Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Impact of the new Pharmacy Contract

The contractual framework that community pharmacists work under changed on the 1st April 2005. Under the new arrangements the Department of Health have reduced the price of around 400 medicines.

A full list of the medicines affected is available on the Pharmaceutical Services Negotiating Committee's website.

There are several items on this list that will be key in the coming year to ensure that you contain costs within your budget allocation. There are:

  • Simvastatin
    Price reduced by approximately 75%. Simvastatin 40mg is now about £15 per month cheaper than Atorvastatin and at least as effective at lowering cholesterol than the 10mg and 20mg strengths of atorvastatin.
  • Pravastatin
    For those patients who would benefits from Pravastatin (perhaps on Warfarin) the price of this drug has been reduced 70%
  • Ramipril
    Price redced by about half. Also note that the capsules are better value than the tablets, saving you more each month and allowing you to treat more patients at evidence based doses (10mg)
  • Lisinopril
    Price reduced by up to half depending on strength.
  • Fluoxetine
    Price reduced by 25%. This drug should be first line where an antidepressant is indicated for moderate to sever depression.
  • Diclofenac and Naproxen
    Prices reduced by between 15% and 50% bepending on drug and strength. Use these agents only if an NSAID is required and Ibuprofen has not worked.

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Soluble Analgesics

Following the recent withdrawal of Gaviscon from prescription and our investigations into the salt content of prescription items we were reminded of the salt content of soluble analgesics.

Some of these soluble analgesics contain 16.9 mmol of sodium per tablet. This is equivalent to 388.7mg of sodium or 970mg of salt.

A person taking 6 tablets a day would therefore have consumed almost the recommended daily amount of salt without any accounting for what they have eaten or drunk! A person taking 8 tablets a day consumes over 7g of salt per day from the tablets alone

Action: Where possible avoid prescribing soluble or effervescent analgesics that have a high sodium content. This should be especially the case in patients with cardiovascular disease, renal disease or hypertension.

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Tramacet

Tramacet has been launched recently and is being heavily promoted in the form of adverts and journal inserts. It contains 325mg of Paracetamol and 37.5mg of Tramadol per tablet.

Given the recent announcement of the withdrawal of Co-proxamol, we feel it would be inappropriate to transfer patients to this drug. We are also concerned that this new product contains subtherapeutic doses of both ingredients.

It currently costs £10.07 for 60 tablets which is over £9 more than the cost of 100 Paracetamol and £3 more than 100 Co-codamol 30/500mg tablets.

Action: There can be no good reason to use Tramacet in any circumstance.

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Duloxetine for Stress Urinary Incontinence

Blackpool Victoria Hospital recently passed Duloxetine (Yentreve) for use in female patients for SUI where pelvic floor muscle exercises alone were not effective.

The consultant agreed that the inital prescription would be issued by the hospital although prescribing would be requested from GPs after this initial supply. It was also made clear at the meeting that prescribing of this drug for this indication was not expected to continue beyond one year.

Action: GPs prescribing of Duloxetine for SUI is to be expected when requested by the consultants in Urology. You should audit reguarly to ensure that supply does not continue beyond one year.

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