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recommended as an option for the management of chronic hyperuricaemia in gout only for people who are intolerant of allopurinol (as defined below) or for whom allopurinol is 1.2 For the purposes of this guidance, intolerance of PRESCRIBING AND DISPENSING NEWS
allopurinol is defined as adverse effects that are sufficiently No 196 FEBRUARY 2009
severe to warrant its discontinuation, or to prevent full dose escalation for optimal effectiveness as appropriate within its 1.3 People currently receiving febuxostat should have the option to continue therapy until they and their clinicians A recent systematic review and meta-analysis (JAMA Nov 26, 2008) found that while inhaled steroid use in COPD did not significantly affect mortality, there was a significantly increased incidence of pneumonia (number needed to harm =25). Clinicians should follow NICE guidance and only NICE GUIDANCE – MEDICINES
prescribe inhaled steroids for certain patients with moderate ADHERENCE
or severe COPD (FEV1 <50% predicted). When considering inhaled corticosteroids in COPD, clinicians should weigh the possible benefits such as reduced Adherence to medicines is defined as the extent to which the exacerbations, with the potential adverse effects, patient’s action matches the agreed recommendations. particularly an increased risk of pneumonia. Extensive reviews of the literature reveal that in developed countries adherence to therapies averages 50%. NICE Guidance (CG76, Jan09) offers best practice advice on how to involve patients in decisions about prescribed medicines and how to support adherence. It also ORAL NSAIDS
recommends that the initial decision to prescribe medicines, the patient’s experience of using the medicines and the Updating the good news described in the Oct08 issue - patient’s needs for adherence support should be reviewed when comparing primary care trend data (the month of regularly. Healthcare professionals involved in prescribing, Oct08 compared with the month of Oct07) in terms of dispensing or reviewing medicines should ensure that there are robust processes for communicating effectively with other healthcare professionals involved in a patient’s care. Cornwall & IoS
This guidance has the potential to impact many key areas of medicines management such as prescribing, dispensing, patient understanding of their medication, medicines waste and patient safety. Improving and encouraging a partnership approach to medicines taking will help to improve these Note that comparing Oct08 items with Oct07 is a relatively areas and others, resulting in a medication regimen that is crude analysis as there are monthly fluctuations, but we more likely to be adhered to by the patient. appear to be heading in the right direction. NICE GUIDANCE - OSTEOPOROSIS
GUIDE TO PRESCRIBING AND THE
DRUGS BILL, ETC
NICE has issued guidance (TAGs 160 and 161, Oct08) on the use of drugs for the primary and secondary prevention of osteoporotic fragility fractures in postmenopausal women What you need to know about prescribing, the ‘drugs bill’ with osteoporosis. They recommend a range of treatment and medicines management – a guide for all NHS managers is a document providing concise information on the fundamentals of medicines usage. It briefly explains the women who cannot comply with the recommended first-line legal framework for medicines supply and regulation, treatment (alendronate), or who have contra-indications to it describes payment mechanisms in primary and secondary or cannot tolerate it. A combination of T-score, age and care, and highlights the importance of medicines number of independent clinical risk factors is specified management activities in the commissioning, provision and within the appraisals for each alternative treatment option. re-design of services. It may be of particular interest to These should be considered when assessing a woman’s suitability for that treatment. Both technology appraisals assume that women who receive treatment have an adequate calcium intake and are vitamin D replete. Unless clinicians are confident that women who receive treatment meet these criteria, calcium and/or vitamin D supplementation should NICE GUIDANCE - FEBUXOSTAT
NICE Guidance (TAG 164, Dec08) on febuxostat (a medicine not yet promoted in the UK) recommends: Although NICE has been forced to reconsider these 1.1 Febuxostat, within its marketing authorisation, is guidelines after a successful high court challenge from one of the affected drug manufacturers, the existing advice the web site is provided by pharmaceutical companies and should continue to be implemented until the review is However, some companies’ products are not listed or only SUMMARIES OF PRODUCT some of them are listed. Links to SPC information for many
of these are listed in this Medicines Q&A link on NeLM: CHARACTERISTICS
The eMC website, which is updated daily, holds summaries of product characteristics (SPCs) and Patient Information Leaflets for most branded UK medicines. All information on MINOCYCLINE IN ACNE

Drug & Therapeutics Bulletin Jan09 revisits the topic of minocycline in acne (previously considered by a 2006 issue of D&TB).
Although an effective treatment for some patients, there is a lack of evidence that minocycline is any better than other options. As
well as general tetracycline-like side effects, minocycline appears to have particular side effects: hyperpigmentation, lupus-like
syndrome, arthropathies, autoimmune hepatitis and vasculitis associated with a production of a range of autoantibodies. The
D&TB article contains a national prescribing trend graph from Mar97 to Mar08. The chart below illustrates the Cornish primary
care trend. Overall the reduction within Cornwall & IoS has not been quite as dramatic as the national picture, though we also
show an increase in use of lymecycline (which is licensed only for acne).
Oxytetracycline (and tetracycline, which is now very expensive) are often used as first line oral tetracyclines for acne but need to be taken twice a day on an empty stomach. Where once-daily treatment is preferred, lymecycline and doxycycline can be used and need not be taken on an empty stomach, though doxycycline may be more likely to cause photosensitivity. Approximate cost for 6 months treatment: doxycycline 100mg daily £12, oxytetracycline 500mg BD £24, lymecycline 408mg daily £44, minocycline tabs 100mg daily £44, minocycline 100mg M/R caps £63, tetracycline 500mg BD £215 Michael Wilcock, Head of Prescribing Support Unit, Pharmacy Department, RCHT, Truro, TR1 3LJ. Telephone 01872 253548. For full prescribing information on any of the drugs mentioned please consult Summaries of Product Characteristics and the current BNF. Every effort is made to ensure the accuracy of information in this Newsletter, which is published only for NHS use in the Cornwall & IoS health community. This newsletter is stored on the following two websites: Request for other formats. Please ask if you would like to receive this
newsletter in large print, braille, on CD or in any other languages. If you would like
the newsletter in an alternative format please contact the PALS team on
palsteam@ciospct.cornwall.nhs.uk or 0845 170 8000.

Source: http://www.swmit.nhs.uk/pdf+/CIOS/cios1960209.pdf

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