Prescribing Advice for GPs

BMI and MI Risk

November 10, 2005 on 2:04 pm | In Prescribing Extra - Other |  Print | No Comments

The Lancet has published a case control study¹ that has looked at the relationship between Myocardial Infarction (MI) and markers of obesity including body mass index (BMI), waist and hip circumferences and waist-to-hip ratio.

The study showed that while BMI did show a graded association with MI, waist-to-hip ratio had a much stronger association. This adds to the growing evidence that BMI is less accurate as a predictor in some populations. The authors conclude that waist-to-hip ratio should be used as a marker for obesity, especially when used to calculate heart disease risks.

It is notable that the correlation was performed on MI risk and not cardiovascular disease risk. At this time it is not clear if there is also an association between waist-to-hip ratio and vascular outcomes other than MI.

Action: This debate is likely to continue until the evidence gives us greater clarity. BMI is still a useful indicator of obesity. Clinicians may wish to use waist-to-hip ratios in addition to BMI until clearer advice becomes available, although currently there is no read code for this information.

References

1. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. The Lancet 2005; 366:1640-1649

Using Evidence to Guide Practice

November 8, 2005 on 11:36 am | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre recently published MeReC Briefing 30 titled Using Evidence to Guide Practice.

This document is a must read for all clinicians, especially those who read clinical papers or who interact at any level with representatives of the pharmaceutical industry. It provides readers with pointers on sourcing, understanding and appraising the vast amounts of medical information that is published every day.

The pointers cover the following areas:

• Where to source information
• How to decide if the information is worth reading
• How valid is the design of the trial to my patients
• What is the magnitude of the risks and benefits
• Should the conclusion change practice
• How should this new information be communicated to patients

Action: All clinicians would benefit from reading this publication. The pointers and methods detailed in the document will allow clinicians to filter the information they receive so that any detailed reading will be more relevant and more likely to impact on current practice.

Generic Sertraline available

November 7, 2005 on 4:40 pm | In Prescribing Extra - Drugs |  Print | No Comments

The antidepressant Sertraline (Lustral) is now available as a generic following the patent expiry.

The availability of generics encourages greater competition and pushes down the price of drugs. This will be of benefit to those who prescribe Sertraline as generic.

Action: Prescribing of Sertraline should be done generically to ensure maximum cost-efficacy. Fluoxetine and Citalopram are still reasonable first choices where an antidepressant is considered necessary.

Rosuvastatin 5mg launched

November 7, 2005 on 4:24 pm | In Prescribing Extra - Drugs |  Print | No Comments

Rosuvastatin (Crestor) has been launched in a 5mg strength. This tablet is half the strength of the previous lowest strength. It is licensed as a starting dose and priced at the same level as the 10mg tablet - £18.03 for 28 tablets.

The new lower dose is intended for use as a start dose in patients who are predisposed to myopathy and Asian patients. Predisposing factors include:

• Renal Impairment
• Hypothyroidism
• Personal or family history of hereditary muscular disorders
• Previous history of muscular toxicity with other statins or fibrates
• Alcohol abuse
• Age over 70 years
• Situations where an increase in plasma levels may occur
• Concomitant use of fibrates

Action: Currently, there are no trial data for Rosuvastatin demonstrating a reduction in mortality or morbidity. This level of evidence is available for other statins e.g. Simvastatin. Rosuvastatin is not currently on the formulary. Prescribers who insist on using Rosuvastatin should be aware of the availability of this new dose and indications.

MeReC Briefing on Depression

November 5, 2005 on 9:20 am | In Prescribing Extra - Other |  Print | No Comments

The National Prescribing Centre has published a MeReC Briefing on the Management of Depression in Primary Care.

The briefing provides information on the diagnosis and treatment depression including assessment of severity and suicide risk, drug and non-drug treatment options and drug choice.

Action: Clinicians involved in the diagnosis and treatment of depression in primary care will find this publication useful and should familiarise themselves with its content. The document is a useful addition to the NICE Clinical Guidelines.