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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC reject Esomeprazole

The Scottish Medicines Consortium has rejected Esomeprazole (Nexium)® for use in Scotland following two separate assessments.

The first assessment concluded that esomeprazole is not recommended for the healing of gastric ulcers associated with non-steroidal anti-inflammatory drug (NSAID) therapy.

The second assessment concluded that esomeprazole is not recommended for the prevention of gastric and duodenal ulcers associated with non-steroidal anti-inflammatory (NSAID) therapy in patients at risk.

In both cases the conclusion was based on the lack of comparative data with other Proton Pump Inhibitors (PPI) and the fact that an economic case had not been demonstrated.

Action: Lansoprazole is currently the first line choice where a PPI is indicated. PPIs have been covered in the Prescribing Formulary category in December 2005 and updated more recently in March 2006.

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Blood glucose meter safety warning

The Medicines and Healthcare product Regulatory Agency (MHRA) has issued a safety warning regarding several blood glucose meters. The MHRA has received several reports of the affected meters (listed below) displaying blood glucose results in mg/dL (milligrams per decilitre) rather than mmol/L (millimoles per litre). This change in units means the numerical readings will be 18 times higher than usual.

This is the third warning in just over a year, the first in May 2005 and the second in June 2005. The manufacturers of the meters will replace affected units free of charge.

The affected meters are as follows:

  • FreeStyle
  • FreeStyle Mini
  • MediSense Optium Xceed
  • LifeScan OneTouch
  • LifeScan InDuo
  • LifeScan PocketScan

Action: All clinicians and healthcare staff should be aware of this safety warning and be able to advise patients about the difference in the numerical reading and how to obtain a replacement meter.

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New Orlistat Interaction

The Summary of Product Characteristics for Orlistat (Xenical)® has been updated by the manufacturers to draw attention to an interaction with the contraceptive pill.

The interaction is not a direct drug-drug interaction however it seems that indirectly orlistat can reduce the availability of contraceptives. Additional contraceptive methods are recommended especially in cases of severe diarrhoea.

Action: Clinicians should be aware of this interaction and provide this information to women of childbearing age, preferably before treatment is initiated.

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MeReC Rapid Review Launched

The National Prescribing Centre has launched a new category of MeReC publications. As detailed in MeReC Extra 22 the Rapid Reviews will only be available online.

Readers can register to receive an email notification when new Rapid Reviews are published.

The topic of the first Rapid Review is the results of the ESPRIT Study. This study was prospective and randomised by design and examined the primary composite outcome of death from all vascular causes, non-fatal stroke, non-fatal myocardial infarction (MI), or major bleeding complications. Patients were randomised to aspirin (30-325mg daily, mean 75mg) with or without dipyridamole (200mg twice daily).

The result was that significantly fewer patients in the dipyridamole arm had a primary outcome event compared to those in the aspirin only arm. This finding supports the recommendations in the NICE Guidance on Vascular Disease - Clopidogrel and dipyridamole.

Action: Rapid Reviews promise to be a useful tool to aid prescribing decisions. Clinicians are encouraged to subscribe to the email notifications.

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The publication of a meta-analysis examining the relationship between Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and atherothrombotic events in the British Medical Journal has prompted widespread media reporting.

The BBC has reported the story online and GMTV has carried the story as a news item.

This latest meta-analysis adds weight to two recent observational studies, one examining the association between NSAID use and hospital admission for heart failure in a UK population1, the other examining the association between NSAID use and hospital admission for myocardial infarction in Finland2.

Clinicians may not be surprised by the results of the studies as it is expected that all NSAIDs will increase the risk of gastrointestinal, cardiovascular and renal complications. The strong media reporting may however encourage patients to contact a healthcare professional with their concerns.

Action: Clinicians can take advantage of the opportunity presented by the media reporting to reduce or stop prescribing NSAIDs, where appropriate, in individuals concerned about potential side effects. Alternative analgesia can be offered where required using paracetamol based pain-killers.

  1. Huerta C et al, Nonsteroidal anti-inflammatory drugs and risk of first hospital admission for heart failure in the general population. Heart 2006
  2. Helin-Salmivaara A et al, NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland. European Heart Journal 2006

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