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Pharmaceutical Fortnightly Focus
Medicines Management Newsletter No.2
Publish date: 26/6/2013
Behind the headlines: High potency statins and link to new-onset diabetes (NOD)
 A recent study published in the BMJ, which has been widely reported in the press, examined the risk of new onset diabetes in patients treated with different statins.  This population based retrospective cohort study in Canada looked at the records of 1.5 million people over 65 years old on statins. It examined individual statin use, dose and NOD.  In line with previous studies, the overall odds of developing diabetes on statins was reported as being low however the risk was higher in patients on atorvastatin, rosuvastatin and simvastatin.  There was no data regarding weight, ethnicity and family history - all important risk factors for the Recommendation: The overall benefit of statins still clearly outweighs the potential risk of incident
diabetes. Simvastatin 40mg should remain first choice statin and pravastatin/atorvastatin as an
alternative option in line with the
European Medicines Agency (EMA) restricts use of diclofenac
Patients with certain cardiovascular risk factors such as high blood pressure, raised blood cholesterol, diabetes or smoking should only use diclofenac after careful consideration. Thewill be issuing updated guidance to patients and healthcare professionals shortly.  Current level of diclofenac prescribing (number of prescriptions issued Quarter 4 2012/2013): R&B: 1322, SWorcs: 3235, Wyre Forest: 841
Recommendation: The increased risk of CV events with diclofenac has been known for some time,
and this EMA advice re-emphasises the safety concerns with diclofenac.
Prescribers should consider using naproxen or ibuprofen in new patients. Switch current diclofenac patients with an underlying heart condition or with a CV risk factor. Nystan® (nystatin 100,000units/ml) suspension savings
 Nystan® suspension (£1.80/30ml) is significantly less expensive than generic nystatin suspension Recommendation: Prescribe nystatin suspension as Nystan® suspension and update the drug
formulary on your clinical system to reflect this cost effective choice.
Product information: new off-patent drugs, drug shortages
 Viagra® came off-patent on 21st June 2013 so we will expect the price to drop dramatically over
the next few months–prescribers are reminded to prescribe as the generic sildenafil. The other
phosphodiesterase type-5 inhibitors do not come off patent for a number of years. See for list of patent expiry dates for 2013-14
 Generic drugs currently in shortage include isosorbide mononitrate 40mg tabs, nabumetone
500mg tabs, naftidrofuryl 100mg caps, temazepam 10mg & 20mg tabs, trazodone 50mg/5ml
oral solution SF. Seewebsite for other drugs in shortage and the increased cost to the NHS
of prescribing these items. Contact the Medicines Management Team for how to manage these
shortages.
 Strattera® (atomoxetine) now has an indication for in addition to adolescents
and children of six years of age or older.  Increased heart rate has been added to theas an undesirable effect of Bydureon® If you require any further information please do not hesitate to contact your Medicines Management
Team: Via email: medicines.management@ardencsu.nhs.uk
Telephone: 01926 493491 (Warwick office)
Or 01905 733273 (Worcester office)

Source: http://psnc.jellyha.us/worcestershire-lpc/wp-content/uploads/sites/29/2013/07/20130626-NHS-Arden-CSU-Pharmaceutical-Fortnightly-Focus-2-Worcestershire.pdf