Prescribing Hints & Tips

October 2011

Sativex

Sativex (tetrahydrocannabinol) is not routinely funded for patients with multiple sclerosis or for any other indication. It is anticipated that there will be no exceptions to this policy. Sativex remains grey on the traffic lights.

NICE hypertension guidelines

Step one is now an ACE inhibitor or low-cost ARB (losartan) for patients under 55, and a calcium channel blocker for patients over 55 and black patients of African or Caribbean origin. Please note that ARBs have not (yet) been shown to reduce mortality against placebo, whereas ACEIs have.
At step three, indapamide should be used instead of bendroflumethiazide. Existing patients on BFMZ need not be switched.

Dabigatran (Pradaxa)

Dabgatran has been classified as grey and is not yet recommended for prescribing within NHS Nottingham City

June 2010

Subscription to Travax website

The subscription to this website will expire in August 2010 and will NOT be renewed. This decision was made as there is a free of charge website (NaTHNaC) that provides the same detailed travel advice as Travax. This website can be accessed from here.

Increased risk of fractures with antidepressants

A review of epidemiological studies, mainly in patients age 50 years or older, shows an increased risk of bone fractures in patients receiving SSRI or tricyclic antidepressants. The MHRA advises healthcare professionals to be aware of a small increased risk of fractures associated with the use of these agents, and to take this risk into account when making prescribing decisions. For full details please see the MHRA drug safety update.

Manufacturing problem with Betnesol

We have reports that pharmacies are finding it difficult to obtain Betnesol ® nasal drops for patients with severe rhinitis or nasal polyps. However, there are other brands of betamethasone
0.1% drops available. It is recommended that betametasone is prescribed generically in the first instance to ensure the pharmacy can supply whichever brand they are able to obtain, rather than issuing an alternative prescription for a more expensive steroid drop.

Myopathy with simvastatin 80mg

There is an increased risk of myopathy associated with high-dose (80 mg) simvastatin. The MHRA advises that health professionals should only consider an 80-mg dose in patients with severe hypercholesterolaemia and high risk of cardiovascular complications who have not achieved their treatment goals on lower doses, when the benefits are expected to outweigh the potential risks. For more details please see the MHRA drug safety update.

Prednisolone cost comparison

Enteric coated (or gastro-resistant) prednisolone tablets are significantly more expensive than the standard tablets; however there is no evidence that they offer any advantage in reducing risk of peptic ulceration.

• Prednisolone 5mg EC tablets - £7.53 for 28
• Prednisolone 5mg tablets - £1.20 for 28

Source: PCT Prescribing Team, June 2010

September 2009

Pregnant patients who have taken Tamiflu or Relenza

Please report all pregnancies where the mother has taken Tamiflu or Relenza to the UK Teratology Information Service.

UKTIS tel. 0191 232 1525

Ferrous fumarate is cheaper

Please consider prescribing ferrous fumarate 210mg (costs 81p for 28 days at 1 bd) instead of ferrous sulphate 200mg (costs £2.58).

Ezetimibe is AMBER 2

The DTB (Aug 2009) say it is unclear whether adding ezetimibe to a statin reduces cardiovascular morbidity or mortality, although it does not seem increase unwanted effects or serious reactions in the short term. Reducing the statin dose while adding ezetimibe (to achieve the same lowering of LDL) does not improve tolerability. The Area Prescribing Committee has therefore classified it AMBER 2 (only to be prescribed following advice from a specialist).

Source: PCT Prescribing Team, September 2009