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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - May 2010

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

Telmisartan (Micardis®) has been rejected for use in cardiovascular prevention and in type 2 diabetes with documented target organ damage. The manufacturer failed to make a submission.

Sitagliption / Metformin (Janumet®) has been accepted for restricted use as an adjunct to diet and exercise to improve glycaemic control in patients with type 2 diabetes mellitus. It is restricted to use in patients for whom a combination of sitagliptin and metformin is an appropriate choice of therapy and only when the addition of sulphonylureas to metformin monotherapy is not appropriate.

Extended release nicotinic acid / laropiprant (Tredaptive®) has bee accepted for restricted use in the treatment of dyslipidaemia, particularly in patients with combined mixed dyslipidaemia and in patients with primary hypercholesterolaemia as monotherapy in patients in whom HMG-CoA reductase inhibitors [statins] are considered inappropriate or not tolerated.

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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2 Comments to “SMC Update - May 2010”

  1. @Bev,

    I suppose what you say is true enough but glitazones carry cardiovascular safety concerns and gliptins have a caution in declining renal function.

    After metformin there really is not a lot to choose between the options we have available based on efficacy and tolerability / safety. So it all boils down to cost and SUs are much less expensive.

    Comment by Matthew Robinson — May 25, 2010 #

  2. It does make me smile when it says 'when SUs are not appropriate'. When are they ever...? NICE says avoid if you're concerned about weight gain or hypos. Presumably clinicians who aren't concerned about those issues don't like their patients very much!

    Comment by Bev Cox — May 25, 2010 #

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