Prescribing Advice for GPs

June CKS Update

June 17, 2008 on 9:24 am | In Prescribing Extra - Other |  Print | No Comments

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

• Dyspepsia - proven GORD
• Dyspepsia - proven peptic ulcer
• Dyspepsia - unidentified cause
• Febrile seizure
• NSAIDs - prescribing issues

In addition, there is also a pointer to the National Knowledge Week topic of age related macular degeneration. This section has recently been updated with new evidence that has emerged in the last year.

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

NICE lipid guideline sparks debate

June 13, 2008 on 4:56 pm | In Prescribing Extra - Other |  Print | No Comments

The Lipid Modification Guideline recently published by the National Institute for Health and Clinical Excellence (NICE) has sparked debate in the British Medical Journal.

Two letters express opinions that the guideline is flawed. The first letter states the risks could be over estimated by adding together heart and stroke risks. NICE opted to use Framingham rather than QRISK for risk calculation.

The second letter questions the feasibility of aspirational cholesterol targets of less than 4 mmol/L for total cholesterol and 2 mmol/L for low density lipoprotein (LDL) cholesterol when the statin recommendation is simvastatin 40mg for all patients.

Action: Clinicians should familiarise themselves with the guidance fully before changing practice or attempting implementation. Audit standards remain at cholesterol levels of 5mmol/L and LDL of 3mmol/L.

MenC may need boosting

June 6, 2008 on 2:49 pm | In Prescribing Extra - Other |  Print | No Comments

The British Medical Journal has published the results of an observational study that aimed to assess the persistence of immunity to meningitis group C following routine vaccination. This study has been reported in the general media (BBC).

The study was conducted in secondary and tertiary educational institutions with 987 participants being healthy adolescents aged 11-20 years previously immunised between 6 and 15 years of age.

The study found that 84.1% had an antibody titre sufficient to demonstrate immunity. Antibody levels were significantly lower in participants who were 11-13 year old compared to those aged 14-16 and 17-20. Additionally, of the cohort who received only one brand of vaccine (70% of the study group) those vaccinated over the age of 10 had higher antibody levels than those vaccinated earlier in life.

The authors conclude that the results “support for adolescent immunisation programmes to generate sustained protection against serogroup C meningococcal disease“.

Action: Clinicians should be aware of this variability in immunity to meningitis group C. The diagnosis of bacterial meningitis should not be discounted solely based on a satisfactory vaccination history.

IHD and HDL relationship queried

June 5, 2008 on 3:23 pm | In Prescribing Extra - Other |  Print | No Comments

The Journal of the American Medical Association has published the results of a population study into the association between levels of high density lipoprotein (HDL) and development ischaemic heart disease (IHD).

Low levels of HDL are known to be associated with IHD but it is unclear if the relationship is causal. Recent attempts to produce drugs that increase levels HDL and therefore reduce cardiovascular morbidity and mortality have proven unsuccessful.

This study was conducted at population level in Denmark and collected data for HDL level, IHD and presence of a gene mutation that results in low levels of HDL. On average people with the gene mutation had HDL levels of 1.05 mmol/L (41mg/dL) while the general population had levels of 1.49 mmol/L (58mg/dL). The average difference was 0.4mmol/L (17mg/dL).

While a difference in HDL of 0.4mmol/L was associated with an increased risk of IHD there was no difference in risk in those patients who had low levels of HDL due to genetic mutations. This finding has thrown into doubt any benefits of artificially raising levels of HDL to protect against heart disease.

Action: Clinicians should continue to focus upon proven methods for reducing cardiovascular risk. These include smoking cessation, increased activity, adoption of a healthy diet and appropriate use of antiplatelets, antihypertensive agents and statins.

Thanks to PharmaGossip for spotting this article

Drug Safety Update, Issue 11

June 4, 2008 on 12:30 pm | In Prescribing Extra - Other |  Print | No Comments

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update Issue 11 (PDF).

This issue includes the following drug safety advice articles:

• Natalizumab (Tysabri): safety overview—progressive multifocal leukoencephalopathy, hypersensitivity, and hepatotoxicity
• Nicorandil: gastrointestinal ulceration

In addition, this issue contains a hot topic containing information about
recent data from the ENHANCE trial and also a stop press warning that several herbal products available for erectile dysfunction have been found to contain prescription only drugs including oral hypoglycaemic agents.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.