Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MTRAC Reviews

The Midlands Therapeutic Review and Advisory Committee (MTRAC) has published reviews covering ibandronate (Bonviva®) and rimonobant (Acomplia®).

Both drugs have been assessed as being "Q4" drugs. This means they have weaker evidence than alternative treatment options and therefore have a lower place in therapy.

MTRAC also makes recommendations on the suitability of the drug for use in Primary Care. Ibandronate is "suitable for prescribing in primary care" but is expected to be secondary to other bisphosphonates. Rimonobant is "suitable for restricted prescribing under defined conditions" but should not be used in patients with psychiatric illness such as depression or in combination with antidepressants.

Action: As already suggested, both ibandronate and rimonobant have a limited place in primary care where current treatment options are unsuitable or have failed. Patients should be made fully aware of the pros and cons of these drugs before treatment is started.

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Generic prescribing for MR opiates

The Practice Committee of the Royal Pharmaceutical Society of Great Britain recently advised clinicians that modified-release (MR) morphine preparations should be prescribed by brand name.

In a recent article recommendations were made on this site that brand name prescribing of fentanyl was avoidable in the majority of circumstances except where the patches were being cut in half before application.

According to a new press release, the Practice Committee has reviewed its advice in light of information provided by the British National Formulary. The advice now states, "the Practice Committee does not recommend routine brand-name prescribing of modified-release morphine preparations and fentanyl patches".

The press release also advises that fentanyl patches of the reservoir type should never be cut before application and that cutting of the matrix type patch renders the use outside the product license.

Action: The recommendations made here previously still apply. Clinicians who prescribe fentanyl should not recommend cutting patches. Fentanyl and modified-release opiates can routinely be prescribed in the generic form.

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MeReC Extra 25

The National Prescribing Centre has published MeReC Extra 25 that provides an analysis and bottom line for two recent clinical trials and pointers to useful Hypertension and UTI guidance on the following areas.

Individual sections are available as follows:

Action: Clinicians involved in the treatment of stroke or diabetes will find the analysis of the recent SPARCL and DREAM studies useful. The MeReC Bulletin on Hypertension and the SIGN Guideline for Bacterial UTI will both be useful in primary care settings.

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Counterfeit Test Strips

The manufacturer of OneTouch® test strips has written to healthcare professionals following the discovery of counterfeit testing strips in the USA, India, Dubai and Greece. OneTouch® and OneTouch® Ultra are affected but other products in the range are not involved.

There have been no reported cases of counterfeit product on the market in the UK. The counterfeit strips have been found to produce inaccurate readings. Patients may be harmed if treatment is altered based upon these inaccurate readings.

Patients in the UK may be aware of this issue however as the international website contains a press release with additional information for users and suppliers.

The manufacturer is working with UK regulatory bodies to prevent counterfeit products from entering the UK supply chain however patients may still be concerned about the authenticity of their testing strips.

Action: Clinicians should be aware of the risk posed by these counterfeit strips. Patients can be reassured that the UK supply chain is currently unaffected.

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Ovranette Supply Problem

The manufacturer of Ovranette® has written to healthcare professionals to advise of a short-term difficulty affecting production that is limiting supplies. Weekly updates of supply difficulties are posted on the manufacturers website.

The product contains ethinylestradiol 30mcg and levonorgestrel 150mcg per tablet and is supplied in packs containing 63 tablets.

Microgynon 30 contains the same active ingredients and is available in the same pack size. It may therefore be a suitable alternative.

Action: Clinicians may need to prescribe alternative contraceptive medication to patients who are unable to source ovranette from pharmacies. Microgynon appears to be a suitable substitute.

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