Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Combivent discontinuation announced

The manufacturer of Combivent® (ipratropium 20micrograms / salbutamol 100micrograms) has announced that the metered dose aerosol inhaler will be discontinued in 2008.

The decision to discontinue this product is based upon European CFC environmental legislation that restricts the use of CFC propellants. There are no concerns about the safety profile, effectiveness or quality of the product.

This product is indicated in the British National Formulary as being less suitable for prescribing.

Action: Clinicians should take this opportunity to review existing treatments. Prescription of ipratropium and salbutamol in separate inhalers is one solution to this discontinuation.

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September CKS Update

Clinical Knowledge Summaries (CKS) has been updated in September for the following clinical areas:

The update also provides access to the September issue of Drug Safety Update and the Skin Disorders Specialist Library's National Knowledge Week on Atopic Eczema as well as improved searching of the CKS site using Google technology.

Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.

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NPCi website launched

The National Prescribing Centre (NPC) website has been redesigned and the new educational portal NPCi has been launched.

The NPCi site is "a new and radically different NHS learning resource designed specifically for busy health care professionals and managers". The site provides access to a host of information including:

  • Existing NPC materials including MeReC and On The Horizon publications
  • Detailed information covering therapeutic topics
  • Detailed information covering medicines management topics
  • Discussion rooms
  • A blog providing rapid commentary on a recent newsworthy health topics

Action: NPCi is likely to be an invaluable resource for clinicians and patients alike. Clinicians should bookmark this site.

Declaration: I have worked closely with the NPC on several aspects of this new site and will be writing some content for NPCi

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BMD is not the only fracture risk

The Journal of the Canadian Medical Association has published the results of a study into the relationship between fracture events and bone mineral density (BMD) in postmenopausal women.

This study was a retrospective cohort study involving 16,505 women aged 50 or older who underwent a baseline bone mineral density assessment at the spine and hip between May 1998 and October 2002. Approximately half of the participants in the study were over 65 years old. The average period of follow up was 3.2 years.

765 fracture events were recorded (186 hip; 208 spine; 189 forearm; 228 humerus) with 520 (68%) of these occurring in women over 65 years old. 59.7% to 67.8% of fractures occurred in patients with a T-score that was non-osteoporotic depending on the site used for baseline assessment of BMD.

This study is limited because it was not a random sample of the population but was a physician selected population on the basis of referral for assessment of BMD. The authors conclude that there is a "strong relation between low bone mineral density and increased fracture risk" but also point out "the fact that most fractures occur in women with normal or osteopenic bone mineral density".

Action: Clinicians should ensure that treatment decisions to prevent fractures are based upon overall fracture risk. The existing NICE Guidance should be used to guide treatment initiations with bisphosphonates.

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Diet and Exercise message failing?

Two recent surveys have indicated that public health messages about diet and exercise may be failing to have the desired effect.

The first survey by the Food Standards Agency (FSA) questioned over 2,000 people about what constituted a healthy, balanced diet. Many respondents did not know that tinned and frozen fruit or vegetables could count towards 'Five-a-Day'. Nearly one in five thought that eating something 'healthy' cancelled out eating something that has a high fat or sugar content. More results have been reported in the media (BBC).

The second survey, conducted by YouGov, questioned 2,100 people about exercise activity and what motivates them to exercise. Three in every five respondents indicated that they would not exercise more if their life depended on it. This story has also been reported in the media (BBC).

Action: Despite these disappointing survey results clinicians should continue to advise patients about diet and exercise at every opportunity.

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