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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MeReC Extra 46

The National Prescribing Centre has published MeReC Extra 46 (PDF) which discusses the place in therapy for simvastatin 80mg daily and the increased risk of cancer observed with angiotensin receptor blockers (ARBs).

The first section notes that earlier this year regulatory authorities drew attention to the increased risk of myopathy with simvastatin at a daily dose of 80mg. This advice is then placed into context with a review of the current Lipid Modification guidance issued by the National Institute for Health and Clinical Excellence (NICE). Statin doses and lipid targets (or the lack of them) are detailed for primary prevention, secondary prevention and acute coronary syndrome (ACS). Clinicians are also reminded that when treatment appears ineffective it is worthwhile checking how concordant the patient is in taking their treatment.

The second section discusses the results of a recent meta-analysis that identified an increased rate of new cancer diagnoses in patients taking ARBs in randomised controlled trials. Although the absolute risk increase is small (1.2% over 4 years) the large number of patients potentially involved means that this information deserves some consideration. Clinicians are advised to review prescribing of ARBs on an individual patient basis. Angiotensin converting enzyme (ACE) inhibitors have more robust efficacy and safety data and may be a suitable alternative.

Action: Clinicians who prescribe statins or ARBs will find this information useful and informative.

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