s NPS Media Releases for April 2013 | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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NPS Media Releases for April 2013

NPS Spokesperson

articles by this author...

Regular information provided by NPS – Better choices, better health - NPS enables people to be medicinewise.

NPS is a valued independent resource for accurate, evidence-based prescribing information and education. Given the marketing pressures applied by global drug companies, NPS plays a vital and unique role across the healthcare sector. For more information please contact Stephanie Childs on (02) 8217 8667 or 0419 618 365 or schilds@nps.org.au

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29 APRIL 2013

NPS MedicineWise is urging health professionals to weigh the risks and benefits of oral anticoagulant therapies in people with non-valvular atrial fibulation (AF) following the Pharmaceutical Benefits Advisory Committee (PBAC) recommendation that newer oral anticoagulants (NOACs) be listed on the Pharmaceutical Benefits Scheme (PBS).

Following an extensive review of NOACs over the past two years, PBAC has now recommended that dabigatran (Praxada), rivaroxaban (Xarelto), and apixaban (Eliquis) be subsidised under the scheme for stroke prevention in non-valvular AF.

 In light of the recommendations, NPS MedicineWise CEO, Dr Lynn Weekes, said GPs must consider the safety and efficacy of newer therapies in context with warfarin – a medicine that has been the mainstay of anticoagulation therapy in clinical practice for many years.

 “There is a clear need to establish good anticoagulant practice in Australia and a decision to subsidise newer anticoagulant therapies under the PBS would present GPs with a choice which needs to be weighed carefully against the alternatives,” says Dr Weekes.

 “Doctors who are prescribing and monitoring patients requiring anticoagulant therapy need to weigh the risks and benefits of newer medicines and carefully consider the safety issues involved in switching therapies.”

Dr Weekes said that while the subsidy of newer oral anticoagulants represents a greater choice for GPs and their patients, evidence suggests that people with non-valvular AF whose anticoagulation is well controlled using warfarin may not benefit clinically from switching to a newer oral anticoagulant.

 “As there are no readily available and validated tests for measuring the anticoagulant effect of the newer oral anticoagulants, routine clinical monitoring of all patients on anticoagulant therapy is still essential, regardless of which type they are using.

 “And while the new oral anticoagulants don’t require monitoring with a blood test, there is significant risk for the patient because there is no readily-available antidote to reverse bleeding should it occur when using these newer agents.”

In February this year, NPS MedicineWise launched a new educational program for health professionals to provide clarity around the newer oral anticoagulants and their place in therapy. The program supports GPs in their clinicial decision-making and assists pharmacist to feel more confident in their role when it comes to advising and educating patients requiring anticoagulant therapy.

 The program – Achieving Good Anticoagulant Practice –  is designed to ensure that people understand the potential benefits and side effects of the full range of oral anticoagulant therapies available.

“The recommendation to make newer anticoagulants more affordable in Australia provides a great opportunity for GPs to review treatment for patients at risk of thromboembolism and evaluate the risk and benefits of the various treatment options available,” says Dr Weekes.

“Our new program for health professionals is designed to cut through the confusion and it is our goal that the program will provide reassurance and accurate, evidence-based information about using anticoagulants safely and effectively.”

For more information about the new program, resources and regular program updates visit www.nps.org.au/anticoagulants     

New decision support tools for oral anticoagulants, including an anticoagulant safety checklist, switching oral anticoagulants, dose adjustments for newer anticoagulants, and a decision algorithm, are also now available at http://www.nps.org.au/anticoagulant-decision-tools


26 APRIL 2013

NPS MedicineWise supports the scientific and evidence-based recommendation made today that medical abortion drug, mifepristone (RU486), should be subsidised under the Pharmaceutical Benefits Scheme (PBS).

RU486 has been included on the Australian Register of Therapeutic Goods (ARTG) since November 2012 and today the Pharmaceutical Benefits Advisory Committee (PBAC) recommended that the medicine be listed for subsidy on the PBS.

NPS MedicineWise CEO, Dr Lynn Weekes, says this decision is not about the morals and ethics of abortion but rather affordable access to options for safe medical termination of pregnancy.

“Mifepristone (RU486) with misprostol is a real alternative to surgical termination, that can be used earlier in the pregnancy than surgery, and evidence shows its safety and efficacy are comparable with surgical abortion,” says Dr Weekes.

“PBS listing will make this alternative accessible to those who may benefit at an affordable price.”

NPS MedicineWise has published advice for health professionals to help them understand the appropriate use of mifepristone (RU486) and misprostol. This information is available at http://www.nps.org.au/publications/health-professional/nps-direct/2012/november-2012/mifepristone-misoprostol-tga-listed

Consumers who would like more information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals), call NPS Medicines Line on 1300 MEDICINE (1300 633 424) for the cost of a local call (calls from mobiles may cost more). Hours of operation are Monday–Friday 9am–5pm AEST (excluding public holidays).

26 APRIL 2013

With the expanding choice of oral anticoagulant medicines, NPS MedicineWise has launched a series of clinical decision support tools to help health professionals safely manage their patients who require oral anticoagulation.

NPS MedicineWise clinical adviser Dr Philippa Binns says the decision support tools will assist prescribers whose patients are starting or continuing anticoagulation therapy or who might be switching between different anticoagulant medicines. 

“Our new Anticoagulant Safety Checklist is designed to prompt a discussion with patients to achieve safe use and monitoring of oral anticoagulants,” says Dr Binns.

“The new guide Switching oral anticoagulants is a series of tables to assist safe switching between whichever oral anticoagulant your patient is using, while the Dose adjustments for newer anticoagulants guides appropriate dosing for age and renal impairment for the newer oral anticoagulants.

“The collection of evidence and expert consensus-based tools provides a one-stop-shop for health professionals who can find the latest information without having to track down the individual product information for each of the medicines.”

The new decision tools are available on the NPS MedicineWise website:

Caring for patients on oral anticoagulants: Anticoagulant safety checklist:


Switching oral anticoagulants:


Dose adjustments for newer anticoagulants:


A warfarin maintenance tool which will include a dose adjustment algorithm to assist managing high and low INRs will be available in May. In addition, a warfarin patient information leaflet and a warfarin dose tracker, to help patients keep track of their INR results and daily dose, are also being developed and will also be available in May for health professionals to share with their patients.

The new resources are in addition to a range of existing tools to assist health professionals with:

  • Starting oral anticoagulants
  • Stroke risk assessment in people with non-valvular atrial fibrillation (CHADS2)
  • Further risk stratifying people with non-valvular atrial fibrillation who are at low risk of stroke (CHA2DS2-VASc)
  • Identifying risk factors for bleeding in people with atrial fibrillation (HAS-BLED)
  • Achieving and maintain INR in the therapeutic range. 

For more information for both health professionals and consumers about being medicinewise with anticoagulants, visit www.nps.org.au/anticoagulants


8 APRIL 2013

General practitioner and professional education advocate Dr Roger Sexton has been appointed as director of the NPS MedicineWise board in the role of Health Practitioner (GP) director.

NPS MedicineWise Chair Dr Janette Randall says that Dr Sexton is an active contributor to the medical profession bringing broad professional experience and a desire to positively influence lifelong medical education, quality prescribing and optimal patient care.

Dr Sexton is a rural and urban General Practitioner, a clinical skills tutor at Adelaide University Medical School, and a recent member of the Pharmaceutical Benefits Advisory Committee from 2010-2013.

He is a past Presiding member of the Medical Board of SA and is a strong advocate for programs to support doctors’ health. He is also a Board member of national medical indemnity insurer MIGA and its Claims Committee, and is a member of the federal AMA Council of General Practice.


In welcoming him to the Board, Dr Randall noted that Roger’s broad professional interests, experience and networks will be of great value to NPS MedicineWise.


Dr Sexton succeeds Dr Chris Mitchell who is retiring from the board having served as a Health Practitioner (GP) director and member of the Audit Committee for the past three years. 

“Chris has been a great contributor to NPS MedicineWise, passionate about evidence based medicine and improving patient care,” said Dr Randall. 

“Chris also brought a high level of knowledge and enthusiasm for the e-health agenda which was highly valued by the Board.”

5 APRIL 2013

The latest edition of NPS RADAR reviews pregabalin (Lyrica), a treatment option recently listed on the PBS for people with neuropathic pain which has not been controlled by other drugs.

According to the independent review by NPS MedicineWise, pregabalin appears to have similar efficacy and similar range of benefits and harms compared to other adjuvant or add-on analgesics for neuropathic pain.

However some uncertainty around its efficacy still exists as there have been no head-to-head trials to test it against other drugs for neuropathic pain.

The NPS RADAR review encourages prescribers to consider initial treatment with another analgesic agent, such as a tricyclic antidepressant, before pregabalin, as pregabalin is only PBS listed as an alternative or an adjunct treatment for people with neuropathic pain which has not been satisfactorily controlled using other drugs.

Prescribers should also inform patients of possible side effects and discuss realistic treatment outcomes.

Dizziness and drowsiness are common dose-dependent adverse events, and in trials, these were the most common issues causing people to stop pregabalin. Patients should also be aware that it may take several weeks to achieve maximal effect with pregabalin and if the drug needs to be discontinued, it should be tapered off rather than abruptly stopped, in order to avoid adverse withdrawal effects.

When prescribing pregabalin in people with impaired renal (kidney) function, the dose should be reduced since the drug is renally excreted.

PBAC has recommended that the drug utilisation subcommittee (DUSC) review the usage of pregabalin 12 months after its PBS listing.

This edition of NPS RADAR also includes full reviews for  imiquimod cream (Aldara) for superficial basal cell carcinoma, and sitagliptin with simvastatin (Juvicor), a fixed dose combination medicine for treating type 2 diabetes and high cholesterol. It also includes In Brief articles on the following medicines and PBS listing changes:

  • Femme-Tab ED 20/100: low-dose-oestrogen combined oral contraceptive
  • Strontium ranelate (Protos) – PBS listing extended to include men with osteoporosis
  • Zoledronic acid (Aclasta) – PBS listing changed to include an extended bone mineral density T-score cut-off
  • Durotram (tramadol, extended release) – PBS listing deleted.

To read the full reviews go to www.nps.org.au/radar.

NPS RADAR is a timely, independent publication for health professionals published by NPS MedicineWise. It provides health professionals with evidence-based information about new drugs, medical tests, and changes to listings on the PBS.

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