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Issue 12 Medicines!December 2016 DICYCLOVERINE In the last 12 months Practices in Cambridgeshire and Peterborough CCGs spent more than £600,000 (65,580 items) on gastrointestinal (GI) anti-spasmodic drugs. These include mebeverine, peppermint oil, hyoscine hydrobromide and dicycloverine. Prescriptions issued for dicycloverine, which is non formulary accounted for £160,000 (25%) of total spend (1,166 items), but relating to only 1.8% of total items for GI Anti-spasmodic drugs.
Effectiveness & Side Effects of Treatment Options for Irritable Bowel Syndrome - NICE CKS a) The evidence base on drug treatments for the management of irritable bowel syndrome (IBS) is generally poor. There is a high placebo response to treatment in people with IBS, but this often wears off after initial success. In general, evidence from controlled studies is of poor quality, shows only moderate responses, and carries a significant risk of positive publication bias as indicated by heterogeneity of the trial results. b) There is insufficient evidence to demonstrate a significant difference in effectiveness between hyoscine, mebeverine, peppermint oil and dicycloverine. c) Evidence suggests mebeverine may produce less adverse effects than dicycloverine. d) Antimuscarinics, such as hyoscine and dicycloverine, have poor selectivity for intestinal smooth muscle and are likely to cause antimuscarinic adverse effects e.g. constipation, transient bradycardia (followed by tachycardia, palpitation and arrhythmias), reduced bronchial secretions, urinary urgency and retention. Mebeverine is the CCG first line formulary choice, if dietary and lifestyle advice alone are unsuccessful. For short term use, for the symptomatic relief of IBS, the CCG recommends to self care and purchase over the counter. C&PCCG Formulary
Cost of antispasmodics based on November 2016 Drug Tariff prices Drug Tariff Drug Tariff Usual dosage Qty - 28 Cost - 28 ACTION REQUIRED Drug/Strength listed qty List price regimen day supply day supply Individual practice data Dicycloverine 10mg 100 £184.25 tds 84 £154.77 will be circulated, Dicycloverine 20mg 84 £196.69 tds 84 £196.69 please review and Dicycloverine £664.37 switch to mebeverine 120ml £189.82 tds 420 – 840ml 10mg/5ml £1328.74 which is first line Alverine 60mg caps 100 £19.48 tds 84 £16.36 formulary choice. Alverine 120mg caps 60 £23.28 tds 84 £32.59 Peppermint oil 0.2ml 84 £7.04 tds 84 £7.04 g/r caps Peppermint oil 0.2ml 100 £12.18 tds 84 £10.23 m/r caps Mebeverine 135mg tabs 100 £7.02 tds 84 £5.89 Mebeverine 200mg MR 60 £6.92 bd 56 £6.46 caps Hyoscine butylbromide 56 £3.00 tds 84 £4.50 10mg tabs Medicines Management Team [email protected] 01480 387126