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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Minocycline Shortage

Minocycline 100mg modified release, an antibiotic often used to treat acne, is currently being affected by supply problems according to the manufacturer.

Tetracycline or oxytetracycline are recommended as first line in the BNF with minocycline or doxycycline suggested as suitable alternatives.

Generic products may still be freely available however oral antibiotic use for acne is a balance between benefits and harms and this product shortage may provide the opportunity to review continued treatment.

Action: Clinicians may wish to take advantage of this supply shortage to review oral antibiotic prescribing in patients with acne.

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Ventodisks Discontinued

Ventodisks® are to be discontinued with effect from the end of September 2006 according to a letter sent by the manufacturers to healthcare professionals.

Ventodisks are foil disks containing eight blisters of salbutamol in either 200 microgram or 400 microgram strengths.

According to the letter the main reason for the choice to discontinue the product is increased demand for the antiviral zanamivir. These two products are made using the same expertise and equipment and the decision has been made to divert manufacturing capacity from ventodisks to zanamivir.

Action: This product is not widely used. Patients should be identified and provided with the opportunity to discuss alternative treatment options.

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OTC Deregulation

The Medicines and Healthcare products Regulatory Agency has announced the deregulation of Amorolfine and Sumatriptan.

Amorolfine is a nail lacquer licensed for the treatment of mild fungal infections of the nails. The over the counter product is called Curanail®. The Pharmaceutical Journal reports and can only be sold to patients over 18 years old with distal or lateral infection affecting up to two nails. The recommended price is £18.61.

Sumatriptan is a tablet licensed for the relief of acute migraine attacks. The over the counter product is called Imigran Recovery®. The BBC report that this product is likely to be available from mid-June at a cost of £7.99 for 2 tablets.

Action: The newly deregulated status of these products is likely to raise public interest and possibly result in increased GP consultations, especially in light of the recommended prices.

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Exubera unpopular in Germany

The Institute of Quality and Efficiency in Health Care (IQWiG), the German equivalent of NICE, has completed a Rapid Review of Inhaled Insulin (Exubera)®.

The report aimed to compare inhaled insulin to subcutaneous insulin over several patient-relevant endpoints including HbA1c control, quality of life, treatment satisfaction, hypoglycaemia, adverse drug events and prevention of complications.

The report concluded that:

  • the risks of hypoglycaemia may be higher
  • long term treatment risks are unclear
  • reductions in the number of injections may not improve patient satisfaction or quality of life

IQWiG recommend that additional work needs to be undertaken in these areas to allow a more conclusive evaluation to be completed.

Action: Clinicians involved in treating diabetes may wish to be aware of the latest reviews of inhaled insulin. A Technology Appraisal from NICE is due in October 2006.

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MHRA Dianette Update

The Medicines and Healthcare products Regulatory Agency has issued an update on the use of Dianette®. The MHRA are currently reviewing the description of psychiatric reactions in the product information.

Dianette is a hormonal medication that is licensed for the treatment of severe acne that fails to respond to antibiotics and moderately severe hirsutism. Dianette also acts as a contraceptive but should not be used for this purpose alone or as a contraceptive in patients with mild acne.

Venous thromboembolism occurs more often in patients treated with dianette than those treated with low-dose combined oral contraceptives. Depression is also a known side effect of dianette.

Action: Clinicians should only prescribe dianette within the product license, review regularly and withdraw treatment upon resolution of symptoms. Repeat courses can be given if symptoms return.

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