The Pharmaceutical Journal
Vol 270 No 7255 p886-887
28 June 2003

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Letters to the Editor

Omeprazole

Need for a new legal category of medicines

From Mr P. Brettle, RGN

Normally the application to classify omeprazole as a pharmacy medicine (PJ, 24 May, p709) would raise little concern. The efficacy of omeprazole (and other proton pump inhibitors) in relieving the symptoms of heartburn and acid regurgitation is widely acknowledged, as is its enviable safety record. However, it is precisely because of this efficacy that there are concerns that omeprazole use might mask the development of serious gastro-oesophageal conditions.

These are not new concerns, and they underlie the post-marketing surveillance of omeprazole. These concerns are acknowledged by Galpharm's proposals to provide training for pharmacists on diagnosis and referral for gastro-oesophageal reflux disease. Unfortunately, such measures are doomed to be ineffective.

Patients may be reluctant to visit their general practitioner with their symptoms for a number of reasons, and an appreciable number of these — because they are reluctant to confront a feared diagnosis or because they have a dread of clinicians — will simply circumvent the proposed measures by presenting to a new pharmacy each time they need more medication.

If it is believed that omeprazole is pharmacologically safe enough to be available from pharmacies but there are concerns that its use should be monitored for good clinical reasons, perhaps there is a need for a new legal category of drugs whereby a condition of the supply is that the NHS number of the patient is recorded. These details could then be fed back to the patient's GP to allow monitoring of drug use. There are other drugs, eg, insulin, which might be appropriate for inclusion in this category if it were created.

Although this would be a nightmare with a paper-based system, it would become far less onerous as the IT links within the NHS become progressively more integrated.

 Paul Brettle
Senior Information Analyst
Walsall Primary Care NHS Trust

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