Tablet Press
The prescribing newsletter for GPs, nurses and pharmacists in
Northamptonshire Primary Care Trust
Issue 66
March 2012
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MTRAC guidance on transdermal analgesic patches
MTRAC, the Midlands Therapeutics Review & Advisory Committee, has issued its latest Commissioning
Guidance report on fentanyl and buprenorphine transdermal patches for the treatment of chronic intractable
non-cancer pain.
They suggest that the use of fentanyl or buprenorphine transdermal patches should be restricted to -
o patients who cannot tolerate tablet formulations, or have difficulty swallowing
o patients with mental health problems
o patients with compliance issues or for those who are socially isolated with limited access to care
They rate the transdermal analgesic patches as having “weaker evidence and a lower place in therapy”.
Use of buprenorphine patches in Northamptonshire is twice the national average and both fentanyl and
buprenorphine patches are included in the Prescribing Incentive Scheme for 2012-13 to try to reduce
inappropriate use.
http://www.keele.ac.uk/media/keeleuniversity/fachealth/fachealthsop/mtrac/documents/esca/Bupren%20SUM5.pdf
http://www.keele.ac.uk/media/keeleuniversity/fachealth/fachealthsop/mtrac/documents/esca/Fentanyl%20TD%20SUM
%205.pdf
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Risks associated with PPIs
Evidence from a large cohort study suggests that postmenopausal women who were previous or current
smokers and who regularly used PPIs for more than two years had about a 50% increased relative risk of
low-trauma hip fracture. However, in absolute terms the risk was small: about 8 extra fractures per 10,000
women years. This was independent of risk factors such as dietary calcium intake, physical activity, history
of osteoporosis or other drugs known to affect the risk of hip fracture. Women who had stopped using PPIs
more than two years previously had a risk of fracture similar to that of women who had never used a PPI.
In addition the FDA has recently issued a communication about a link between use of proton pump
inhibitors (PPIs) and an increased risk of Clostridium difficile–associated diarrhoea.
Health professionals should carefully review PPI prescribing and make sure it is in line with the relevant
NICE guidance. PPIs have several important places in therapy. Nevertheless, PPIs should not be initiated
or continued long term without careful thought and a discussion with the patient of the likely risks and
benefits.
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Prescribing for patients with swallowing difficulties
We are aware that representatives from companies which manufacture liquid “specials” have been offering
advice to care homes, community pharmacist and GP practices regarding the relative merits of different
options for patients with swallowing difficulties.
We would advise all practices to contact one of the Care Home Advice pharmacists
(xxxxx.xxxxx@xxxxxxxxx.xxx.xx or xxxxxxxx.xxxxx@xxxxxxxxx.xxx.xx)
or their Prescribing Adviser before changing any patients’ medicine formulation.
The NHS Northamptonshire Guidelines for prescribing for patients with swallowing difficulties are available
on Pathfinder at Prescribing difficulties Prescribing Guidelines and Swallowing difficulties flow chart
and are circulated with this bulletin.
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Acne algorithm
An algorithm which advises on the place in treatment of various agents including Epiduo has been agreed
with KGH dermatologists. The algorithm will shortly be available on Pathfinder.
This edition is also available on HNN (Health Network Northants)
http://nww.northants.nhs.uk/Display/Dynamic.jsp?topid=14070&lhsid=514&oid=2854¤tid=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