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The prescribing newsletter for GPs, nurses and pharmacists
NHS Nene CCG and NHS Corby CCG
• COPD: risk of pneumonia with 2 different inhaled corticosteroid / LABA combinations
A large observational study (the PATHOS studyhas found that use of fluticasone dipropionate / salmeterol in people with COPD was associated with a greater risk of pneumonia, and of death associated with pneumonia, than budesonide / formoterol. The study reinforces MHRA advice to be vigilant for the development of pneumonia and other infections of the lower respiratory tract when using inhaled corticosteroids to treat people with COPD, and to follow NICE guidance for the care of people with COPD. For further discussion of the study please see the NICE Medicines Evidence Commentary at
• Rizatriptan now off-patent.
The patent for rizatriptan [Maxalt brand] has now ended and the Drug Tariff price is expected to fall as generic alternatives become available. In order to take advantage of this price decrease, please prescribe generically. However, please pay special attention when selecting the formulation. Maxalt Melts are a patented technology known as lyophilisates so a prescription for rizatriptan lyophilisates will be filled by dispensing Maxalt Melts and charged as such. In order to ensure that a generic is supplied, please prescribe as “oro-dispersible tablets”. This description is available on SystmOne and is expected to be on EMIS in the near future.
• Sildenafil price fall
The Drug Tariff prices of generic sildenafil have fallen significantly in October – all strengths are now approximately £1.50 for 4 tablets, compared to approximately £20 for branded Viagra and £27 for tadalafil (Cialis).
• Insulin needles – care in selecting the right length.
Traditionally, needles for the sub-cutaneous injection of insulin have been available in a variety of lengths, from 4mm up to 12mm. When using the longer needles, care is required to make sure that the angle of injection does not bring a risk of injecting into the muscle, where it is absorbed faster, is likely to be shorter-acting and is more painful. This is particularly important for slim patients. In order to reduce the risk, it is recommended that needles longer than 8mm are no longer prescribed.
• Friends, doctors, and tramadol: we might have a problem
This is the title of a recent letter in the BMJwritten by a consultant addiction psychiatrist who raises concerns about addiction to tramadol. The letter states, “Over the past two decades, opioid prescription for chronic non-cancer pain has risen rapidly in the US, partly as a result of aggressive marketing. As prescribing increased, so did non-medical use. Prescription opioid misuse is now the leading drug problem in the US, with more overdose deaths from prescription opioids than from heroin. Recent data show that deaths related to prescription opioids are also increasing in England and Wales. In particular, deaths due to the painkiller tramadol have doubled in the past four years to 179 last year. As part of our on-going monitoring of drug trends, Global Drug Survey explored the misuse of prescription drugs at the end of 2012. Questions on tramadol were included for the first time, and 369 UK respondents reported using tramadol during the past year. Although 60 of the 91 respondents (66%) who reported using the drug to get high obtained it from friends or a dealer, 18 (20%) obtained it by prescription. In the 264 respondents for whom tramadol was the only prescription drug used in the past year, 75 (28%) reported mixing it with alcohol or other drugs (or both) to enhance its effect. Fifty one (19%) had taken more tramadol than was prescribed and 27 (10%) reported feeling physically or emotionally unwell when attempting to use less tramadol. Our data should remind doctors that responsible prescribing of opioids is the best way to ensure that we do not emulate the US, Australia, and other developed countries in creating a new epidemic of opioid dependence”. In the UK a consultation is underway proposing that tramadol is re-categorised as a Controlled Drug
• Statin use linked to small increase in cataracts risk
This story has been reported in several newspapers recently and is based on an observational study published in JAMA. Most of the media has reflected the findings of this story appropriately. The exception is the Daily Express, which made the claim that “thousands 'at risk of losing their eyesight by taking statin pills'”. NHS Choices “behind the headlines” has published a useful summary of what this study actually shows.
This edition is also available on PathfinderRF via the following lin
and on the Nene CCG and Corby CCG websites
Disclaimer Information in this newsletter is believed to be accurate and true. NHS Nene CCG and NHS Corby CCG and their employees accept no liability for loss of any nature, to persons, organisations or institutions that may arise as a result of any errors or omissions.
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Sodium Cromoglycate in the Management of Chronic or Recurrent Enterocolitis in Patients With Hirschsprung’s Disease Background/Purpose: Chronic or recurring enterocolitis is a Results: The follow-up of the patients ranges from 8 months rare but perplexing complication of Hirschsprung’s diseaseto 26 months. Three of the 5 patients with chronic enteroco-affecting especially patient