1/ Generic Lamotrigine
You may be aware that the patent on Lamictal, an anti-epilepsy drug from GSK, is due to expire soon. The DH have taken the unusual step of re-assuring prescribers that the generic will be a safe and effective alternative to the brand. This view is also supported by the Medical Director at the National Society for Epilepsy.
Action: Continue to prescribe Lamotrigine as generic, change prescriptions to brand only where you clinically feel this action is appropriate.
2/ Esomeprazole on Hospital Discharges
You may be getting some discharge notes from the hospital trust, usually written by SHOs asking for patients to be prescribed Esomeprazole (Nexium). This drug is not on the hospital formulary and is initiated by the hospital. The evidence available on the efficacy between PPIs shows that like for like there is nothing to choose between them.
Action: Continue to prescribe Omeprazole capsules at a suitable dose for patients where a PPI is indicated.
3/ Glucophage SR
A sustained release version of metformin has been released by Merck. They are claiming that the product is better tolerated than 'instant release' (IR) metformin. This assertion is backed by an observational study but a randomised controlled trial (RCT) did not support this finding. The RCT showed that the SR version was no better tolerated then the IR version. There is also a greater limitation on the dosing scope (2000mg maximum compared to 3000mg with IR metformin) and the substantially increased cost there can be no good reason to use Glucophage SR.
Action: Continue to prescribe the IR version of Metformin to those diabetic patients where metformin is indicated.
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