Prescribing Advice for GPs

BNF 54

September 14, 2007 on 11:31 am | In Prescribing Extra - Other |  Print | No Comments

The 54th Edition of the British National Formulary is currently being printed and distributed.

New content in this version includes advice on:

• Avoiding use of rimonabant in patients with a history of depressive illness
• Restrictions on the use of piroxicam due to gastrointestinal side effects and skin reactions
• The fire hazard posed by paraffin-based emollients after a fatality

The web version has already been updated and printed version is available for purchase.

The print version is distributed by the Department of Health to Dentists, Doctors, Nurses and Pharmacists providing NHS services.

Action: All clinicians should start using BNF 54 as soon as the print version arrives. The web version can be used to access the latest information if necessary.

Two new reviews of glitazones

September 13, 2007 on 9:17 am | In Prescribing Extra - Drugs |  Print | 2 Comments

The Journal of the American Medical Association (JAMA) has published two meta analyses, the first reviewing the long-term cardiovascular risks of rosiglitazone and the second reviewing the effect of pioglitazone on ischaemic cardiovascular events.

Concerns have been raised about the cardiovascular safety of rosiglitazone following the publication of a meta analysis in the New England Journal of Medicine.

The new rosiglitazone analysis extracted data from 4 studies after screening 140. Studies were required to be randomised controlled studies of at least 12 months duration of rosiglitazone in the treatment or prevention of type 2 diabetes. The study was required to monitor for cardiovascular events and provided numerical data for adverse events.

This study found statistically significant increases in myocardial infarction (RR 1.42; 95% CI 1.06-1.91; P = 0.02) and heart failure (RR 2.09; 95% CI 1.52-2.88; P < 0.001).

No statistical difference was found in terms of the risk of cardiovascular mortality.

This analysis adds more weight to the assertion that rosiglitazone is implicated in causing cardiovascular events.

In the same issue of JAMA a second analysis examines the effect of pioglitazone on ischaemic cardiovascular events. This analysis was conducted independently using a database administered by the drug manufacturer. The database holds individual patient-level data collected during pioglitazone clinical trials. It includes data from 19 trials for over 16,000 patients.

A composite outcome of death, myocardial infarction or stroke was statistically less likely in patients taking pioglitazone (RR 0.82; 95% CI 0.72-.094; P = 0.005). The individual components of the primary outcome were also reduced and by a similar magnitude, although it is unclear if these reductions were statistically significant in the abstract. An expected increase in heart failure was also seen (RR 1.41; 95% CI 1.14-1.76; P = 0.002).

Action: As previously recommended, rosiglitazone use should be restricted. Clinicians may wish to consider changing patients who are currently taking rosiglitazone to a sulphonylurea or pioglitazone.

SMC September Update

September 12, 2007 on 9:47 am | In Prescribing Extra - Drugs |  Print | No Comments

The Scottish Medicines Consortium has issued its monthly advice on new medicines.

Testosterone 24 hours transdermal patch (Intrinsa^®) has been rejected for the treatment of hypoactive sexual desire disorder (HSDD) in surgically induced menopausal women

Pioglitazone (Actos^®) has been accepted for use in combination with insulin in type 2 diabetes mellitus patients.

Celecoxib (Celebrex^®) has been rejected for use in ankylosing spondylitis. This rejection was made because the manufacturer failed to submit a New Product Assessment Form as required by the SMC evaluation process.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected medicines should be avoided.

NICE issue amended Alzheimer’s advice

September 11, 2007 on 9:12 am | In Prescribing Extra - Other |  Print | No Comments

The National Institute of Health and Clinical Excellence (NICE) has issued revised guidance for Alzheimer’s disease following the outcome of the recent judicial review.

According the NICE website, the amendments specifically address using the Mini Mental State Examination (MMSE) for patients when it is not clinically appropriate due to the patient’s learning or other disabilities or where it is not possible to apply the MMSE in a language in which the patient is sufficiently fluent.

In such circumstances NICE suggests that healthcare professionals should not rely on the MMSE test - or not rely on it alone - to assess whether someone has moderate Alzheimer’s disease. They further recommend that different methods should be used to judge disease severity when deciding about starting or stopping treatment.

Action: Clinicians should be aware of this amendment and the impact it may have upon their clinical practice.

PMCPA website revamped

September 10, 2007 on 1:07 pm | In Prescribing Extra - Other |  Print | 1 Comment

The website for the Prescription Medicines Code of Practice Authority (PMCPA) has been redesigned.

The new layout provides quicker and easier access to details about the Code of Practice as well as details of completed and on going cases.

The front page also details Latest News relating to announcements about the Code of Practice and recent breaches of The Code and Latest Advice for the pharmaceutical industry on application of The Code.

Action: All clinicians should be aware of the PMCPA and their website. The new website provides easy access to information on cases, The Code and how to make a complaint.