PJ Online | P&MM: Feedback on brand-switching of diltiazem preparations

Prescribing & Medicines Management
Issue no 2, p11-12
March/April 2003

Features

Feedback on brand-switching of diltiazem preparations

In a previous issue of Medicines Management (2002, 6, p13) Monica Kapoor discussed the importance of prescribing longer-actingpreparations of modified-release diltiazem by brand. She described how she had undertaken brand-switching of diltiazem modified-release preparations to Zemtard XLŽ capsules. Now she is able to report on the outcome of this switch

Monica Sharma Kapoor
Doncaster West Primary care Trust
Contact e-mail: vishamon@hotmail.com

PACT data for September to December 2002 in the area revealed that overall, the number of prescriptions for unbranded diltiazem had decreased and the number of prescriptions for Zemtard XL® capsules had increased. With respect to practices C and F, December saw an increase in the number of unbranded diltiazem prescriptions. This coincides with the increase seen in prescriptions for diltiazem on the whole (Table 1).

Table 1. Number of diltiazem products prescribed

Practice	September 2002	October 2002	November 2002	December 2002
A	60	72	72	79
B	48	51	41	44
C	37	38	40	58
D	27	36	32	33
E	14	11	12	9
F	14	11	12	17

Table 2. Number of items of unbranded diltiazem products

Practice	September 2002	October 2002	November 2002	December 2002	Percentage prescribed as generic in December 2002
A	39	38	9	7	9
B	15	16	12	8	18
C	17	17	5	9	16
D	11	13	6	11	33
E	4	2	1	1	11
F	10	7	5	8	47

Table 3. Number of items of products prescribed as Zemtard® XL

Practice	September 2002	October 2002	November 2002	December 2002	%age of diltiazem prescribed as Zemtard®XL in December 2002
A	0	12	40	46	58
B	6	12	9	14	32
C	0	5	15	26	45
D	1	1	10	4	12
E	0	3	3	3	33
F	0	2	3	6	35

The reason for these changes is that patients may have been discharged from hospital on unbranded diltiazem, or that a GP has prescribed unbranded diltiazem. If the latter is the case, I will need to reiterate the message that Zemtard XL® is the chosen one! There is a reason for practice D's seemingly unusual data. The practice changed its computer systems in December and unfortunately, there was a problem with the data transfer. The result was that recent transactions did not transfer over from the old computer system to the new one. Therefore, all my Zemtard switches were lost!

Mechanics of switch at practice A

At this practice, 42 patients' prescriptions were switched to Zemtard XL® capsules. Of these, 37 patients (88 per cent) remain on Zemtard XL® today.

After changing diltiazem prescriptions to Zemtard XL®, I sent follow-up letters to patients to see how they were getting on (see below).

Sample of letter sent to patients with angina

Sample of letter sent to hypertensive patients

Practice details

Date

Re: Diltiazem modified release tablets/capsules

I recently altered your diltiazem prescription from __mg tablets, one ____ daily to Zemtard® __XL capsules, one daily.

I am writing to check that you found this change satisfactory; I hope you are happy with the amended dose, but should you have any questions/concerns, please feel free to contact me at the surgery on _____.

Thank you.

Yours sincerely,

Pharmacist
On behalf of (GPs)

Practice details

Date

Re: Diltiazem modified release tablets/capsules

I recently altered your diltiazem prescription from __mg tablets, one ____ daily to Zemtard® __XL capsules, one daily.

I would also ask that you make an appointment to see the practice nurse for a routine blood pressure check.

Thank you.

Yours sincerely

Pharmacist
On behalf of (GPs)

Of the five patients who are not on Zemtard XL® now, two came to see me regarding problems. One patient experienced gastrointestinal disturbances, and another found the capsules too large to swallow. No reason was given for one patient reverting back to her former dosing of diltiazem. The remaining two patients had been admitted to hospital. On discharge, one was taken off diltiazem and another was prescribed a lower dose.

There is still some work to be done, but the results to date are encouraging. I think it is fair to say that on the whole Zemtard XL® appears to have been tolerated well, with patients appreciating the once-daily dosage as opposed to multiple daily dosing.