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National Prescribing Service Press Releases

Katie Butt
From a Good Prescribing Perspective

Issue 75: September 2008
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version
The National Prescribing Service (NPS)is a valued independent resource for good and unbiased prescribing information and education.
Given the marketing pressures applied by global drug companies, Australia is blessed to have such a resource.
Pharmacists are moving closer to a prescribing role within the health system and it is appropriate that i2P promote the message of the NPS.
This Month:

 * Our antibiotic "addiction" is not helping our children fight their colds

* Zolpidem (Stilnox) and insomnia management - NPS info for prescribers and patients

* New drug for type 2 diabetes: is it as good?

Our antibiotic “addiction” is not helping our children fight their colds

Kids got a cold? Don’t trouble your doctor.

The National Prescribing Service Limited (NPS) has a clear message for parents seeking to ease their child’s cold by asking their doctor for antibiotics: don’t bother, as antibiotics simply don’t work for a common cold.

While it is a natural reaction for a worried parent to seek medicine for a sick child, Australians are among the highest users of antibiotics in the world – and peak prescribing is during “cold season” – August. NPS Executive Manager of Quality Use of Medicines (QUM) Programs, Karen Kaye, says, “Antibiotics don’t work on the viruses which cause common colds, so asking for a script will not help your child.”

The Australian love affair with antibiotics is like few other nations on Earth. We are estimated to be among the highest users of antibiotics in the world, with about 22 million prescriptions dispensed by community pharmacies in 2006, but consider this: like all medicines, antibiotics can cause side-effects, including nausea, diarrhoea and indigestion. In women some antibiotics can also stop the contraceptive pill from working. What’s more, the overuse of antibiotics is resulting in new strains of antimicrobial-resistant bacteria at a time when fewer new antibiotics are being discovered. This may have a profound effect on the health of future generations.

"When antibiotics were discovered they were a miracle cure and are still immensely popular – but because of the worldwide overuse of antibiotics, the World Health Organisation (WHO) says antibiotic resistance puts us at risk of returning to the horrors of the pre-antibiotic era, when scores of children and older people died of infectious diseases and major surgery was impossible because of the risk of infection,” Ms Kaye said.

“The best things parents can do for children with a cold virus is ensure the children rest, drink something soothing and are kept away from cigarette smoke,” Ms Kaye said.

Saline (salt water) sprays or drops for the nose or steam from the shower can help clear mucus. Common pain relief medicines such as children’s paracetamol or ibuprofen can ease the pain however aspirin is not suitable for children. While decongestants for the nose work for some adults, there is not sufficient evidence to recommend using them for children under 12 years and they can cause serious side effects. Over-the-counter medicines for ‘cough and cold’ and ‘cold and flu’ are not recommended at all for use in children under 2 years.

Vitamins and minerals are often thought to assist with health and wellbeing. “It is important parents know there is not enough information from good quality clinical trials to show that vitamins and mineral supplements or herbal medicines help treat or prevent colds in children,” Ms Kaye said. “There is not enough evidence to prove their safety, and some can cause side effects. Parents may choose to experiment with their own health by taking supplements but this is not recommended for children.”

So when should you see your doctor? “Some serious diseases may initially appear like a cold virus or a ‘flu’ but may in fact require urgent medical attention,” Ms Kaye added. “Go to your doctor if symptoms come on suddenly, are severe or last longer than usual and also make sure your child’s immunisations are up to date.”

The NPS Common colds need common sense, not antibiotics campaign is the only Australia-wide strategy aimed at reducing the development and spread of antibiotic-resistant bacteria. Free resources for parents, children’s services and primary schools are available at www.nps.org.au/commoncolds.


Zolpidem (Stilnox) and insomnia management –
NPS info for prescribers and patients

To help prescribers and pharmacists counsel patients concerned about the sleep-related adverse effects associated with zolpidem (Stilnox), the National Prescribing Service Limited (NPS) has today released a position statement on the drug and sleep-related behaviours.

NPS Deputy CEO, Karen Kaye said the position statement explains the background to the TGA’s decision to impose a boxed warning on zolpidem and to describe the current place of this hypnotic drug in insomnia therapy.

The paper examines the evidence linking the medicine with bizarre sleep-related behaviours, such as sleepwalking, sleep-eating and sleep-driving. It also outlines treatments for insomnia and guidance for counselling patients, pointing GPs and pharmacists to the NPS Fact Sheet on zolpidem released in February this year.

Ms Kaye reminded prescribers that the many potential causes of insomnia should be addressed before making a treatment decision and that the risks associated with hypnotics generally outweigh any benefits they provide with continous long term use.

“NPS advises that patients should avoid alcohol, other CNS depressants, and higher than recommended doses of zolpidem – as these probably increase the risk of sleep-related events.

“However sleep-related events can occur with therapeutic doses of zolpidem in people without these or other predisposing factors. While these events are rare, they can have serious consequences, so consumers and their prescribers should weigh this up when deciding on how to manage sleep problems,” Ms Kaye said.

Non-drug therapies are recommended as initial treatment for insomnia. These include sleep hygiene principles and stimulus control advice, sleep restriction, cognitive therapy, relaxation therapies, and regular exercise.

NPS advises prescribers to reserve short-acting benzodiazepines (eg, temazepam), zolpidem, or zopiclone for short-term severe insomnia, and for intermittent use in chronic severe insomnia that is unresponsive to non-drug therapies.

“For all hypnotics, use the lowest dose for the shortest time possible (ideally for less than two weeks) and re-evaluate within seven to fourteen days of starting therapy,” Ms Kaye said.

The TGA recommends limiting use of zolpidem to a maximum of 4 weeks.

The position paper can be read online at the new-look NPS site www.nps.org.au. The NPS website design was updated this week to make searching for the most relevant and up-to-date information about medicines much easier.

The latest edition of NPS RADAR, published online today, carries an excerpt of the position statement to help ensure doctors and pharmacists are aware of the information, and have easy access to it.


New drug for type 2 diabetes: is it as good?

A new drug in a new class provides another option for improving blood glucose control in diabetes, but its effect on diabetes-related complications and mortality is not known. NPS RADAR reminds prescribers that when it comes to weighing up treatment options for people with diabetes, some drugs do have evidence for preventing diabetes-related complications as well as a more established safety profile.

The NPS RADAR review of sitagliptin (Januvia), the first of a new class of oral drugs for improving glycaemic control in type 2 diabetes, was published online at www.npsradar.org.au today.

Sitagliptin is PBS-listed for dual oral therapy with either metformin or a sulfonylurea, when a combination of these drugs is contraindicated or not tolerated.

National Prescribing Service Limited (NPS) Deputy CEO, Karen Kaye said that insulin or a glitazone are other treatment options when metformin cannot be used with a sulfonylurea.

“Sitagliptin is not associated with weight gain or an increased risk of hypoglycaemia, but we must consider a number of important points when choosing between treatment options for diabetes,” Ms Kaye said.

“Insulin has been shown to reduce the risk of diabetes-related complications. Sitagliptin’s efficacy and safety have not been compared with those of insulin, and its effect on diabetes-related complications and mortality is not known. NPS encourages prescribers not to delay treatment with insulin when oral drugs no longer control blood glucose.

“Weight gain and hypoglycaemia can still occur when sitagliptin is used with drugs that cause these effects (e.g. sulfonylureas). While there are safety concerns with the glitazones, the long-term benefit–harm profile of sitagliptin is yet to be established,” Ms Kaye said.

All drugs have benefits and harms. Adverse effects with sitagliptin include nasopharyngitis, upper respiratory tract infection, headache and nausea.

Postmarketing reports of anaphylaxis, angioedema, rash, urticaria and exfoliative skin conditions (including Stevens–Johnson syndrome) have occurred during treatment with sitagliptin. While a causal link is yet to be established, NPS RADAR advises prescribers to stop sitagliptin if a hypersensitivity reaction is suspected. Prescribers are advised to reduce the dose of sitagliptin in moderate to severe renal impairment.

NPS also published consumer reviews of both sitagliptin and duloxetine (Cymbalta), for major depressive disorder, in the latest editions of Medicine Update online at www.nps.org.au today.

NPS RADAR also reviews duloxetine, along with escitalopram (Lexapro, Esipram) for generalised anxiety disorder and social anxiety disorder (social phobia), memantine (Ebixa) for dementia in moderately severe Alzheimer’s disease and the role of automatic eGFR reporting in screening for kidney disease and drug -dosing decisions.

In addition, NPS RADAR carries an excerpt of the newly-released NPS position statement on zolpidem (Stilnox). Written to explain the background to the TGA’s safety change and to describe the current place of the drug in insomnia therapy, the statement can be read online at www.nps.org.au.

Health professionals who subscribe to NPS RADAR e-alerts are first to know of each edition as it is published. Visit www.npsradar.org.au to subscribe and to read all current and previous editions.


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