This is an HTML version of an attachment to the Freedom of Information request 'Tablet Press The prescribing newsletter for GPs, nurses and pharmacists'.

 
Tablet Press 
 
 
 
The prescribing newsletter for GPs, nurses and pharmacists in  
 
 
Northamptonshire Primary Care Trust 
  Issue 46 
July 2010 
 
 
•  Monitored dosage systems (MDS) 
Local guidance on the use of MDS has been agreed between primary care (GPs and community 
pharmacists), the acute trusts, Provider Services and Northamptonshire County Council and is 
circulated with this issue of Tablet Press. 
 
•  Increased risk of C diff infections and of fractures: two more good reasons to review PPI 
prescribing 
A group of US studies published under the theme less is more adds to earlier evidence around two 
potential harms associated with proton pump inhibitor (PPI) use. A large observational study found that 
hospital inpatients taking daily PPIs were over 70% more likely to develop Clostridium difficile infection 
than non-users. A second US study found that people who already have C difficile infection and are 
treated with PPIs had a more than 40% increased relative risk of recurrence of infection. A third study 
alongside earlier evidence, has prompted the FDA to update PPI product information to warn of a 
possible increased risk of hip, wrist and spine fractures, especially in long term users of PPIs and when 
used at high doses.  
 
•  DTB editorial questions NICE neuropathic pain guideline recommending pregabalin 
This editorial in the Drug and Therapeutics Bulletin (DTB) questions the recommendation in the recent 
guideline on neuropathic pain from NICE that clinicians should “offer oral amitriptyline or pregabalin as 
first-line treatment.” The guideline excluded gabapentin, based on indirect comparisons, suggesting that 
it offers less net benefit, is less cost-effective, and requires more complex dosing and titration compared 
with pregabalin. However, the DTB notes that pregabalin is still a black triangle drug and this too should 
be considered in any comparison with the much longer established gabapentin.   
The DTB concludes “the guideline’s promotion of pregabalin creates a dilemma for those who know 
from the published data that gabapentin remains an effective treatment option for neuropathic pain. 
Gabapentin is by far the cheaper of the two drugs and therefore for the same level of investment, the 
NHS faces the choice of treating more patients with a cheaper but (on indirect evidence) slightly less 
effective drug, or fewer patients with a more expensive, seemingly more effective one. So can clinicians 
be sure that a wholesale switch away from using gabapentin is a justifiable and affordable investment 
option? At a time of belt-tightening in the NHS, this could be a particularly expensive capsule to 
swallow.” 
As you may be aware NPAG, with input from the pain consultants, has discussed this particular 
dilemma and has recently advised (NPAG bullets June 2010) that it supports an alternative approach to 
that given in the NICE guideline. 
 
First line – amitriptyline (or nortripyline/ imipramine if sufficient pain relief but not tolerated)  
Second line – gabapentin 
Third line – pregabalin 
The double red status of duloxetine will be fully reviewed at the next meeting 
 
•  Patient Decision Aids 
The PCT Prescribing Advisory team have been promoting the use of some of the NPC's patient 
decision aids (PDAs) locally. They are keen to find out more about users’ experiences and your 
suggestions on how their PDAs can be developed. They would be very grateful if you would take about 
5 minutes to complete a short anonymous survey. Please click here to take the survey.  
 
The NPC’s PDA directory has been updated and now has more extensive information on the ideas 
behind PDAs, suggestions on how to use PDAs, and supporting information about relative and absolute 
risk, and the evidence base for the use of PDAs. The directory is easy to find at www.npci.org.uk/pda.  
This edition is also available on HNN (Health Network Northants) 
http://nww.northants.nhs.uk/Display/Dynamic.jsp?topid=14070&lhsid=514&oid=2854&currentid=2854 
 
Disclaimer 
Information in this newsletter is believed to be accurate and true.  NHS Northamptonshire and its 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. 
 
Contact No 01604 651360