Drug and Therapeutics Bulletin recent issues

No recycling

2012-05-08T21:01:06-07:00

The quantity of medicines that is ‘wasted’ remains an area of concern for all those involved in healthcare. An estimated £450m worth of prescription medicines are discarded every year in England, Scotland, Wales and Northern Ireland.1–3 It is thought that a fifth of the population has one or more unused medicines in their possession, and that on average, 75 prescription items are returned to each community pharmacy every month.1 Nationally, around 1% of dispensed items are eventually returned to a pharmacy or dispensing GP practice unused or partially used.1 The national health services pay for medicines to be dispensed and then pay for those that have been returned to be collected and destroyed. Patients, relatives and carers are always dismayed to discover that returned medicines cannot be recycled for use by another patient. And if not in this country,...

DTB Select: 5 | May 2012

2012-05-08T21:01:06-07:00

Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned. We also include comments on, for example, the strengths of the information, whether it contains anomalies, ambiguities, apparent error or omissions, or whether or how it affects current practice.

Very low calorie diets

2012-05-08T21:01:06-07:00

In the UK, over 50% of adults are overweight (body mass index [BMI] of 25–29.9kg/m²) or obese (BMI 30kg/m² or more); it is thought that over half of the UK population could be obese by 2050 because of the increasing availability of calorie-dense food and sedentary lifestyles.1–3 Interventions to achieve weight loss include diets, increased physical activity, behavioural modification strategies, drugs (e.g. orlistat) and bariatric surgery.4 Dietary interventions include low-calorie diets (LCDs; 1,000–1,200kcal/day for women and 1,200–1,600kcal/day for men), very low calorie diets (VLCDs; including Very Low Energy Diets [VLED]; below 800kcal/day) and Low Energy Liquid formula diets (LELD; above 800kcal/day).4,5 However, drop-out rates from such interventions are often high. Here we consider the safety and effectiveness of VLCDs and practical issues about their use.

{blacktriangledown} Indacaterol for COPD

2012-05-08T21:01:06-07:00

Indacaterol powder for inhalation (Onbrez Breezhaler – Novartis) is a long-acting beta2 agonist, licensed for once-daily use as maintenance bronchodilator therapy for chronic obstructive pulmonary disease (COPD). In this article, we consider the evidence for indacaterol and how its use fits with current management strategies for COPD.

Testing, testing, testing

2012-04-11T02:26:04-07:00

It is said of screening programmes that "all do harm; some do good as well, and, of these, some do more good than harm at reasonable cost".1 Arguably the same can be said of testing done in the context of routine clinical practice to inform diagnosis or prognosis.2 Editorials and correspondence in the medical literature have discussed the problems associated with over-reliance on diagnostic testing, and cite examples of clinical harm and waste of scarce resource caused by inappropriate testing.2–4 A recent editorial highlighted the problems associated with a large increase in requests for measurement of blood concentrations of 25-hydroxyvitamin D.5 It is thought that some of the reasons for the inappropriate use of tests include inadequate training of clinicians in dealing with clinical uncertainty, healthcare systems that encourage testing, and perceived concerns that medicolegal systems punish...

DTB Select: 4 | April 2012

2012-04-11T02:26:04-07:00

Routine vaccination against chickenpox?

2012-04-11T02:26:04-07:00

Varicella-zoster virus (VZV) causes both varicella and herpes zoster.1,2 In 1995 a varicella vaccine was licensed in the USA and was incorporated into the routine vaccination programme for children; a decline of varicella among children and adults, and a reduction in associated hospitalisation, complications and mortality, has resulted.2 In the UK, a policy of targeted vaccination of at-risk groups has been in place since the vaccine was introduced.3 Here we review the evidence for the different approaches to VZV vaccination policy.

Management of simple insect bites: where's the evidence?

2012-04-11T02:26:04-07:00

Many insects bite in order to obtain a blood meal and, in the process, inject the victim with saliva that may contain a number of substances, some of which can be immunogenic. The consequences of insect bites include local reactions, immune (allergic) reactions including anaphylaxis, and secondary bacterial infections (e.g. impetigo, cellulitis). Although insect bites are perceived to be common in the UK, the exact incidence is difficult to estimate since most are likely to go unreported: only those causing the more serious reactions are seen in primary care settings. Simple insect bites are those that are not accompanied or followed by anaphylactic shock or systemic infection. Many preparations for the treatment of insect bites, including antihistamines and topical corticosteroids, are available for purchase over the counter (OTC) in the UK. However, there is a lack of evidence for the efficacy of these treatments and, in general, recommendations for treatment are based on expert opinion and clinical experience. This article reviews the evidence for the management of simple bites by insects commonly encountered in the UK, but excludes ticks, mites and lice.

What matters most to patients?

2012-03-14T04:41:01-07:00

The concept that patients should make decisions about their treatment in partnership with healthcare professionals has become firmly enshrined in NHS strategy and policy documents. Although there is a risk that the impact of the adopted mantra "no decision about me, without me" will become blunted by overuse, it is reassuring to know that shared decision-making is finally being taken seriously.1,2 However, shared decision-making implies shared knowledge, and patients need meaningful information about their treatment options, in order to take fully-informed decisions. Is the information we give them good enough?

Organisations like the Information Standard have been working to improve the quality of healthcare information; patient decision aids help to present evidence-based information in a clear and unbiased fashion.3 However, producing evidence-based patient information requires evidence about outcomes that matter to patients and sometimes that can be hard to come by. A recent...

DTB Select: 3 | March 2012

2012-03-14T04:41:01-07:00

{blacktriangledown}Tapentadol (Palexia) for moderate to severe acute pain

2012-03-14T04:41:01-07:00

Tapentadol (Palexia – Grünenthal) is a recently introduced strong analgesic with µ-agonistic opioid and additional noradrenaline reuptake inhibition properties. The summary of product characteristics (SPC) states that it is indicated for the relief of moderate to severe acute pain in adults, which can be adequately managed only with opioid analgesics.1 Here we review the place of tapentadol in the treatment of patients with moderate to severe acute pain.

Topical therapy for scalp psoriasis in adults

2012-03-14T04:41:01-07:00

An estimated 2% of the UK population has psoriasis. For many patients this affects the scalp. Particular challenges in managing scalp psoriasis include choosing an appropriate treatment option, difficulties of applying topical treatments and deciding how to treat severe disease. Moreover, there is a lack of good-quality evidence on which to base treatment decisions. Here, we offer some practical advice, taking into account the available evidence.

Getting the timing right

2012-02-13T02:01:25-08:00

In order to be able to prescribe, dispense and administer medicines appropriately, healthcare professionals need access to accurate and timely information on a drug's safety and effectiveness. Data relating to licensed products are published in the Summary of Product Characteristics (SmPC) and associated Public Assessment Reports, and many (but not all) of these documents are available online.1,2 European Commission guidelines governing the content of the SmPC state that it "sets out the agreed position of the medicinal product as distilled during the course of the assessment process. As such the content cannot be changed except with the approval of the originating competent authority".3 This clearly positions it as a regulatory document. However, the guidelines also state that the SmPC "is the basis of information for healthcare professionals on how to use the medicinal product safely and effectively". This is very much aimed at...

DTB Select: 2 | February 2012

2012-02-13T02:01:25-08:00

{blacktriangledown}Fingolimod for multiple sclerosis

2012-02-13T02:01:25-08:00

Fingolimod (Gilenya - Novartis) is a new treatment for patients with highly active relapsing-remitting multiple sclerosis. It is the first oral disease-modifying drug for the treatment of patients with multiple sclerosis. Here we assess the place of this drug.

Problems of multidrug- and extensively drug-resistant TB

2012-02-13T02:01:25-08:00

Worldwide, it is thought that in 2010 around 9 million people developed tuberculosis (TB) and around 1.5 million people died from the disease.1 Standard therapy (6 months of rifampicin and isoniazid, plus pyrazinamide and ethambutol for the first 2 months) is recommended for newly diagnosed active respiratory TB and is effective if taken correctly.2,3 However, its effectiveness can be compromised by a number of factors including poor adherence (e.g. because of the long duration of treatment, occurrence of unwanted effects) or inadequate drug levels for other reasons (e.g. drug-drug interactions, poor quality medicines).4,5 These factors also contribute to the development of resistance to one or more of the drugs. Multidrug resistant TB (MDR-TB) is defined as TB with resistance to both rifampicin and isoniazid.1,6 Patients with MDR-TB are treated with a combination of first-line and second-line drugs based on the results of drug susceptibility testing.4 The treatment is longer, less effective, less tolerable, and more expensive than standard therapy, and involves the use of injectable drugs. Extensively drug-resistant TB (XDR-TB; defined as TB with resistance to rifampicin and isoniazid, and to at least one fluoroquinolone and one second-line injectable agent such as amikacin or capreomycin) is now emerging.7 Here we highlight patient groups at increased risk of MDR- and XDR-TB, and discuss how to investigate, manage and treat them.