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Amlodipine
Give pharmacists power to substitute generics
From Mr C. Morris, MRPharmS
In a bid to save NHS money pharmacists are informed that they can now
dispense, and be paid for, generic amlodipine. Unfortunately, most prescriptions
turn up as amlodipine besilate, not amlodipine maleate, so we are still
forced to dispense Istin.
I initially thought this was a scheme by the drug companies but have
now realised that it is not that complex. It is purely because that is
the way the prescribing computers are set up and GPs do not realise the
problem this causes.
I should have realised that this would be the case — how many pharmacists
face the problem of patients only wanting a certain brand but doctors
not understanding that the brand name needs to be written on the prescription?
How many pharmacists have seen hormone replacement therapy prescriptions
written generically, or dangerous lithium and theophylline prescriptions
written generically?
Is it not time that it was pointed out that any government campaign to
cut costs will not work until the final choice of which brand is given
is wrested from the GPs who are unaware of the way prescriptions are
paid for.
Let doctors go back to writing prescriptions for branded drugs, therefore
saving time, and possibly lives, on inappropriate generic prescribing
and give pharmacists the power to substitute generics when it is advisable.
If a three-month test were put into practice I am sure the power would
not be revoked.
Chris Morris
Newquay,
Cornwall
Clear instructions needed
From Mr G. J. Weaver, MRPharmS
I am sorry if there has been an announcement in The Pharmaceutical
Journal that I have missed, but I believe that the Royal Pharmaceutical Society’s
legal department must give a clear instruction to pharmacists dispensing
prescriptions for amlodipine. Until generic amlodipine maleate became
available there was no doubt that amlodipine besilate (Istin) was dispensed.
Now patients using several pharmacies may find they sometimes receive
besilate and sometimes maleate. If it is to be accepted the two are bioequivalent
the patient information leaflet must include a text of reassurance for
the patient.
G. Weaver
Bathford,
Avon
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LYNSEY BALMER, pharmacist adviser, fitness to practise directorate,
Royal Pharmaceutical Society, replies:
The Code of Ethics requires
that “except
in an emergency, pharmacists must not substitute any other product for
a specifically named product without the approval of the patient or carer
and the prescriber”. Therefore, if a prescription specified
an amlodipine salt, a pharmacist would be expected either to dispense
that
salt or to
consult both the prescriber and patient regarding any substitution.
It has been brought to the Society’s attention that some GP
computer prescribing systems automatically default to a specific amlodipine
salt.
In such circumstances,
pharmacists may wish to develop locally agreed protocols with prescribers.
However, consideration would need to be given to instances where a
patient is expecting
a particular salt and the prescription would need to be appropriately endorsed.
Patient information leaflets are product-specific and the information provided
is the responsibility of the individual marketing authorisation holder.
Pharmacists are required to ensure that patients have sufficient information
to enable safe
and effective use of their medicine. As with all generic medicines, the
different amlodipine products that are now available may give patients
cause for concern.
Pharmacists would be expected to ensure patients are appropriately counselled
on the different amlodipine salts and their recognised bioequivalence. |
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The
Pharmaceutical Journal