Prescribing Advice for GPs

BNF 59

March 16, 2010 at 10:35 am | In Prescribing Extra - Other |  Print | No Comments

The 59th Edition of the British National Formulary is currently being printed and distributed.

New or revised content in this version includes updated advice regarding:

• Withdrawal of sibutramine
• Community-acquired pneumonia
• Safe use of cytotoxic medicines
• Azathioprine and thiopurine methyltransferase (TPMT) testing
• Prescribing and dispensing of ciclosporin by brand name

Additionally, in this version prescribing information for hepatic and renal impairment, pregnancy, and breast-feeding is now in-chapter rather than in an appendix and the equivalent doses of morphine sulphate and diamorphine hydrochloride table has been revised to improve clarity.

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.

The BNF quality management system is now ISO 9001:2008 certified in recognition that the procedures that underpin the production of BNF products are robust and carried out to the highest of standards.

Action: All clinicians should start using BNF 59 as soon as the print version arrives. The web version can be used to access the latest information if necessary.

Episodic hypertension and stroke risk

March 12, 2010 at 1:20 pm | In Prescribing Extra - Other |  Print | No Comments

The Lancet has published the results of an analysis that has identified a correlation between stroke risk and variability or maximal in systolic blood pressure (SBP). This study has been reported in the general media (BBC).

The study noted that guidelines for the treatment and diagnosis of hypertension focus upon assessment of blood pressure over a time period, essentially providing an average over the time the readings are taken. This study aimed to assess stroke risk in comparison to visit-to-visit variability in SBP (expressed in standard deviations) or maximum SBP using data from the UK-TIA and ASCOT-BPLA studies.

The analysis founds that mean SBP, variability in SBP (as standard deviation, coefficient of variation and variation independent of the mean) all positively correlated with stroke risk. The correlations in variability remained after correction for mean SBP.

Additionally, it was noted that the association was strong individuals in the top decile of variability and this association grew stronger after correction for mean SBP, age, sex and other risk factors (Hazard Ratio [HR] 12.08, 95% CI 7.40-19.72, p<0.0001). Maximum SBP was also strongly correlated after correction for mean SBP (HR 15.01, 95% CI 6.56-34.38, p<0.0001).

The authors note that their findings do not prove causality and recommend that consideration be given to how visit-to-visit strong>variability in blood pressure might be integrated into clinical practice. Attention is also drawn to the “false reassurance of a few normal blood-pressure readings “.

Action: Clinicians should be aware of this study. While clinical guidelines are reviewed perhaps it would be prudent to give a little more weight to one-off high blood pressure readings.

No Smoking Day – 2010

March 10, 2010 at 9:00 am | In Prescribing Extra - Other |  Print | No Comments

Today is No Smoking Day and this year the theme is WeQuit.

The web site contains information and resources to help people quit smoking. This year there is also an increase in use of internet and technology solutions such as a video blog, Twitter and Facebook pages and even an App for the iPhone that counts days, hours minutes and seconds since someone quit smoking and also how much money they have saved.

Action: Clinicians should be aware of these materials and use them to support local smoking cessation activities.

SMC Update – March 2010

March 8, 2010 at 4:28 pm | In Prescribing Extra - Other |  Print | No Comments

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

Ketoprofen and omeprazole (Axorid^®) has been rejected for the symptomatic treatment of rheumatoid arthritis, ankylosing spondylitis and osteoarthritis in patients with a previous history or who are at risk of developing NSAID associated ulcers or erosions in whom continued treatment with ketoprofen is essential. The economic analysis provided was not sufficiently robust to gain approval.

Saxagliptin (Onglyza^®) has been accepted for restricted use in adult patients with type 2 diabetes mellitus as add-on combination therapy with metformin, when metformin alone, with diet and exercise, does not provide adequate glycaemic control. This agent is only recommended when the addition of sulphonylureas is not appropriate and is an alternative to other agents such as thiazolidinediones (glitazones).

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

Peer pressure blamed for excessive drinking

March 2, 2010 at 11:54 am | In Prescribing Extra - Other |  Print | 3 Comments

The Department of Health (DH) has published the results of a survey into the drinking habits of more than 2,000 English adults.

The survey found that 22% of respondents have drunk more alcohol than they planned because of peer pressure. 39% stated that they made up an excuse or lied to avoid another drink.

However, the survey also noted that these steps may be unnecessary because the survey also found that:

• Only 1% of respondents think less of people who refuse a drink or choose to drink less than them
• Just 4% expect their friends to keep up with them when drinking
• Only 2% admit to piling on the pressure for friends to drink more when they don’t want to

The DH has also issued the following advice to those wanting to drink less:

• Take it a day at a time: try and cut back a little every day. Each day you cut back is a success
• Make it a smaller one: you can still enjoy a drink but have less. Try bottled beer instead of a pint or a small glass of wine instead of a large
• Have a lower strength drink: manage how much you drink by swapping a strong strength beer or wine for one with a lower ABV [Alcohol By Volume]
• Take a break: have the odd day here and there when you don’t have a drink

Action: Clinicians may find this information useful when advising patients on strategies to reduce alcohol consumption. The results of this survey indicate that peer pressure to drink is more of an internal pressure than an external one.