Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Fruit juice may affect drugs

The BBC has reported a recent finding that suggests fruit juices may block the uptake of medication from the bowel.

It is already know that grapefruit juice interacts with several medications (including antipsychotics, calcium channel blockers and statins) resulting in elevated blood levels of the affected drugs.

Recent studies have identified that grapefruit juice had the reverse effect on the antihistamine fexofenadine resulting in absorption being reduced to approximately half that observed in patients who took the medication with water. It has also been suggested that orange and apple juice may have a similar effect.

Action: Further research is needed to establish and confirm these interactions. It would be prudent to advise patients to take their medication with water until the clinical importance of any interactions is known.

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Co-proxamol withdrawal reduces suicides

The National Prescribing Centre has published a summary of a recent paper that has found a reduced rate of suicides following the withdrawal of the marketing authorisation for co-proxamol.

An analysis of the General Register Office in Scotland for the period 2000–2006 identified an average rate of deaths due to co-proxamol overdose of 37 per year between 2000 and 2005. When usage started to decline in 2006 the rate of deaths dropped to 10 per year with the difference being statistically significant. The authors conclude that if the reduced rates are mirrored across England and Wales that 300 lives per year will have been saved.

Action: Clinicians should ensure co-proxamol use is minimised in favour of licensed alternatives in light of these apparent benefits.

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Exenatide safety warning

The Food and Drugs Administration has issued a safety warning following six cases of haemorrhagic or necrotising pancreatitis were linked to concurrent use of exenatide (Byetta®). Two of these cases proved to be fatal.

Healthcare professionals are advised that there are no clinical signs or symptoms that distinguish acute haemorrhagic or necrotising pancreatitis from less severe form of pancreatitis. It is therefore recommended that exenatide and other potentially suspect drugs should be immediately discontinued in cases of suspected pancreatitis.

Pancreatitis is already discussed in the Summary of Product Characteristics but it is likely that stronger and more prominent warnings will be added.

Action: Clinicians should be aware of this safety concern and react to stop medication rapidly if pancreatitis is suspected.

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SMC August Update

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

Following a resubmission, lidocaine 5% patches have been accepted for restricted use the treatment of neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia). The patches are recommended only when first-line systemic therapies have been ineffective or poorly tolerated.

Following a resubmission, buprenorphine transdermal patch (BuTrans®) has been rejected for the treatment of severe opioid responsive pain conditions because the economic analysis was not sufficiently robust to gain acceptance.

Melatonin 2mg prolonged-release tablets (Circadin®) for the short-term treatment of primary insomnia and venlafaxine extended release capsules (Efexor XL®) for treatment of moderate to severe generalised social anxiety disorder/social phobia in adults have both been rejected because the manufacturers failed to make a submission to SMC regarding this product in this indication.

[Update]
Clobetasol propionate (Etrivex Shampoo®) has been accepted for use in the topical treatment of moderate scalp psoriasis in adults. This product was shown to be non-inferior and of an equivalent price to an existing clobetasol formulation when used daily for a maximum of 4 weeks.

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

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