Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Innovo Insulin Pen Discontinued

The Innovo Insulin Injection Device will not be available in the UK from the end of August 2006. This device is used to inject insulin from 3ml cartridges however declining demand and large numbers of complaints about this device have brought about the decision to discontinue this product. It is expected that few patients will be currently using this device.

NovoNordisk, the manufacturer of the device are providing information about possible alternative devices on their medical information team on 0845 600 5055. The NovoPen 3 appears to be a suitable alternative to the Innovo especially if the intention is to maintain the provision of insulin therapy through 3ml cartridges.

Action: Clinicians should be aware of the discontinuation and work to identify patients using the Innovo device.

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NICE may reject Inhaled Insulin

The National Institute of Health and Clinical Excellence (NICE) has issued an Appraisal Consultation Document for Inhaled Insulin (Exubera)® for Type I and Type II Diabetes.

This Appraisal is a preliminary recommendation and subject to change before publication however this document states that NICE do not recommend Inhaled Insulin for use on the NHS unless it is part of a clinical trial.

The BBC and Guardian have already reported this information.

Inhaled Insulin has many limitations in general use as discussed already. In addition to these clinical concerns this new product is likely to cost more at £1,100 per patient per year compared to £300 for injected insulin.

Action: Clinicians involved in the treatment of diabetes may be asked about this product by patients and should be aware of current information.

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Ibuprofen Isomer

Dexibuprofen (Seractil)® has been launched in the United Kingdom. It is the active isomer of Ibuprofen.

It is available in 300mg and 400mg tablets, priced at £9.47 for 60 tablets. According to the Summary of Product Characteristics is has been shown to be non-inferior to Ibuprofen in osteoarthritis and dysmenorrhoea over short periods.

Based on current prices it is at least 50% more expensive that Ibuprofen and is likely to cause side effects of dyspepsia or diarrhoea in over 10% of patients. At normal doses this product is also more expensive that diclofenac and naproxen.

Action: Based on the increased cost and lack of evidence for superior efficacy over Ibuprofen there is no reason to use this drug before current first choice options of Ibuprofen, Diclofenac and Naproxen as recommended in the Formulary.

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FDA petitioned to ban Orlistat

Public Citizen have petitioned the Food and Drugs Administration in the United States to withdraw Orlistat (Xenical)® from the market amid claims it may be linked to colonic cancer.

In a press statement it is claimed that orlistat is associated with a significant increase in aberrant crypt foci, which are widely believed to be a precursor to colon cancer. This comes at a time when orlistat is being considered for availability to purchase "over the counter" in community pharmacy.

Action: Clinicians who prescribe orlistat should be aware of this development. Patients may ask questions if this information is reported in the media.

[Source: PharmaGossip]

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SMC reject Rectogesic

The Scottish Medicines Consortium (SMC) has rejected Glyceryl Trinitrate 0.4% Ointment (Rectogesic)® for use on the NHS in Scotland for a second time.

This latest advice is based upon a resubmission of data after the SMC had rejected the product last year as reported here.

The SMC accept that this product is associated with a very small decrease in pain the economic case has not been demonstrated. The economic case is based on a comparison to Anacal, Anusol and Xyloproct all of which are licensed for the relief of pain associated with anal fissures. Rectogesic is about 10 times more expensive than these products.

Action: First line treatment of anal fissures should be based on lifestyle advice about diet and bowel habit. Prescriptions for products containing topical steroids or anaesthetics may be appropriate for management of pain and inflammation.

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