Rotherham Area Prescribing Committee s1

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 re- allocated 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 Co-proxamol 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: [email protected] Phil Scorah: [email protected] Daniel McNulty: [email protected] Eloise Summerfield: [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