Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MHRA confirm co-proxamol withdrawal

The Medicines and Healthcare products Regulatory Agency (MHRA) has confirmed the withdrawal of co-proxamol in a press release in the face of growing resistance from patients and healthcare professionals.

The press release states that co-proxamol is implicated in 300-400 deaths from overdose each year and in almost a fifth of drug related suicides. The remaining product licenses for co-proxamol will have been withdrawn by the end of 2007. The Committee on Safety of Medicines has published Pain Management Guidance to assist clinicians in finding suitable alternatives.

The MHRA also clarify that co-proxamol will remain available as an unlicensed medicine after the licence withdrawals. This will allow clinicians to prescribe in patients for whom alternatives are not effective or suitable. In these instances, liability will rest with the prescribing clinician as with all unlicensed products.

Action: Co-proxamol should only be prescribed in exceptional circumstances. Patients currently taking co-proxamol should be reviewed and alternative treatments sought.

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Ghost writing common in trials

PLoS Medicine has published an article examining the extent of ghost writing in industry-initiated trials.

The authors defined ghost writing as "the failure to name, as an author, an individual who has made substantial contributions to an article".

44 trials were identified and it was found that in 75% of the papers there was evidence of ghost authorship. This rose to 91% when papers were included that acknowledged a contribution but still did not name the individual as an author.

The authors conclude that ghost authoring is common and may undermine accountability and transparency.

Action: This article raises an interesting dilemma: How much should we trust a paper if we don't really know who wrote it?

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SMC accept varenicline

The Scottish Medicines Consortium (SMC) has accepted varenicline (Champix®) for use on the NHS in Scotland.

The recommendation additionally states that the treatment should be made available as part of a smoking cessation support programme.

The SMC also points out that efficacy and safety data are uncertain in patients who have significant co-morbidity and that the additional treatment course after an initial twelve-week supply provides modest benefit.

Action: As previously discussed, Nicotine Replacement Therapy remains the first line choice. Bupropion and then varenicline are suitable alternatives where NRT treatment fails.

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Nystatin pastilles discontinued

Nystatin pastilles (Nystan®) have been discontinued for commercial reasons.

This product has been out of stock recently and supplies are already difficult to source.

Alternative products include:

  • Nystatin Oral Suspension
  • Amphotericin Lozenges
  • Miconazole Oral Gel

Action: Clinicians should make an early switch to alternative treatments to ensure that there are no delays to treatment initiation.

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NSF for CHD: Update

The Department of Health has published a report providing an update on the progress being made since the publication of the National Service Framework for Coronary Heart Disease (NSF for CHD) in 2000.

The update gives details of the investment and progress being made in order to reach the government target of a 40% reduction in the number of premature deaths from CHD by 2010. Since 1996, the number premature deaths decreased by 35.9%.

In addition to this the report also demonstrates reductions in adult smoking prevalence and waiting times for heart surgery. In addition there have been increases in the number of consultant cardiologists and heart surgeons, the number of children receiving free fruit at school, patients receiving thrombolysis within 30 minutes and statin use.

Action: Significant progress has been made in the six years since the publication of the NSF. Continued efforts in the implementation of national policy are likely to produce further improvements.

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