Prescribing Advice for GPs

Watchdog urges Medicines Vigilance

August 11, 2006 on 2:28 pm | In Prescribing Extra - Other |  Print | No Comments

The Healthcare Commission is urging hospitals to improve the management of medicines in a report published today. The BBC has also reported this story.

Comparative assessments of medicines management in 173 acute hospital trusts rated 18 as “excellent“, 70 as “good“, 73 as “fair” and 12 as “weak“. In the 12 months up to July 2006 there were over 40,000 medication errors reported in hospitals in England and Wales but over 95% of these errors caused little or no harm.

Areas highlighted as requiring improvement include:

• Giving information to patients
• Involving pharmacists in patient care
• Assessing the risks of intravenous drugs
• Empowering patients to take control of their own medicines

Areas of good performance included management of the risk of infection through prescribing and administering medicines, prevention of allergic reactions and using patients’ own drugs upon admission to hospital.

Action: Clinicians may wish to be aware of the reports recommendations if patients express concerns following the media coverage.

Rimonobant and Psychiatric Disorders

August 10, 2006 on 3:13 pm | In Prescribing Extra - Drugs |  Print | 2 Comments

The Journal of the American Medical Association has published a letter that has raised safety concerns with respect to the rates of psychiatric disorders in those patients who received rimonobant (Acomplia^®) compared to those who received placebo in the published studies.

In reply to this letter the authors of the study point out that patients were not excluded from the study based upon an abnormal score on the Hospital Anxiety and Depression scale (scores of above 7). Patients with serious uncontrolled psychiatric illness were excluded for the study including those with major uncontrolled depression.

The Summary of Product Characteristics recommends that rimonobant should not be used in patients who are taking antidepressants. It also lists several psychiatric disorders as common (occurring at rates between 1% and 10%), these are:

• Depressive disorders
• Mood alterations with depressive symptoms
• Anxiety
• Irritability
• Nervousness
• Sleep disorders
• Insomnia
• Parasomnias

Action: As already suggested, rimonobant is the fourth line choice after existing treatment options. Patients should be warned about psychiatric side effects and treatment stopped should they occur.

New CFC-Free Beclometasone

August 9, 2006 on 10:48 am | In Prescribing Extra - Drugs |  Print | No Comments

A new CFC-free beclometasone inhaler has been launched in the UK. Clenil Modulite^® has been accepted for use on the NHS in Scotland by the Scottish Medicines Consortium.

This new product is licensed for mild, moderate and severe asthma in adult and children but there are some key differences between this product and existing beclometasone inhalers including the CFC-free beclometasone inhaler, Qvar^®.

The Medicines and Healthcare Products Regulatory Agency (MHRA) have cascaded a press release that highlights some of the differences.

• Clenil Modulite^® inhalers are equipotent to the existing CFC-containing inhalers and therefore require no dose adjustment
• Qvar^® inhalers are not equipotent to existing CFC-containing inhalers; doses are usually halved. Further information is available in the Summary of Product Characteristics or the BNF
• Clenil Modulite^® is licensed for use in children. Qvar^® is not licensed for use in children aged 12 and younger

The MHRA recommend that, to avoid confusion for the patient and during dispensing, prescriptions for CFC-free beclometasone products are written for branded products. They also recommend that pharmacists establish which product is required when prescriptions are generic; this information may come from existing patient medication records, the patient or the prescriber.

Action: Care should be taken when prescribing and dispensing prescriptions for beclometasone inhalers to ensure the intended product is provided.

Insulin Discontinuations

August 8, 2006 on 4:34 pm | In Prescribing Extra - Drugs |  Print | No Comments

The manufacturer of Mixtard^® and Velosulin^® has announced that several products in the range are to be discontinued and will not be available after 31st December 2007.

The affected products are:

• Mixtard^® 10 3ml penfil
• Mixtard^® 20 3ml penfil
• Mixtard^® 40 3ml penfil
• Mixtard^® 50 3ml penfil
• Velosulin^® 10ml vial

These products are not available in an alternative dosage form and patients will therefore need to be reviewed before alternative products are selected and prescribed. Assistance is available in the United Kingdom from the Medical Information and Customer Care Team on 0845 600 5055 or online [Registration Required].

Action: Patients who are currently using the affected products should be identified as soon as possible to ensure a smooth transition to an alternative insulin therapy.

Pregabalin rejected by SMC

August 8, 2006 on 10:44 am | In Prescribing Extra - Drugs |  Print | No Comments

The Scottish Medicines Consortium has rejected Pregabalin (Lyrica^®) for use in peripheral neuropathic pain in adults on the NHS in Scotland.

This is the third time the SMC has reviewed pregabalin for nerve pain following a review in March 2005 and a re-submission in September 2005. The result of the re-submission was reported here.

Despite 18 months having passed since the first review the SMC still state that, “Comparative clinical and cost effectiveness have not been demonstrated”.

Action: Pregabalin currently has no place in the treatment nerve pain. Conventional therapies, including amitriptyline, carbamazepine and gabapentin, should continue to be used.