A letter and information pack was sent to GPs about recently announcing that Gavsicon was being discontinued in NHS pack sizes. For several reasons including assessment of sodium content and the fact that patients on Gaviscon don't use spoons to measure doses we recommended that you did not change prescriptions to Gaviscon Advance.
Action: Any patient on a concurrent GI medication for acid (PPI or H2RA) should have the Gaviscon stopped and be re-assessed. Patients on Gaviscon only should be changed to Algicon (or Peptac if for pregnancy).
2/ Aspirin and PPI safer than Clopidogrel
A POEM published in the BMJ in May 2005 presented the results of a study comparing Aspirin and PPI with Clopidogrel. The study showed that while there were bleeding complications in the clopidogrel group there were none in the Aspirin and PPI group.
Action: In patients with significant GI history who need an antiplatelet for secondary prevention, consider using aspirin and omeprazole in combination instead of clopidogrel.
3/ Glyceryl Trinitrate for Anal Fissures
It has recently come to my attention that prescriptions for GTN for anal fissures are often generated incorrectly. The product strength as recommended in the BNF should be 0.2% to 0.3% however this product is not available on the market and must be made specially. This is further confused by the fact that there is a product available in 2% (licensed for Angina). Prescriptions generated for the latter item will cause headaches and dizziness without any beneficial effect if applied to fissures. There is a new product available in 0.4% strength called Rectogesic that may be more appropriate now.
Action: Take care when generating prescriptions for GTN for the treatment on Anal Fissures, ensure you choose the correct strength or amend the prescription by hand.