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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

DTB - December 2010

The Drugs and Therapeutics Bulletin (DTB) for December 2010 has been published. It reviews insulin therapies, topical antibacterials for acne and Targinact®.

The review of insulin therapies compares human insulins with analogue insulins, regimens and devices. Relative costs and national guidelines from NICE and SIGN are also considered. The authors note that there is little cost difference between devices and therefore device choice should be patient-led. However, they also note that "analogue insulins offer no significant clinical advantage and are much more expensive" and it is recommended that it would be appropriate to start most patients on basal isophane insulin treatment with the addition of short-acting human insulin if needed.

The review of topical antibacterial products for acne considers the place in therapy for these products, either alone or in combination with benzoyl peroxide, compared to benzoyl peroxide alone. The review also considers the impact of microbial resistance to the continued use of such products. The authors note that these products are effective but are no more effective than benzoyl peroxide alone. Where antibacterial agents are indicated in acne they recommend use "in combination with a topical agent that has anti-resistance properties" with a short term review.

The review of Targinact® considers whether this product offers any advantages over using strong opioids plus laxatives where required. Targinact contains oxycodone and naloxone. The addition of naloxone is proposed to counteract opioid-induced constipation. This review notes that there little data to demonstrate a reduced need for laxatives and that no comparative studies with usual care (morphine plus laxative) have been performed. The authors conclude that they "can see no reason why Targinact should be prescribed".

Action: Clinicians will find these review articles useful and informative. Current practices may need review based on these recommendations.

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