and manage patients with asthma should ensure they are familiar with and implementing current recommendations.

Drug Safety Update, Issue 10

May 6, 2008 on 11:33 am | In Prescribing Extra - Other |  Print | No Comments

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update Issue 10 (PDF).

This issue includes the following drug safety advice articles:

• Rimonabant (Acomplia): depression; psychiatric adverse reactions
• Exenatide (Byetta): risk of acute pancreatitis

In addition, this issue contains a hot topic containing information about monitoring the safety of antiretroviral drugs. There is also a pointer to the Drug Analysis Print (DAP) area of the MHRA website. These DAP documents contain detailed listings of suspected adverse drug reactions reported to the MHRA through the Yellow Card scheme. Finally, there is a stop press section highlighting important safety issues that have arisen in the last month.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

Bisphosphonates linked to AF

May 2, 2008 on 1:01 pm | In Prescribing Extra - Drugs |  Print | No Comments

The Archives of Internal Medicines has published the results of a case-control study that aimed to assess any relationship between alendronate use and risk of incident atrial fibrillation (AF).

The recent HORIZON study found an unexpected increase in the risk of AF in patients assigned to the study drug. This study reviewed an American patient database system for female patients diagnosed with AF between October 2001 and December 2004. 719 patients were identified and matched with 966 controls.

More patients in the AF group had used alendronate (6.5% versus 4.1%). Comparing use of alendronate with no use of any bisphosphonate the risk of AF was statistically higher (Odds ratio 1.86; 95% CI 1.09-3.15).

The authors conclude that, “use of alendronate was associated with an increased risk of incident AF“. This observational study demonstrates that there is an association but not one of cause and effect. Other factors may explain the increase in AF that has been observed and therefore additional studies would be required to demonstrate causality.

Action: Clinicians should be aware of this potential link and be vigilant for AF in patients prescribed alendronate.