Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Script charge to rise in April

According to a Department of Health press release prescription charges will be increased from 1st April 2008 to £7.10 per item, an increase of 25p.

The price of pre-payment certificates will also rise to £27.85 for a 3 month certificate and £102.50 for a 12 month certificate. Pre-payment certificates are a cost effective choice for patients who require more than 3 prescriptions in three months or 14 prescriptions in twelve months.

The press release points out that 88% of dispensed prescriptions are exempt from payment and that the increase in price is below the rate of inflation.

Action: Clinicians should be aware of the current prescription charge and the cost effective option of pre-payment certificates.

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MeReC Bulletin - Chronic heart failure

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that provides an overview of the diagnosis and drug treatment of chronic heart failure in primary care

The bulletin details:

Action: Clinicians involved in the diagnosis and treatment of patients with chronic heart failure will find this bulletin useful and informative.

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Glucosamine linked to liver failure

According to a story in the Telegraph, glucosamine has been associated with liver failure and death of a patient in Scotland.

The article gives details of a fit and healthy man aged 64 who started top take a glucosamine supplement. Shortly after starting this medication he fell ill and died of liver failure. A Consultant Gastroenterologist who treated this patient is also aware of two other cases where patients taking glucosamine have suffered reactions.

A cause and effect cannot be demonstrated but the potential for a link between the use of glucosamine and liver failure cannot yet be dismissed and is cause for concern.

Recent guidance from the National Institute for Health and Clinical Excellence (NICE) for osteoarthritis has advised clinicians that glucosamine supplements should not be prescribed.

Action: Clinicians should reflect on their prescribing practices for glucosamine. NICE do not recommend this treatment and it may not be free from risk.

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Drug Safety Update, Issue 8

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update Issue 8 (PDF).

This issue includes the following drug safety advice articles:

  • Ketoconazole: restricted indications
  • Telbivudine: risk of peripheral neuropathy with pegylated interferon
  • Modafinil: serious skin reactions, hypersensitivity, and psychiatric symptoms

In addition, this issue contains hot topic information about sales restrictions for nasal decongestants containing pseudoephedrine or ephedrine because of concerns about diversion into the illegal manufacture of methylamphetamine and informs readers of the new and improved electronic Yellow Card for the reporting of suspected adverse drug reactions.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

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Statins safe and effective in CKD

The British Medical Journal has made the results of a meta-analysis into the efficacy of statins in patients with chronic kidney disease (CKD) available early online.

The study examined data from fifty trials including 30,144 patients although not all studies were included for all analyses. Treatment with a statin significantly lowered total cholesterol, low density lipoprotein and levels of proteinuria but had no effect on glomerular filtration rate.

In looking at patient orientated outcomes, fatal and non-fatal cardiovascular events were both statistically reduced. Fatal cardiovascular events were reduced by 19% (95% CI 0.73 to 0.90, p < 0.001) and non-fatal events were reduced by 22% (95% CI 0.73 to 0.84, p < 0.001). Withdrawal rates were not statistically different when comparing statin and placebo arms.

The authors conclude that, "statin treatment is safe and reduces the risk of major cardiovascular events in patients with chronic kidney disease". It is also noted that an effect on all-cause mortality was not detected but that this may be due to inadequate statistical power and populations chronic kidney disease are understudied. Finally, attention is drawn to on-going randomised controlled trials in chronic kidney disease patients that aim to clarify the role of statins in primary prevention.

Action: Clinicians should ensure that patients with CKD and existing cardiovascular disease are offered treatment with a statin. Other patients with CKD should be risk assessed for cardiovascular disease and offered treatment appropriate to their level of risk.

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