ash wrote:
what exactly is wrong with doxepin and amitriptyline?
If used as antidepressants, especially in the elderly, many argue that
the anticholinergic, sedative and postural hypotension side-effects of
tricyclics make them a less appropriate choice than an SSRI.
However, I agree that tricyclic antidepressant drugs (or antiepileptic
drugs) can have a place for neuropathic pain.
Horst Herb wrote:
So, would my patients have been labelled in this "study" as prescribed
something "potentially inappropriate", or did they undertake the effort to
investigate whether there was an acceptable indication where no alternative
drug would have been likely to yield a better benefit/risk ratio?
Clearly, this is the crux of the matter as Ash also implied. A drug that
may not be the drug of choice for all can certainly be the best drug for
a particular patient. And this degree of detail can only come from
discussion with the treating doctor, not from analysing computer
databases. Hence the paper's title, "Potentially inappropriate..."
Having said that, I don't agree that studies such as this are only an
"academic wank".
It's a reasonable hypothesis that the levels of "potentially
inappropriate" prescribing in the elderly revealed by this study are
greater than what might be expected if all doctors were as thoughtful in
their prescribing as Ash & Horst. Such data can cause each of us to
reflect on whether we are always prescribing appropriately &/or whether
our knowledge is up-to-date.
I remember a relatively recent survey of prescribing for uncomplicated
UTI which showed a number of GPs were still prescribing co-trimoxazole.
When I asked them why they said that I had taught them to do so!
And so I had, 30 years ago!
But subsequently, we found that the so-called "synergy" between
trimethoprim and sulphamethozaxole only occurred in vitro, the cure
rates of trimethoprim alone were identical to the combination, and the
long-acting sulphonamide component was associated with occasionally
severe and totally unnecessary side-effects. So 20 years ago we changed
to teaching that trimethoprim alone was preferable to the combination.
But not everyone caught up!
So drug utilisation surveys can be useful despite their obvious
limitations.
We are left with the question of how best to stimulate people to reflect
on whether or not their prescribing is "potentially inappropriate..."
Cheers
Ken
--
Dr. Ken Harvey
Adjunct Senior Research Fellow
School of Public Health, La Trobe University
http://www.medreach.com.au
VOIP: +61 (03) 9029 0634; Mobile +61 (04) 1918 1910
_______________________________________________
Gpcg_talk mailing list
[email protected]
http://ozdocit.org/cgi-bin/mailman/listinfo/gpcg_talk
