Prescribing Advice for GPs

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MeReC Extra 47

The National Prescribing Centre has published MeReC Extra 47 (PDF) which discusses the latest information regarding ezetimibe (Ezetrol®), antipsychotic drugs and the management of infections in primary care.

The section covering ezetimibe reviews a recent editorial in the Drugs and Therapeutics Bulletin that questioned whether this drug provides good value for money. This discussion reviews the recommendations from NICE and notes that the "acquisition cost considerably over simvastatin 40mg". It is also noted that the current evidence base for ezetimibe has not shown improvements in patient orientated outcomes.

The section covering antipsychotic drugs discusses the results of a meta-analysis that compared first and second generation antipsychotic drugs (also termed typical or conventional and atypical respectively) in early psychosis. This analysis found no significant differences in efficacy or rates of discontinuation between the two classes. There was more weight gain with the second generation drugs and more extrapyramidal symptoms with the first generation drugs. The current NICE guidance does not favour a particular class of antipsychotic so drug selection should be tailored to the individual patient after consideration of the side effect profile and acquisition cost.

This issue also directs readers to updated advice from the Health Protection Agency in the management of common infections in primary care. This update takes into account the advice of other organisations, such as NICE, SIGN and CKS.

Action: Clinicians who prescribe lipid modifying drugs, antipsychotic drugs or who treat infections in primary care will find this information useful and informative.

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