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Clinical effectiveness news
Citalopram top doses reduced
3 November 2011, 11:17 pm
At the end of October 2011, the UK MHRA reduced the top doses of citalopram that are recommended. The top dose in adults is now 40mg a day (was 60mg a day) and is now 20mg a day in the elderly, people with liver damage or a heart problem, or if taking some other medicines. This is because higher doses of citalopram seem to cause some heart effects (making the “QT interval” longer). This prolonged QT interval is not a problem as such (you wouldn’t notice it) but can increase the risk of other heart problems e.g. this could then cause the heart beat to become irregular and be dangerous in some people.
This means that anyone on 45mg a day or more shouldn’t panic. Talk about this to your doctor next time you meet. You could either reduce the dose, switch medicines (although this effect has been known with other antidepressants too), or carry on, but with an ECG (a test of your heart’s electrical activity).
Citalopram and heart rhythms
30 August 2011, 9:08 pm
There has been some guidance issued in USA that citalopram should not be used at a dose higher than 40mg a day. This is because at high doses citalopram can have an effect on the heart’s beat (making the QT interval a bit longer). This could then cause the heart beat to become irregular and be dangerous in some people e.g. if taking other medicines that have the same effect, or if you have low potassium or magnesium levels in the blood (you wouldn’t know this without a blood test).
There is no need to panic. If you are taking up to 40mg a day there is no problem. If you are taking 45mg or more a day you should probably see your doctor about this in the next few weeks. You may get a bit of a blank look because this warning has not been issued in Europe yet, just the USA.
Asenapine (Saphris)
22 July 2011, 10:34 am
Asenapine (Saphris) has now been licensed in Europe and is due to be launched in UK later in 2011 or early 2012. It will be available for mania and hypomania in bipolar disorder. It is also licensed in some countries (e.g. USA and Australia) for schizophrenia.
Paliperidone depot injection (Xeplion®) launched
5 April 2011, 12:21 pm
Paliperidone palmitate is known by the brand name Xeplion® in Europe, and Invega Sustenna® outside Europe. It is one of a group of medicines called antipsychotics or neuroleptics. Antipsychotic drugs are usually used to help treat illnesses or conditions such as psychosis, schizophrenia, schizoaffective disorder and hypomania.
A long-acting depot injection (once-a-month) became available in April 2011 in the UK.
A long-acting injection of paliperidone (which is very similar to risperidone) for psychosis or schizophrenia .
- Good points: Can be given monthly, can be given in the arm or bum, easier to use than risperidone Consta
- Bad points: it’s not risperidone
PCT prescribing data January to March 2011
2 April 2011, 5:27 pm
This dataset from the NHS Information Centre provides information about Primary Care Trust (PCT) prescribing data between January and March 2011. Previous quarters are also available for comparison.
The dataset answers questions, such as: How many prescription items were dispensed? What was the net ingredient cost of prescriptions? Which NICE appraised drugs are used in hospitals? What is the variation in hospital supplied medicines across strategic health authorities?
- Download the dataset in full
- Access and use a free tool called iView, which will allow you to manipulate and extract data. To use NHS iView you need to register for an NHS IC account.
Olanzapine depot injection (Zypadhera®) launched
22 July 2010, 9:51 am
Olanzapine (Zypadhera®) is now available as a long-acting injection, to be given every 2 or 4 weeks.
- Good points: can be given every 2 or 4 weeks, and is a long-acting injection of the well known and effective antipsychotic olanzapine
- Bad points: very rarely, the injection can cause heavy sedation for a few hours after an injection. So the injection has to be given in a health care establishment (e.g. hospital, surgery), and the person looked after for 3 hours afterwards.
Agomelatine (Valdoxan®) launched UK 2009
22 October 2009, 10:03 am
Agomelatine is commonly known by the brand name Valdoxan® in the UK. Agomelatine is a new and different antidepressant. It mainly boosts melatonin in the brain. It is available in tablet form only and was first made available in the UK in 2009, although it was available in some countries in 2008.
Download a PILL (Patient Information Leaflet), a two-page summary about Agomelatine which can be printed.
Agomelatine is a different type of antidepressant.
- Good points: very different way of working, effective, almost no side effects, helps sleep
- Bad points: need a blood test every few weeks for several months, considered to be too expensive by some parts of the NHS (£30 a month for the standard 25mg a day dose)
Patient experience news
Citalopram top doses reduced
3 November 2011, 11:17 pm
At the end of October 2011, the UK MHRA reduced the top doses of citalopram that are recommended. The top dose in adults is now 40mg a day (was 60mg a day) and is now 20mg a day in the elderly, people with liver damage or a heart problem, or if taking some other medicines. This is because higher doses of citalopram seem to cause some heart effects (making the “QT interval” longer). This prolonged QT interval is not a problem as such (you wouldn’t notice it) but can increase the risk of other heart problems e.g. this could then cause the heart beat to become irregular and be dangerous in some people.
This means that anyone on 45mg a day or more shouldn’t panic. Talk about this to your doctor next time you meet. You could either reduce the dose, switch medicines (although this effect has been known with other antidepressants too), or carry on, but with an ECG (a test of your heart’s electrical activity).
Citalopram and heart rhythms
30 August 2011, 9:08 pm
There has been some guidance issued in USA that citalopram should not be used at a dose higher than 40mg a day. This is because at high doses citalopram can have an effect on the heart’s beat (making the QT interval a bit longer). This could then cause the heart beat to become irregular and be dangerous in some people e.g. if taking other medicines that have the same effect, or if you have low potassium or magnesium levels in the blood (you wouldn’t know this without a blood test).
There is no need to panic. If you are taking up to 40mg a day there is no problem. If you are taking 45mg or more a day you should probably see your doctor about this in the next few weeks. You may get a bit of a blank look because this warning has not been issued in Europe yet, just the USA.
Antidepressant use in women
6 July 2011, 12:06 pm
Platform 51 (what used to be WYCA) have published a report in July 2011 about the use of antidepressants in women, especially in people taking them for many years.
The research shows that a huge number of women use antidepressants for long periods without being reviewed or offered any alternatives to drugs.
http://www.platform51.org/resources/Check_and_choices:_women_and_antidepressants
NICE guidelines on Alzheimer’s Disease
18 March 2011, 11:11 am
Memantine was first made available in the UK in 2002 (although it has been available for many years in other countries e.g. Germany). It is used in the UK, Republic of Ireland and the rest of the world for moderate to severe dementia. However, it has been restricted in many areas of UK due to cost. This should change after the latest NICE Technology Appraisal for the anticholinesterases (donepezil, galantamine, rivastigmine) and memantine.
This was issued on 23rd March 2011 and says that:
The review and re-appraisal of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease has resulted in a change in the guidance. Specifically:
- donepezil, galantamine and rivastigmine are now recommended as options for managing mild as well as moderate Alzheimer’s disease, and
- memantine is now recommended as an option for managing moderate Alzheimer’s disease for people who cannot take AChE inhibitors, and as an option for managing severe Alzheimer’s disease.
This is a change because before memantine was not approved, but now it is considered an option. English PCTs and Trusts have to implement the guidelines by the end on June.
Professor Bazire explains the aims of the Choice and medication website
22 November 2010, 4:34 pm
In this series of videos Professor Steve Bazire, MBE, Director, Mistura Enterprise explains more about the Choice and medication website.
Patient safety news
Citalopram top doses reduced
3 November 2011, 11:17 pm
At the end of October 2011, the UK MHRA reduced the top doses of citalopram that are recommended. The top dose in adults is now 40mg a day (was 60mg a day) and is now 20mg a day in the elderly, people with liver damage or a heart problem, or if taking some other medicines. This is because higher doses of citalopram seem to cause some heart effects (making the “QT interval” longer). This prolonged QT interval is not a problem as such (you wouldn’t notice it) but can increase the risk of other heart problems e.g. this could then cause the heart beat to become irregular and be dangerous in some people.
This means that anyone on 45mg a day or more shouldn’t panic. Talk about this to your doctor next time you meet. You could either reduce the dose, switch medicines (although this effect has been known with other antidepressants too), or carry on, but with an ECG (a test of your heart’s electrical activity).
Citalopram and heart rhythms
30 August 2011, 9:08 pm
There has been some guidance issued in USA that citalopram should not be used at a dose higher than 40mg a day. This is because at high doses citalopram can have an effect on the heart’s beat (making the QT interval a bit longer). This could then cause the heart beat to become irregular and be dangerous in some people e.g. if taking other medicines that have the same effect, or if you have low potassium or magnesium levels in the blood (you wouldn’t know this without a blood test).
There is no need to panic. If you are taking up to 40mg a day there is no problem. If you are taking 45mg or more a day you should probably see your doctor about this in the next few weeks. You may get a bit of a blank look because this warning has not been issued in Europe yet, just the USA.
Research helping to reduce inappropriate prescribing of antipsychotics
19 July 2011, 5:22 pm
Studies into depression and agitation and aggression will play a key role in helping to reduce inappropriate prescriptions of antipsychotics for people with dementia. These symptoms can cause significant distress for people with dementia and carers and are often the reason for antipsychotics being prescribed.
Findings from the studies include:
- two common antidepressants are not clinically effective for treating significant depression in Alzheimer’s
- agitation levels of people with moderate or severe dementia in care homes who were treated with pain medication were reduced by 17 per cent over eight weeks
- the Alzheimer’s drug Ebixa was not beneficial for treating clinically significant agitation in people with later stage Alzheimer’s although there was a potential benefit for aggression and it did improve cognition
Read more about the studies on the Alzheimer’s Society website
Call to action: the use of antipsychotic drugs for people with dementia
20 June 2011, 5:24 pm
The NHS Institute for Innovation and Improvement and the Dementia Action Alliance have launched a call to action to work together to improve the quality of life of people with dementia and their carers by reducing the inappropriate use of antipsychotics for these people.
- Download The Right Prescription: a call to action on the use of antipsychotic drugs for people with dementia
- Alzheimer’s Society and the Department of Health (2011) Optimising treatment and care for people with behavioural and psychological symptoms of dementia. London, Alzheimer’s Society.
The guide provides information, advice and resources for treatment and person-centred care for people with dementia experiencing behavioural and psychological symptoms.
Consultation on adult acute mental health units guidance
21 August 2009, 3:56 pm
The Department of Health is developing new guidance on adult acute mental health units and are seeking your views on the latest draft.
Comments should be added to the comments matrix and emailed to Bryony.Stuart@coi.gsi.gov.uk
The deadline for responses is Monday 21 September 2009.