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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Suicidal Ideation and SSRIs

The journal of Psychotherapy and Psycosomatics has published two articles examining the association between suicidal ideation and prescription of selective serotonin reuptake inhibitors (SSRIs). PharmaTimes has also reported the publication of these articles.

The first article is a secondary analysis of a 12-week open study of fluoxetine. Analysis of the data found that 14.3% of individuals in the study who had no suicidal ideation at baseline reported it at least once during the course of the study.

The second article is an evaluation of the evidence supporting treatment of children and adolescents with SSRIs. The author found 10 studies comprising 2,046 patients who were treated with fluoxetine, paroxetine, sertraline or citalopram. An additional 6 studies were also found that were not published due to lack of efficacy or problematic side effects. The analysis found no data supporting the use of SSRIs, except for fluoxetine. The author concluded that SSRIs are second line for severe and resistant forms of adolescent depression.

Action: When prescribing SSRIs for the first time an assessment of suicide risk should undertaken and repeated periodically. Guidelines are available from the National Institute for Health and Clinical Excellence for depression in Adults and Children and Young People.

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Creative Commons Licence

The original purpose of this website was to provide Prescribing Information to the doctors in Blackpool.

The readership of this site is now far beyond that original purpose. Readers come from many geographical locations and also many differing clinical backgrounds. It is also clear that many readers work in an advisory capacity to doctors.

There has been a copyright notice on each post for a long time that may have been restricting the usage of this site and it is with this in mind that I have made a small change to the copyright licence contained in each article.

In the interest of gaining greater benefit from the articles on this site, all articles are now licensed under a Creative Commons Licence.

Readers are allowed to copy, distribute, display and perform articles and to make derivatives of articles on this site provided:

  • You attribute any materials used back to this site as the original source
  • You do not use any materials from this site for commercial purposes including promotion of products for financial gain
  • You distribute any derivatives of articles from this site only under an identical licence

The full legal licence contains more detail.

Action: Make use of the articles on this site within the (broad) limitations of the licence.

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Code of Practice Review published

The Prescription Medicines Code of Practice Authority has published a Code of Practice Review for the quarter ending November 2006.

This review comments on matters of current concern in the application of the Association of the British Pharmaceutical Industry Code of Practice and also details the outcome of complaints heard in the previous three months.

Normally the reviews remain confidential however I did briefly mention a complaint I had raised in a recent article when I was misquoted by drug company representatives during their promotional activity. More details are available in the review starting on page 52.

In summary, the complaint followed a meeting between a company and myself where there was disagreement about the place in therapy of a product. Following this meeting the company in question started to promote their product stating that I endorsed it. During the meeting I made no such endorsement if this product and refused to provide an endorsement in writing.

In such a case it is difficult for the panel at the hearing to reach a final decision, as it is one person's word against another's. However, in this instance the panel felt that, on the balance of probabilities and based on the evidence presented, the Code of Practice had been breached.

I have learned a lot from this situation. Firstly, I never overtly endorse any product and refuse to provide written endorsement of any product to representatives of the pharmaceutical industry. Secondly, I make it very clear, when necessary, that my name and that of the organisation I work for must not be used during any promotional activity for any pharmaceutical product.

Action: All clinicians who may be considered as opinion leaders should exercise caution when discussing or endorsing pharmaceutical products. To ensure clear understanding it is worthwhile putting your views in writing if they are to be used during promotional activities.

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Malaria prevention guideline from HPA

The Health Protection Agency has published a guideline for malaria prevention in travellers from the United Kingdom.
A press release about the guideline states that it is primarily intended for use by healthcare professionals. It may also be of use to prospective travellers who wish to read about the options for themselves. Each year up to 2000 people return to the UK with malaria and 11 people died from this disease in the UK in 2005.

The guideline provides advice for specific types of traveller and special medical groups as well as general advice including the ABCD of Malaria Prevention:

  • Awareness of risk
  • Bite prevention
  • Chemoprophylaxis
  • Diagnosis and treatment

Action: This guideline will be of use to clinicians who offer advice to travellers visiting areas with endemic malaria.

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New Green Book published

A new print version of Immunisation against Infectious Disease (more commonly known as the Green Book) has been published and distributed by the Department of Health.

This new version is the first print update since 1996 and has therefore been completely revised and features new sections and chapters. It can be ordered online from the Stationary Office at a cost of £45.00.

Alternatively, if you believe you should have received a free copy as part of the NHS mailing a letter sent with the Green Book states that you should telephone 0845 954 000 or email greenbook@broadsystem.com and leave the following details:

  • your name
  • your occupation
  • contact address
  • relevant professional registration number (GMC, RPSGB or nursing registration number)

This letter also contains details of how to return a book if you have received a copy but don't feel it is relevant to your work.

Action: The Green Book is available online but an updated print copy is a welcome update. All clinicians involved in any aspect of immunisation should have access to a copy of the Green Book (either online or in print).

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