Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Hypertension Guideline Slips

The National Institute for Health and Clinical Excellence (NICE) has deferred the expected date of issue for the new Hypertension Guideline to June 2006.

The following comment was posted on the 2nd May in the section detailing the project history:

"The timeline for the review of this guideline has been extended. The Guideline Development Group needed more time to consider the stakeholder comments received during consultation on the first draft guideline carried out in February. The final guideline is now expected to be published in June."

Action: The delay is disappointing however clinicians should not be tempted to change practice until the new Guideline is published.

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MeReC Extra 22

The National Prescribing Centre has published a new issue of MeReC Extra.

This issue covers:

  • ASTEROID Study
  • Developments for MeReC
  • CHARISMA Study
  • NRT in Pregnancy

ASTEROID and CHARISMA are studies relating to two cardiovascular drugs, both studies have already been covered on this site.

MeReC developments include the introduction of support materials with MeReC Bulletins, new MeReC Rapid Reviews to be made available shortly after new findings are published and greater use of electronic distribution.

Use of Nicotine Replacement Therapy (NRT) in pregnancy has recently been a cause for concern following the results of an observational study. The section highlights the flaws in the study and suggests that where pregnant smokers should be encouraged to quit without using NRT. However, it is also concludes that the results of the study do not mean that pregnant smokers are better off smoking than using NRT.

Action: Clinicians who are involved in treating cardiovascular disease or who offer smoking cessation advice will find this MeReC Extra of value. A useful update on the development plans affecting MeReC is also provided.

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New Paroxetine Evidence

The manufacturer of Paroxetine (Seroxat)® has conducted an analysis into clinical trials of paroxetine in adults under instructions from the Food and Drugs Administration.

The Chairman of the Commission on Human Medicines has written to healthcare professionals informing them of the key findings.

The findings do not alter the current prescribing advice relating to Selective Serotonin Reuptake Inhibitors (SSRI) however they do highlight that:

  • Careful and frequent patient monitoring by healthcare professionals and, where appropriate, other carers, is important in the early stages of treatment with paroxetine, especially if a patient experiences worsening of symptoms or if new symptoms arise after starting treatment
  • Young adults (18-29 years of age) are at a higher background risk of suicidal behaviour than older adults and therefore should be monitored particularly closely

Action: Clinicians are reminded of the need to carefully monitor patients who are prescribed SSRI antidepressants, especially young adults and those prescribed paroxetine.

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More Antihypertensive Data

The National Electronic Library for Medicines has reported on two recent papers regarding hypertension.

Circulation has published an analysis of the ALLHAT study and each of the study medications preventative effects on heart failure. This paper found that diuretics were better than calcium channels blockers at preventing heart failure. Diuretics were also superior to ACE Inhibitors in the short term.

Diabetes Care has published the results of a prospective cohort study into the association between different antihypertensive agents and the development of diabetes. There is also an editorial to accompany this paper. The paper concludes that thiazide diuretics and beta-blockers are associated with an increased risk of diabetes and therefore patients on these drugs should be monitored more closely.

The editorial questions if the increased risks of developing diabetes detracts from the cardiovascular benefits. ALLHAT for example compared chlorthalidone, lisinopril and amlodipine, all of these drugs reduced cardiovascular outcomes to a similar extent despite chlorthalidone being associated with higher rates of new-onset diabetes.

Action: This new information will be of interest to clinicians treating hypertension. The NICE Guidance on Hypertension is expected this month and changing current practice at this stage would be unwise.

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