Random prescribing points

Statins: Fluvastatin, simvastatin and atorvastatin are predominantly lipid-soluble, whereas pravastatin and rosuvastatin are predominantly water-soluble. Therefore, if a patient gets SEs on a lipid-soluble statin, it’s worth trying water-soluble.

 

Remember that the cut-offs for stopping are liver enzymes >3x ULN or CK >5x ULN. Check ALT at 3/12 & 12/12 after treatment, CK only if symptomatic.

 

 

PPIs: Splitting the dose & taking as a bd regime can sometimes work better in controlling symptoms than taking it once daily. They work best if administered 30 to 60 mins before the first meal of the day (if a split dose is given, take the second dose before the evening meal) as this means their action will coincide with the postprandial gastric cell stimulation.

 

 

Rebound hyperacidity is probably only a problem in patients who’ve been on the PPIs for >6/12. In these cases, a 50% dose reduction every week should be enough, stopping after 1 week on the lowest dose.

 

 

There is one study showing esomeprazole to be better than omeprazole in healing oesophagitis (Expert Rev Gastroenterol Hepatol 2012; 6: 533 – 44) but none showing it to be better in dyspepsia.

 

 

SSRIs: Monitor U&Es in patients over 80 or those with a history of hyponatraemia, due to the hyponatraemia risk.

 

 

(Prescriber 24(7), 5th April 2013, plus old article from BMJ 2010, 3rd April, pg 755)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in BMJ, Cardiovascular, Credits 2013, Gastroenterology, Medication, Prescriber, Psychiatry. Bookmark the permalink.

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