Prescribing Advice for GPs

More PPI fracture data

August 18, 2008 on 12:07 pm | In Prescribing Extra - Drugs |  Print | No Comments

The Canadian Medical Association Journal has published the results of a retrospective analysis of the Population Health Research Data Repository that aimed to further explore the relation between duration of exposure to proton pump inhibitors (PPIs) and osteoporosis-related fractures.

The study matched 15,792 cases of fracture for age, gender and co-morbidities with 47,289 controls. The study did not appear to correct for different doses of PPIs but analysed the data in terms of duration of exposure.

A statistically significant increase in hip fractures was detected as 5 years exposure (adjusted OR 1.62, 95% CI 1.02–2.58) and for all osteoporosis-related fractures (hip, vertebra or wrist) after 7 years exposure (adjusted OR 1.92, 95% CI 1.16–3.18).

These results are consistent with other similar analyses. An editorial accompanying this paper notes that this is the third large studies of administrative databases that has found an association between hip fractures and usage of PPIs. It also calls for further prospective research to be conducted to confirm these findings.

Action: As previously suggested, clinicians should ensure patients are made aware of the potential risks and make effective use of step-down, step-off and when required treatment strategies to minimise drug exposure.

August CKS Update

August 12, 2008 on 10:38 am | In Prescribing Extra - Drugs |  Print | No Comments

Clinical Knowledge Summaries (CKS) has been updated in August for the following clinical areas:

• DMARDs
• Irritable Bowel Syndrome
• Osteoarthritis
• Post-herpetic neuralgia
• Pruritus ani
• Red eye
• Rosacea
• Shingles

Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.

Dietary advice can prevent diabetes

August 1, 2008 on 2:47 pm | In Prescribing Extra - Drugs |  Print | No Comments

The Cochrane Library has published a review of the impact of dietary advice in the prevention of type 2 diabetes mellitus.

The review could only identify two randomised controlled studies of 12 months duration or longer. The data included just 358 people. The two studies examined different end points so the data were analysed. In the longer (6 year) study there was a 33% reduced risk of developing diabetes in the intervention group assigned to dietary advice. In the shorter (12 month) study there were significant reductions in several biological markers including body mass index, fasting blood glucose, lipids, mean blood pressure and fasting insulin.

American endocrinologists are recommending more systematic identification of patients with prediabetes so that lifestyle interventions, including diet and exercise, can be started to avoid huge financial costs in the future.

Action: Clinicians must ensure that lifestyle interventions are regularly reinforced and not overlooked in favour of “easier” alternatives.

HPV programme extended

July 28, 2008 on 1:59 pm | In Prescribing Extra - Drugs |  Print | 1 Comment

The Department of Health has announced (PDF) that the human papillomavirus vaccination programme is to be extended to include young women aged 17-18.

The decision to use Cervarix^® has been criticised but this announcement does start to explain why the programme is using an apparently inferior vaccine.

Action: Clinicians should be aware of the extension to the vaccination programme.

Melatonin for Primary Insomnia

July 22, 2008 on 2:26 pm | In Prescribing Extra - Drugs |  Print | No Comments

Melatonin prolonged release (Circadin^®) has been launched for the treatment of primary insomnia.

It is currently only recommended for patients aged 55 years or older and for a period of three weeks. The Regional Drugs and Therapeutics Centre has published a review that highlights the lack of comparative trials, small effect size and cost difference.

Similarly, the National Prescribing Centre has written a Rapid Review that draws attention to the need for clinicians to accurately diagnose primary insomnia and provide patient education to improve sleep hygiene. The lack of comparative data means it is difficult to place this therapy in relation to existing treatments, including hypnotics.

Action: The benefits of the drug are modest. Usage is currently limited to patients aged 55 years and over who already practice behaviours in keeping with good sleep hygiene.