Download APC Newsletter 2004

ROTHERHAM AREA PRESCRIBING
COMMITTEE
BULLETIN NO. 2
MARCH 2004
HOT TOPIC NO. 1
Atypical Antipsychotics in Elderly Confused Patients
I am sure you will all have received the CMO’s urgent guidance on 9 March 2004
regarding Atypical Antipsychotic Drugs and Stroke. Many of you will be
considering what action should be taken with existing patients in this group who
are taking Atypical Antipsychotics. Following detailed discussions, the Area
Prescribing Committee decided that rather than rush into giving unconsidered
advice, it would be more appropriate to signpost GPs to detailed current
guidance. This is available on the following website:
http://www.rcpsych.ac.uk/college/faculty/oap/professional/index.htm
http://www.rcgp.org.uk/corporate/position/drugs.ask
http://www.bgs.org.uk
http://www.mhra.gov.uk
http://alzheimers.org.uk
Further Rotherham specific guidance will follow after the meeting of the DASH
Medicines Management Group which will take place early in April.
HOT TOPIC NO. 2
Oxcarbazepine
Oxcarbazepine
has been considered at the APC meeting and is to be reallocated from a red light drug to an amber light drug.
HOT TOPIC NO. 3
Suicide Risk
Following guidance from the NSF Standard 7 Suicide Group, the APC has recommended
that patients who have a history of self harm or attempted suicide within the previous
three months should be prescribed with no more than two weeks’ medication at any one
time. In addition, drugs which are considered to be particularly toxic especially Coproxamol and Dosulepin (Dothiepin) should not be prescribed to these patients at all.
HOT TOPIC NO. 4
Prescribing Incentive Scheme
Following discussions at the PCT Prescribing Committee meeting we questioned whether
the Prescribing Incentive Scheme was an appropriate use of the allocated funds.
Whilst prescribing in Rotherham is generally improving, thanks to a strong relationship
between the prescribing team and individual prescribers, we still have significant areas
of weakness. We have tried to address these through the GP Incentive Scheme but in
areas such as non-steroidal anti-inflammatories (and COX 2s), PPI’s and combination
analgesics, the effect over the past year of the GP Incentive Scheme has not had the
desired effect. The significant majority of practices this year will not meet their
targets in these areas. In discussions with the Professional Executive, Local Medical
Committee and you, we are starting to plan a revised scheme. We are not sure yet
precisely what form this new scheme will take, so we will be producing a set of options
followed by a recommendation from the prescribing committee of the PCT, to go to the
Professional Executive. Any suggestions would be helpful and welcomed
Please note the email address of the Prescribing Team:
Sue Wright:
Phil Scorah:
Daniel McNulty:
Eloise Summerfield:
[email protected]
[email protected]
[email protected]
[email protected]
HOT TOPIC NO. 5
Statin Prescribing
It
has come to our attention that representatives from AstaZeneca have been
informing both nurses and GPs in Rotherham that Rosuvastatin is recommended second
line by the Primary Care Trust. This is not the case (and we will be taking this up with
the company at a high level). The reason Rosuvastatin is not considered in our opinion
to be a second line drug is because it is still a black triangle drug and long term data
does not exist. This is not particularly a cost issue, as rosuvastatin is quite
competitively priced. The reason we recommend simvastatin first line is because of the
overwhelming body of all evidence associated with this drug. Rotherham District
General Hospital has recently reviewed their recommendations for the use of statins,
these guidelines were formulated in consultation with Primary Care. A copy of these
guidelines is enclosed.
HOT TOPIC NO. 6
Calcium and Vitamin D Supplements
Rotherham
District General Hospital now dispense AdCal D3 for prescriptions of
Calcium and Vitamin D3x.
Intranet Link:
http://195.104.72.23/lib/3484/1717/guidelines.html
Drug and Therapeutics Committee’s statement on
Lipid Lowering agent Prescription at
Rotherham General Hospital NHS Trust
Starting Date February 1, 2004
Drugs
Starting Dose
Maximum Dose
First Line drugs
Simvastatin
20 – 40 mgs daily
80 mgs daily
Pravastatin
40 mgs daily
80 mgs daily
Second line drugs for patients who failed to respond
+
those with mixed hyperlipidaemia
Atorvastatin
10 – 20 mgs daily
80 mgs daily
Third Line Drugs – Specialist use only
Rosuvastatin
10 mgs daily
40 mgs
Ezetimibe
10 mgs daily
Niaspan
1 gm daily
2 gm daily