Prescribing Advice for GPs

Cipralex Update

October 13, 2005 on 4:22 pm | In Prescribing Extra - Drugs |  Print | No Comments

Lancashire Care Trust has agreed to allow Escitalopram (Cipralex) onto their formulary but with heavy restrictions.

This drug is allowed for use by the Trust only when agreed by the Chief Pharmacist; there are also restrictions on where in therapy it is used as several other drugs must have been used first. Lancashire Care Trust does not therefore expect GPs to initiate treatment with this drug.

Action: As previously stated, the use of Escitalopram as a first line antidepressant in Primary Care is not supported by evidence.

GSK criticised over salmeterol study reporting

October 11, 2005 on 7:53 pm | In Prescribing Extra - Other |  Print | No Comments

Reuters report that an American consumer group, Public Citizen, have accused GlaxoSmithKline (GSK) of manipulating data from the Serevent Multicentre Asthma Research Trial (SMART).

The SMART study was a 28 week study initiated in 1996. It found that there was an increased risk of asthma-related death in the Salmeterol arm of the study compared to the control arm according to interim results presented to the Food and Drugs Administration (FDA) in 2003. The full paper has never been published although it is worth noting that many of the patients in the Salmeterol arm of the study were not prescribed steroid inhalers.

Public Citizen have accused GSK of including post-study data relating to adverse events in data submitted to the FDA with the effect of misleading the FDA.

Action: Prescribers need to be aware of this as patients may ask questions about their asthma treatment. UK patients can be re-assured that the trial in America does not mirror UK practice; most patients in the UK are prescribed a steroid inhaler for their asthma.

Rectogesic rejected by SMC

October 11, 2005 on 7:31 pm | In Prescribing Extra - Drugs |  Print | No Comments

The Scottish Medicines Consortium has rejected Glyceryl Trinitrate 0.4% Ointment (Rectogesic) for use in Scotland.

The advice issued by the Consortium agrees that this product lowers pain scores more than a placebo ointment but they felt the effect was small and that an economic case for use was not demonstrated. This economic case was made based up healing rates compared to surgery, but rectogesic is not licensed to heal anal fissures.

Action: Symptomatic treatment of anal fissures at presentation should be based on lifestyle advice about diet and bowel habit. Prescriptions for products containing topical steroids or anaesthetics may be appropriate for management of pain and inflammation.

Average Salt consumption still too high

October 9, 2005 on 7:05 pm | In Prescribing Extra - Other |  Print | No Comments

A report published by Human Nutrition Research at the Medical Research Council has revealed that average salt consumption in the UK is still too high. The recommended salt intake is 6g per day but the average adult consumes 9.5g per day despite efforts by the food industry to reduce the salt content of foods.

The report also shows that only 15% of men and 31% of women manage to consume 6g or less of salt per day despite the fact that about a third of the population are hypertensive or on treatment for blood pressure.

The report estimates that achieving the 6g per day target would reduce the incidence of strokes by 13% and heart disease by 10%.

This report has quantified both the level of the problem of excessive salt consumption and detailed the continued efforts must be made to educate the general public in moderating their daily salt consumption.

Action: At every opportunity clinicians must recommended to all patients that they monitor and restrict their daily salt intake. This step will reduce the incidence of cardiovascular diseases like stroke and heart disease.

Bonviva for postmenopausal osteoporosis

October 7, 2005 on 9:35 am | In Prescribing Extra - Drugs |  Print | No Comments

Ibandronic Acid (Bonviva) is licensed and available on the NHS for “Treatment of osteoporosis in postmenopausal women in order to reduce the risk of vertebral fractures”.

This is a new bisphosphonate with the novelty of a once monthly administration. The marketing of this product is focussed on this aspect of the product and also on the improved effect on Bone Mineral Density.

It should be noted that the SPC specifies that “Efficacy on femoral neck fractures has not been established” and therefore this drug should not be considered as an alternative for established treatments like Alendronate without good reason.

Poor compliance with any bisphosphonate should be investigated fully and information should be given to the patient about strategies for taking bisphosphonates before a change of treatment is made.

Action: In a very small number of patients who cannot manage to comply with bisphosphonate therapy (for reasons other than side effects) it may be appropriate to change to Ibandronic Acid. These patients should be made aware of the lack of efficacy data on femoral neck fractures.