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

Editorial

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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News Flash

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

Comments: 1

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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
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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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 February 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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13 FEBRUARY 2013

REVIEW OF NEWER ORAL CONTRACEPTIVES: MEDICINEWISE ADVICE FOR HEALTH PROFESSIONALS

NPS MedicineWise is advising health professionals to weigh patient needs against the possible increased risk of venous thromboembolism (VTE) when considering combined oral contraceptives (OCs) containing new generation progestogens.

In response to new data indicating that some newer (oral) contraceptives carry a higher risk of VTE than older drugs, the Therapeutic Goods Administration (TGA) has announced a review of combined OCs containing new-generation and anti-androgenic progestogens. 

As the TGA monitors the risk of VTE and conducts a review of the safety information available, NPS MedicineWise clinical advisor Andrew Boyden says health professionals should consider the risks in light of their patients’ individual circumstances and educate consumers to recognise the signs and symptoms of VTE.

“It is well established that oral contraceptives carry a small risk of VTE - much lower than the risk of VTE during pregnancy and during the postpartum period,” says Dr Boyden.

“The risk will differ according to the generation of combined oral contraceptive, and increasingly evidence suggests that oral contraceptives containing newer synthetic progestogens carry a higher risk of VTE.”.

“So when choosing an oral contraceptive, or when considering Diane-35 or its generics for the treatment of acne, health professionals should weigh the risks of VTE against the clinical needs of their patients and take care especially in women with risk factors for venous or arterial thrombosis including obesity or smoking.–.”

Whilst the TGA and the European Medicines Agency (EMA) have both announced reviews of new generation combined OCs, NPS MedicineWise says at this time there is generally no need to discontinue use in patients who have not experienced any adverse medicines events,”

“Health professionals are encouraged to talk to their patients about the possible increased risk of VTE with newer oral contraceptives but says Dr Boyden.

“Educating your patients to recognise the signs and symptoms of VTE is an important step in managing the potential risks associated with oral contraceptives.

An article about the review of new-generation and anti-androgenic progestogen OCs appears in this month’s NPS Direct e-newsletter, written by NPS MedicineWise and distributed free to health professionals. To subscribe visit http://www.nps.org.au/nps-direct

For more information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, patients can 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).

 

12 FEBRUARY 2013

PHARMACIST PARTICIPATION IN NPS MEDICINEWISE PROGRAMS REMAINS STRONG
 

During 2011-12, 20% of registered pharmacists and interns, more than half of Australian GPs, and one quarter of all registered nurses working in general practice took part in NPS MedicineWise programs.

NPS MedicineWise CEO Dr Lynn Weekes says that the results of the latest annual Evaluation Report reflect the many ways that the organisation contributes to the quality use of medicines and other medical technologies. 

“The number of unique pharmacists and intern participants in NPS activities – and the total number of activities completed – has increased steadily over the past five years,” says Dr Weekes.

“This is a very positive result for us given the important role pharmacists play in the community and the impact their behaviour has on community health.”

During the year 5,167 unique pharmacists and pharmacist interns (20% of registered pharmacists and enrolled interns in Australia) participated in NPS activities in 2011-12. 

Case studies were the most popular learning activity amongst pharmacists and interns, with the fact these are now available online meaning they are a convenient and accessible professional development option. 

Pharmacy practice reviews and small group case-based discussions were also popular, with a 10% increase in the number of pharmacy practice reviews completed compared to the previous year, again due in part to the release of the first online version of this activity in early 2012.

14,133 unique GPs (57% of registered GPs in Australia) and 2,748 unique nurses, mostly working in general practice, also participated in NPS activities during this time.

The Evaluation Report report also highlights the positive impact of three key therapeutic programs on GP prescribing behaviour.

“GP participation in the 2005 and 2008 NPS diabetes programs Reducing risk in type 2 diabetes and Early use of insulin and oral antidiabetic drugs was associated with an estimated relative increase in the modelled rate of prescribing of metformin of 7% in 2009–10 and the same again in 2010–11, in line with the programs’ key messages,” says Dr Weekes.

“Similarly, GP participation in the 2008 NPS dementia program Treating the symptoms of dementia was associated with a 9% relative reduction in the modelled rate of prescribing of cholinesterase inhibitors and memantine in 2010–11, which was also in line with the program’s messages.”

The report also shows that GPs who participated in the NPS acute low back pain interactive workshops were less likely to order CT scans (52%) compared with non-participants (62%). This shows an improvement in referral behaviour according to best practice guidelines.

Another area of improvement was in NPS e-learning resources for health professional students, with a 29% increase in the number of students completing at least one National Prescribing Curriculum module between 2010–11 and 2011–12.

“The findings from our evaluation activities play a pivotal role in ensuring that we maintain the rigour of our work, and that our products and services remain appropriate to the needs of our audiences,” says Dr Weekes.

To read the full ‘NPS MedicineWise Evaluation Report No. 15, 2011-12’, visit http://www.nps.org.au/annual-evaluation-report

 

5 FEBRUARY 2013

MAKING SENSE OF ANTICOAGULANTS: NEW NPS MEDICINEWISE PROGRAM

A new educational program for health professionals by NPS MedicineWise will help provide clarity around the newer anticoagulants and put them into context with warfarin, an anticoagulant that has been the mainstay of clinical practice for many years. The program – Achieving Good Anticoagulant Practice – launches on 5 February 2013.

NPS MedicineWise clinical adviser Dr Danielle Stowasser says that the program will assist pharmacists to feel more confident in their role when it comes to advising and educating patients requiring anticoagulant therapy. 

The latest edition of Medicinewise News, ‘Good anticoagulant practice’, distributed to over 70,000 health professionals from 5 February, looks at optimising treatment with warfarin as well as whether and when to consider switching patients from warfarin to a newer anticoagulant.

“This latest edition of Medicinewise News outlines why people with non-valvular AF whose anticoagulation is well controlled using warfarin may not benefit clinically from switching to a newer oral anticoagulant,” says Dr Stowasser.

“Importantly, it also reminds prescribers that although there are no readily available and validated tests for measuring the activity of the newer oral anticoagulants, routine clinical monitoring of all patients on anticoagulant therapy is still essential, regardless of which type of anticoagulant they are using.

“In other words, newer oral anticoagulants may not need monitoring via a blood test, but the people taking them certainly still do, particularly as there is currently no readily available antidote for reversing these medicines’ effect.”

Medicinewise News covers starting treatment with anticoagulants, treatment of non-valvular AF based on stroke risk, the newer anticoagulants and their place in therapy, issues around switching, the importance of ongoing monitoring in people taking oral anticoagulants, and a decision tool to assist with starting oral anticoagulants. It also contains a ready reference chart outlining the steps for warfarin best practice and for achieving and maintaining INR in the therapeutic range. 

“It’s estimated that as many as 90% of patients who present with AF-related strokes have received inadequate anticoagulation therapy, and 60% of patients are not receiving any anticoagulants at the time of their stroke,” says Dr Stowasser.

“We know that people with non-valvular AF do not receive adequate stroke prevention treatment even when assessment of their risk indicates that anticoagulation is required. 

“This discrepancy between the need for anticoagulation and the evidence for under-treatment represents one of the major evidence–practice gaps in medicine today. The new NPS program aims to address some GP uncertainties that may be contributing, such as fears about bleeding risks.”

“The program will also provide upskilling for pharmacists who play an important education role in optimising warfarin treatment and in helping to explain the risks, benefits and place in therapy of the newer anticoagulants.”

NPS facilitators will begin delivering face to face educational visits on the Achieving Good Anticoagulant Practice program for GPs and pharmacists from February.  Educational visits are free and attract CPD points, and can be booked by contacting the NPS facilitator at your Medicare Local or contacting NPS directly.

“The availability of newer oral anticoagulants provides a great opportunity for health professionals to review treatment for patients at risk of thromboembolism and assess whether current warfarin management could be improved,” says Dr Stowasser.

“It is our goal that the new program will cut through the confusion and 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   



13 FEBURARY 2013

REVIEW OF NEWER ORAL CONTRACEPTIVES: MEDICINEWISE ADVICE FOR HEALTH PROFESSIONALS

NPS MedicineWise is advising health professionals to weigh patient needs against the possible increased risk of venous thromboembolism (VTE) when considering combined oral contraceptives (OCs) containing new generation progestogens.

In response to new data indicating that some newer (oral) contraceptives carry a higher risk of VTE than older drugs, the Therapeutic Goods Administration (TGA) has announced a review of combined OCs containing new-generation and anti-androgenic progestogens. 

As the TGA monitors the risk of VTE and conducts a review of the safety information available, NPS MedicineWise clinical advisor Andrew Boyden says health professionals should consider the risks in light of their patients’ individual circumstances and educate consumers to recognise the signs and symptoms of VTE.

“It is well established that oral contraceptives carry a small risk of VTE - much lower than the risk of VTE during pregnancy and during the postpartum period,” says Dr Boyden.

“The risk will differ according to the generation of combined oral contraceptive, and increasingly evidence suggests that oral contraceptives containing newer synthetic progestogens carry a higher risk of VTE.”.

“So when choosing an oral contraceptive, or when considering Diane-35 or its generics for the treatment of acne, health professionals should weigh the risks of VTE against the clinical needs of their patients and take care especially in women with risk factors for venous or arterial thrombosis including obesity or smoking.–.”

Whilst the TGA and the European Medicines Agency (EMA) have both announced reviews of new generation combined OCs, NPS MedicineWise says at this time there is generally no need to discontinue use in patients who have not experienced any adverse medicines events,”

“Health professionals are encouraged to talk to their patients about the possible increased risk of VTE with newer oral contraceptives but says Dr Boyden.

“Educating your patients to recognise the signs and symptoms of VTE is an important step in managing the potential risks associated with oral contraceptives.

An article about the review of new-generation and anti-androgenic progestogen OCs appears in this month’s NPS Direct e-newsletter, written by NPS MedicineWise and distributed free to health professionals. To subscribe visit http://www.nps.org.au/nps-direct 

For more information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, patients can 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).

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