The Pharmaceutical Journal
Vol 268 No 7204 p895-899
29 June 2002

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Weigh benefits of losartan against costs, says MeReCaa

The benefits of losartan (Cozaar) in reducing cardiovascular morbidity and mortality in people with hypertension should be balanced against increased prescribing costs and monitoring requirements. This is the conclusion of the latest issue of MeReC Extra.

MeReC points out that the main limitation of the LIFE (losartan intervention for endpoint) study is that it involved a selected group of high-risk patients. This study does not support first-line use of losartan in people without left ventricular hypertrophy, it says.

In its review of other randomised controlled trials of cardiovascular drugs, MeReC concludes that in the HOPE (heart outcomes prevention evaluation) study, the reduction in stroke risk seen in patients treated with ramipril (Tritace) was modest. And giving the drug to all patients at high risk of stroke has considerable cost implications.

In its analysis of the CURE (clopidogrel in unstable angina to prevent recurrent events) trial, MeReC says that it is important to note that the benefits seen with clopidogrel plus aspirin are limited to patients with acute coronary syndromes.

Nicorandil (Ikorel) may be a worthwhile add-on treatment for stable angina, MeReC concludes in its analysis of IONA (impact of nicorandil in angina). However, it points out that the study does not indicate when nicorandil should be added.

MeReC Extra is available on the National Prescribing Centre websites (www.npc.co.uk and nww.npc.ppa.nhs.uk). It is also included in this week's issue of The Journal sent to community and hospital pharmacists in England and Wales.