The Script Press Issue 48, September 2007 Duloxetine: marketed as Cymbalta Second HPV Vaccination Licensed For and Yentreve for different disorders Use Duloxetine is indicated for treatment of three A second HPV vaccination is now licensed for different disorders – major depressive disorder use in the UK. Practices are reminded that in and diabetic neuropathy (marketed as June the Government agreed in principle that Cymbalta) and the treatment of stress girls aged around 12 to 13 years of age should urinary incontinence (marketed as be vaccinated against HPV. The Joint Yantreve). Committee on Vaccination and Immunisation, the body of experts which advises the Government on vaccination issues, is expected Cases of suicidal ideation and suicidal to make formal recommendations to Health behavior have been reported during Ministers later this year. treatment with duloxetine or early on after stopping treatment. Patients and caregivers should be asked to monitor and report to their A decision on whether other age groups should doctor any distressing thoughts of self-harm if be able to benefit from a national vaccination programme against cervical cancer is still they occur at any time during or after pending. treatment with duloxetine. Please await further guidance from your Cymbalta and Yentreve should be Prescribing Adviser. prescribed for their correct intended use, and should not be used together Also inside This Issue Page The benefit to the patient of taking Competition to WIN a Luxury Hamper 2 duloxetine (Cymbalta) for diabetic for the best display neuropathy should be assessed by a Advice regarding Ramadan 2 doctor at least every 3 months COMVIBENT® inhaler – 2 The benefit of duloxetine (Yentreve) for discontinuation announcement patients with stress urinary incontinence Brief Advice to Stop Smoking: a 2 should be assessed regularly clinical imperative Duloxetine should not be prescribed to Prescribing low-cost statins 2 patients who have: liver disease leading to impaired liver function; severe kidney impairment; uncontrolled hypertension Yellow Card Scheme Update The Yellow Card scheme collects information from Duloxetine should not be prescribed to healthcare professionals and patients on suspected patients who are also taking: non- adverse drug reactions. selective, irreversible monoamine oxidase inhibitors for depression; fluvoxamine for The MHRA encourage healthcare professionals and depression or obsessive compulsive patients, parents and carers to send reports for: disorder; or ciprofloxacin. Cymbalta should be used with caution alongside All adverse drug reactions associated with other antidepressants or St John’s Wort. black triangle drugs and vaccines (ie, those The use of Yentreve in combination with new to the market and monitored intensively) antidepressants is not recommended. All adverse drug reactions in children Patients should avoid abrupt withdrawal associated with a drug or vaccine of treatment from duloxetine. Healthcare All serious reactions associated with professionals should prescribe gradually established drugs and vaccines reduced doses over at least 1-2 weeks to Suspected delayed drug effects; congenital minimize withdrawal reactions. If a abnormalities; and adverse drug reactions patient has intolerable symptoms after associated with herbal remedies decreasing or stopping Cymbalta or Yentreve, the drug may be re-prescribed Please continue to send Yellow Cards to the or the dose increased; any subsequent CSM, in line with the guidance above. For further reductions in dose may be done more information, see http://www.yellowcard.gov.uk gradually Competition to WIN a Luxury Hamper By now practices and community pharmacies If you win, one suggestion for sharing out the should have started to receive their support goods in the hamper is to use cloakroom tickets materials to deliver the West Midlands wide and stick a ticket to each of the products; the Medicines Waste Campaign. other halves of the tickets are then shared out among the members of staff to allocate prizes For a chance to win a luxury hamper full of The closing date for entries is 31st October 2007. goodies worth £200, please enter our COMBIVENT® inhaler – Discontinuation display competition. Announcement All you need to do is Boehringer Ingleheim Ltd has provided early create an eye notification regarding the planned discontinuation catching display using of Combivent® Metered Aerosol during 2008. The the materials provided company emphasise that the decision is driven and submit a solely by the restriction in the use of CFCs. It is in no photograph of it to way based on the safety profile, effectiveness or Riva.Eardley@wolvespct.nhs.uk (If you need any quality of the product itself. Combivent® UDVs® help with taking the digital image, please do not will continue to be available. hesitate to contact us and we will be able to help). Brief Advice to Stop Smoking: a clinical imperative Brief advice to stop smoking from a clinician is the Gold Standard of prevention interventions. No other preventive activity produces such significant results from such a small investment in time. Failure to discuss cessation could be regarded as falling short of good clinical practice. The following Numbers Needed to Treat (NNT) for various routine preventive interventions demonstrates why brief advice to stop smoking is called the Gold Standard of preventive interventions. Intervention Outcome NNT Statins1 Prevent one death over five years 107 Antihypertensive therapy 2 Prevent one stroke, MI, death over one year 700 Cervical cancer screening 3 Prevent one death over ten years 114 GP brief advice to stop smoking < five minutes 4 Prevent one premature death* 80 Add pharmacological support 5 Prevent one premature death* 38-56 Add behavioural support 6, 7 Prevent one premature death* 16-40 * Over half of all continuing smokers will die prematurely from a smoking-related disease. For every two long term quitters, one premature death is avoided 8 References (1) Statins, NNTs & risk. Bandolier @ http://www.jr2.ox.ac.uk/bandolier/booth/cardiac/statcalc.html (2) Implementing NNTs. Bandolier @ http://www.jr2.ox.ac.uk/bandolier/painres/download/whatis/Imp-NNTs.pdf (3) Gates TJ. Screening for cancer: evaluating the evidence. Am Fam Phys 2001; 63(3):513-522 (4) West R. Smoking and smoking cessation in England: 2006. www.smokinginengland.info/Ref/paper4.pdf (5) Bandolier 2006 @ http://www.jr2.ox.ac.uk/bandolier/band151/b151-2.html (6) Levinson et al. Health Educ. Res. 2007(August) (7) Anthonisen et al. Ann Intern Med, Feb 2005; 142: 233 - 239 (8) Doll & Peto. BMJ, Jun 2004; 328: 1519 PRESCRIBING OF LOW COST STATINS The media coverage of the prescribing of low cost statins, especially the recent reports concerning atorvastatin switches, is making it more difficult for practices to reach and maintain the >75% target. In recognition of the increased work required by practices to reach target, the Prescribing Board has secured an additional £400 per 1000 patients for this incentive. Practices reaching the target will therefore now receive £700 per 1000 patients. The Prescribing Board will also consider rewarding practices that have made significant progress but have just failed to meet the 75% target.
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