The Pharmaceutical Journal
Vol 276 No 7387 p166
11 February 2006

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· Skin conditions (2)
· Statins
· Independent prescribing
· Compliance aids (2)
· Universal health care
· Assisted dying
· CPD
· The Society

Letters to the Editor

Statins

Dosing issues

From Mrs I. Gummerson, MRPharmS

At a recent multidisciplinary meeting, a consultant (from Northern Ireland) criticised pharmacists, saying that he wished that when he wrote “one in the morning” on prescriptions for statins, that the pharmacists would not advise the patient to take them at night. He explained that in his experience, some patients had side effects if they took a statin at night and he had read no evidence that he should not prescribe them to be taken in the morning. Surely, he said, it was better for a patient to take the statin, than not comply due to side effects.

After the meeting, I telephoned Merck Sharpe and Dohme and asked about Zocor (simvastatin). The adviser there said something to the effect that 36.3 per cent of the dose was effective if the tablet was taken at night, and only about 20 per cent if taken at lunchtime.

I would welcome pharmacists views on the following issues:

Liaison issues I felt if the consultant had a problem with local pharmacists he should contact the local primary care trust (or equivalent health authority) adviser or the local pharmaceutical committee (or equivalent for NI) and come to some amicable arrangement. Perhaps pharmacists, not knowing his reasoning, might have thought the morning dosage was a typing error, and amended it to the licensed dosage.

Licensing issues If the medicine was licensed to be used at night, would it be right for the PCT or LPC to advise pharmacists to comply with the prescription and type “one in the morning”?

Compliance issues If the patient could only take it in the mornings, should pharmacists say anything to the patient about it being an unlicensed dosage? Would this put doubt in the patient’s mind about conflicting messages? As a result they may not take the dose at all.

Medicines use review opportunity? Perhaps pharmacists should see a morning dosage written for statins that are licensed for night time as an opportunity for an MUR intervention, and ask whether the patient has had side effects with a night-time dose.

Typing error or policy? Perhaps pharmacists seeing a morning dose should have a discussion with the prescriber to see whether they have a deliberate (occasional) morning policy, rather than just assuming it is a typing error.

Irene Gummerson
Wakefield, West Yorkshire

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