Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

New Obesity Treatment Launched

Rimonabant (Acomplia®) has been launched in the UK. It is licensed as an adjunct to diet and exercise in patients with a BMI > 30kg/m2 or a BMI > 27 kg/m2 and associated risk factors such as Type II Diabetes.

The full Summary of Product Characteristics is available online. It should be noted that this drug is black triangle and all suspected adverse reactions should be reported.

It is expected that there will be a high level of media interest, especially as this drug is a cannabinoid-1 (CB1) receptor blocker. At this time there are no comparative studies comparing this new treatment with the currently available treatment options.

The costs of the available treatments are:

  • Orlistat (Xenical®) - £39.51 per month
  • Sibutramine (Reductil®) - £41.29 to £45.14 per month
  • Rimonobant (Acomplia®) - £55.20 per month

Action: Based on the lack of comparative studies and the higher acquisition cost this drug provides a fourth-line choice in patients who fail to respond to diet and exercise followed by both existing treatment options.

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NICE Hypertension Guideline Published

After a month delay, the National Institute for Health and Clinical Excellence (NICE) has published the Guideline for Hypertension.

The Guideline recommends using Angiotensin Converting Enzyme Inhibitors (ACEI) as first line in all patients under the age of 55. It also suggests using Calcium Channel Blockers or Thiazide Diuretics for patients aged over 55 or black patients of any age.

The BBC has reported the publication of the guideline and it is expected that media coverage will be heavy.

The Quick Reference Summary appears to have been adjusted from the draft to place Thiazide Diuretics earlier in the drug treatment algorithm.

Beta-blockers are suggested as a fourth line drugs along with alpha-blockers or further diuretic therapy. However, the guideline also suggests that if blood pressure is well controlled on a beta-blocker there is no absolute need to change therapy. It is also recommendeds that beta-blocker therapy is withdrawn gradually where appropriate.

Action: All clinicians who treat hypertension should familiarise themselves with the new guidelines and reflect on how it may change current practice.

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MeReC Updates

The National Prescribing Centre has released new three new MeReC publications covering Chronic Obstructive Pulmonary Disease (COPD) and the Cardiovascular Risks of NSAIDs.

The publications are available as follows:

The Rapid Review covers a recently published meta-analysis from the British Medical Journal examining the cardiovascular risks of non-selective and Cox-II selective NSAIDs. It recommends avoiding all NSAIDs where possible, using low doses for short periods where necessary and considering gastroprotection in those at high risk of upper gastrointestinal complications.

The Briefing and Bulletin cover different aspects of COPD care. The Briefing details recognition and diagnosis, spirometry, management of stable COPD and pulmonary rehabilitation. The Bulletin covers the available drug options in the management of stable COPD.

Action: Clinicians involved in the diagnosis and treatment of COPD will find useful information in the Bulletin and Briefing. Clinicians who prescribe NSAIDs will find the recommendations in the Rapid Review of use in minimising cardiovascular risks.

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Advantage ii Renamed

Advantage ii Testing Strips® have been renamed as Advantage Plus Testing Strips® by Roche Diagnostics.

At the time of posting the Accu-Chek website contained no information regarding this change but some details are available from the Customer Careline - 0800 701 000 (UK). The Careline confirmed that there are no changes to the strips; only the name has changed.

The Prescription Pricing Authority has confirmed that prescriptions for either name will be passed for payment during the transition.

Action: Prescriptions for Advantage ii strips should be changed to Advantage Plus opportunistically.

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Current Problems in Pharmacovigilance

The Medicines and Healthcare product Regulatory Agency (MHRA) has made the latest Current Problems in Pharmacovigilance available online. An index of recent issues dating back to 2001 is also available.

The latest issue details over 20 separate issues including:

  • Cancer risk with tacrolimus and pimecrolimus
  • HRT and risk of endometrial cancer
  • Jaw osteonecrosis with bisphosphonates
  • Optic neuropathy with linezolid

Action: Current Problems in Pharmacovigilance is a must read for all clinicians to raise awareness of new prescribing issues, interactions and potential adverse events brought to light through post-marketing surveillance.

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