Items which should not routinely be prescribed in primary care: A Consultation on guidance for CCGs
A consultation was made under the aegis of NHS Clinical Commissioners (the CCG collective body) and NHSE which closed on 21st October. Constituents might like some early warning about the drugs likely to be discouraged or even prohibited from being normally prescribed in the near future? astonishingly COPROXAMOL still costs the NHS some £9m a year and it is likely that in future all prescribing will be under a shared care agreement. DOSULEPIN is the subject of a NICE “do not do” recommendation as its tolerability in comparison with other antidepressants has been judged to be outweighed by increased cardiac risk and toxicity in overdose. DOXAZOSIN MR is judged to have no benefits compared with the relative cost of plain doxazosin. IMMEDIATE RELEASE FENTANYL in all its various forms is not to be useful enough to continue to be freely prescribed. GLUCOSAMINE & CHONDROITIN are judged to be of low clinical effectiveness as are LIDOCAINE PLASTERS. LIOTHYRONINE costs the NHS nearly £35m and is likely to be recommended only for patients undergoing treatment for thyroid cancer and to be issued by the specialist centre. LUTEIN & ANTIOXIDANTS have been the subject of two Cochrane reviews and although some with age-related macular degeneration may slow the progression of the disease there is growing evidence that taking supplements will not delay or prevent its onset. OMEGA-3 FATTY ACID COMPOUNDS are also the subject of various NICE “do not do” guidance. OXYCODONE & NALOXONE and PARACETAMOL & TRAMADOL combinations are likely to be discouraged. PERINDOPRIL ARGININE costs £6 a month compared with £1 for P. Erbutamine. RUBIFACIENTS (excluding topical NSAIDs) are also likely to be added to the list. ONCE DAILY TADALAFIL, except the specialist-prescribed version licenced for pulmonary hypertension, is judged to be clinically effective but no more so than when used “as required.” TRAVEL VACCINES including those for Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow fever, Tick-borne encephalitis, rabies and the BCG are still sometimes prescribed in error and cost the NHS some £4.5m a year. PHE is to conduct a review into the appropriateness of cholera, DTP, Hepatitis A and typhoid travel vaccines. TRIMIPRAMINE costs about £20m a year and more cost effective tricyclic antidepressants are available. The consultation also covers homeopathy and herbal remedies. It considers that the matter of GLUTEN-FREE products is now closed. With this in mind it is far from clear whether any of the drugs and substances listed above will actually be black-listed. We await the final decision and recommendations.