Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

AF not prevented by valsartan

The New England Journal of Medicine has published the results of a randomised controlled trial that aimed to assess whether valsartan could reduce the recurrence of atrial fibrillation (AF).

Some clinical studies have suggested that treatment with angiotensin receptor blockers like valsartan (Diovan®) may prevent AF. This study recruited 1,442 patients in sinus rhythm who had two or more episodes of AF in the previous 6 months or who had been successfully undergone cardioversion in the previous 2 weeks. Participants also had existing morbidities of cardiovascular disease, diabetes or left atrial enlargement.

Participants were randomly assigned to treatment with placebo or valsartan and followed up for 1 year. Data were collected based on time to first recurrence of AF and proportion of patients in whom AF recurred within follow up.

AF recurred in 51.4% of the active treatment arm and in 52.1% of the placebo arm. This difference was not statistically significant (p=0.73) and there was also no difference in the time to recurrence. The authors conclude that, "valsartan was not associated with a reduction in the incidence of recurrent atrial fibrillation".

Action: Clinicians should ensure that treatment choices in AF are based on current evidence; valsartan should not be used to prevent recurrence of AF.

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SMC April Update

The Scottish Medicines Consortium (SMC) has issued its monthly advice on new medicines.

Budesonide (Pulmicort®) CFC-free has been accepted for use in the treatment of asthma based upon it replacing the equivalent CFC-containing metered dose inhalation device.

Brinzolomide eye drops (Azopt®) have been accepted for the treatment of elevated intraocular pressure in ocular hypertension and open-angle glaucoma.

Fluticasone furoate (Avamys®) nasal spray has been accepted for the treatment of the symptoms of allergic rhinitis in adults, adolescents (12 years and over) and children (6 to 11 years). The appraisal notes that other intranasal steroids are available at a lower cost.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

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2009/10 Influenza Programme

The Chief Medical Officer at the Department of Health has written (PDF) to healthcare professionals providing early details of the 2009/10 influenza vaccination programme.

The vaccination programme is unchanged and includes those aged 65 years and older and the following clinical risk groups:

  • Chronic respiratory disease
  • Asthma requiring repeated use of inhaled or systemic steroids
  • Chronic heart disease
  • Chronic renal disease
  • Chronic liver disease
  • Chronic neurological disease
  • Diabetes
  • Immunosuppression

In addition to these groups, vaccination of poultry workers is recommended as a precautionary measure to reduce the risk of new influenza viruses emerging.

Action: Clinicians will find this information useful in the early planning stages for the vaccination campaign this year.

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Minimum alcohol prices gaining support

Earlier this year the Chief Medical Officer recommended introducing a minimum price for each unit of alcohol.

The Annual Report for 2008 devoted an entire chapter to the topic of excessive alcohol consumption and examined the concept of passive drinking. This concept includes effects beyond the drinking individual such as behavioural and emotional problems in families and alcohol-related crime.

The proposal to introduce a minimum price of 50p per unit of alcohol is predicted to result in:

  • Over 3,000 fewer deaths
  • Almost 98,000 fewer hospital admissions
  • 45,800 fewer crimes
  • 296,900 fewer sick day
  • A saving of over £1 billion

According to the BBC, the Prime Minister is concerned that raising the price of alcohol may unfairly penalise sensible drinkers, however the recommendation has received support from the Royal College of Physicians and the Royal College of Nurses.

Action: Clinicians will already be aware of the harms that result from excessive alcohol consumption. Clinicians should continue to encourage sensible drinking levels to reduce personal and social harms.

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Calories on some menus

The Department of Health has announced that eighteen major catering companies will start to start to include calorie information on menus from the end of April. The general media has reported this announcement (BBC).

The companies include some popular high street chains as well as hospital and college catering firms. Each company has agreed to:

  • Display calorie information for most food and drink they serve
  • Print calorie information on menu boards, paper menus or on the edge of shelves
  • Ensure the information is clear and easily visible at the point where people choose their food

The Foods Standards Agency stated that this move aims "to ensure that consumers have better information so they can make informed choices to improve their diet when eating out".

Action: Clinicians should be aware of this development. Patients can be advised to look out for calorie information when eating out.

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