Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - December 2011

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for December 2011 (PDF).

This issue contains drug safety information reminding clinicians that citalopram and escitalopram are associated with dose-dependent QT interval. It is recommended that these drugs are avoided in patients with prolonged QT interval, that ECGs are considered in patients with cardiac disease and that electrolyte imbalances are corrected before starting treatment. This section also reminds clinicians that renal function testing is recommended prior to starting treatment with dabigatran following several cases of serious and fatal haemorrhage in elderly patients with renal impairment. Annual testing is also recommended in patients over 75 years old and in those with a suspected decline in renal function.

The hot topic section advises that a substantial body of evidence now exists that offers reassurance that there is no link between use of angiotensin receptor blockers and cancer.

Finally, readers are directed to the new SSRI learning module and offered an End of Year Quiz that tests drug safety knowledge based on the updates published this year.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

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Smoking cessation and mortality

The Archives of Internal Medicine has published the results of a 22 year follow up of the Physicians' Health Study (PHS) to assess the effect of smoking cessation on total and cause-specific mortality.

PHS recruited 22,071 male US physicians between 1982 and 1984 and collected detailed information about smoking habits via a questionnaire 5 years into the study. This review analysed cause of death from death certificates for individuals who died between 3 years after the questionnaire and a fixed date of 9th March 2010. This review therefore included data for 19,705 individuals.

Crude mortality rates are 11.5 per 1,000 patient years for never smokers, 16.6 for ex-smokers and 26.1 for current smokers. Current smokers were at significantly higher risk of death from cardiovascular and pulmonary causes as well as lung cancer.

In ex-smokers, the risk of death was significantly reduced within 10 years of stopping smoking (Hazard Ratio 0.60, 95% CI 0.54-0.68) and this risk declined further by 20 years (HR 0.48, 95% CI 0.43-0.54). At 20 years the risk was not significantly different from that of individuals who had never smoked.

The paper includes several charts showing the risks of death from all, cardiovascular and pulmonary causes as well as several types of cancer. These charts may prove useful in communicating the risks of smoking and demonstrating the benefits of smoking cessation.

Action: Clinicians who encourage smoking cessation may find the data in this paper useful in illustrating the health benefits of stopping smoking.

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Prodigy update - December 2011

Prodigy (formerly CKS) has been updated in December 2011 for the following clinical areas:

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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SSRI learning module

The Medicines and Healthcare products Regulatory Agency (MHRA) has launched an educational module that aims to assist health professionals in maximising the benefits and minimising the risks of selective serotonin reuptake inhibitor (SSRI) treatment.

The module notes that SSRIs are the most widely prescribed class of antidepressants. Common and rare adverse effects are identified as well as strategies that minimise and manage the risks. It is suggested that reading will take about two hours and the self assessment test would take about 30 minutes.

Action: Healthcare professionals who prescribe SSRIs will find this a useful resource.

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