Latest edition of Australian Prescriber out now
1 APRIL 2015
PATIENT EDUCATION ABOUT WARFARIN PIVOTAL TO SUCCESSFUL USE
Warfarin can be a challenging drug to manage. Long-term anticoagulation is recommended for patients with atrial fibrillation at risk of stroke, and for those with recurrent venous thrombosis or prosthetic heart valves.
An article in the latest issue of Australian Prescriber authored by Dr Philip Tideman and co-authors from South Australia argues that patient education before starting warfarin is pivotal to its successful use. They discuss how to optimise warfarin management.
The use of warfarin is limited by several factors including a narrow therapeutic range, and drug-drug and drug-food interactions. Bleeding is a major concern.
Dr Tideman says “The instructions for taking warfarin can be daunting—warfarin needs to be taken at the same time each day and regular blood tests are required. Patients must be informed about the impact of diet, potential drug interactions and actions to take if a dose is missed.
“Warfarin is subject to multiple interactions including from foods like beetroot and green leafy vegetables, medicines including some antibiotics and statins, St John’s wort, weight loss or weight gain, and excess alcohol. Interactions can increase the risk of bleeding.
“In addition, regular monitoring of the anticoagulant effect is required. The evidence suggests that patients who self-monitor using point-of-care testing have better outcomes than other patients.”
Point-of-care testing can be used to monitor the anticoagulant effect. This testing can be done in general practice, pharmacies or by patients themselves. The authors argue that these approaches are more convenient for patients than regular visits to a pathology practice or an anticoagulation clinic in a hospital.
“There is evidence that monitoring is poorly understood by health professionals both overseas and in Australia, and this warrants further investigation. Improved outcomes are achieved by patients who have been taught how to monitor their treatment, with a reduction in thromboembolic events and death,” says Dr Tideman.
For the full article “How to manage warfarin therapy” visit www.australianprescriber.com
Other articles in this issue include:
* Treatment for Alzheimer’s disease: has anything changed?
* Long-term drug treatment of patients with alcohol dependence
1 April 2015
LATEST NPS MEDICINEWISE PROGRAM: STEPPING DOWN FROM PROTON PUMP INHIBITORS
NPS MedicineWise today launches a new learning program and health professional tools on the use of proton pump inhibitors (PPIs) in the treatment of uncomplicated gastro-oesophageal reflux disease (GORD).
The program focuses on optimal use of PPIs and provides practice points and tools to facilitate step-down therapy in patients whose symptoms are well controlled.
PPIs are a mainstay of the management of acid-peptic disorders; they are highly effective at relieving symptoms and generally well tolerated.
Their success is reflected in the fact that over the last decade PPIs have been consistently listed in the ten most commonly used PBS-subsidised medicines in Australia (based on defined daily dose, prescription count and cost to the government). Across the 2013–14 financial year there were over 19 million prescriptions for PPIs in Australia.
However, while reflux symptoms such as heartburn are common—about 1 in 5 Australian adults experience heartburn at least once a week—not everyone that has heartburn needs to be on prescription medicine, and not everyone that has been prescribed a PPI needs to take it on a regular, long-term basis.
NPS MedicineWise Clinical Adviser Dr Jeannie Yoo says, “There is growing international concern over the increasing use of PPIs and about reports associating PPI use with serious, though rare, adverse effects. Especially in older people, PPI use has been associated with an increased risk of fractures, enteric infection, pneumonia, and vitamin B12, iron and magnesium deficiencies.
“Health professionals are aware that not all patients need to be on a PPI long term, but sometimes unnecessary long-term use can be missed; for instance, if the medicine has been started in a different environment like after surgery. When a patient with GORD is started on a PPI, it’s an opportunity to plan a date for review and for a discussion about stepping down therapy if their symptoms are well controlled.
“NPS MedicineWise tools such as the symptomatic management pad can make it easier to discuss recommendations with patients, including lifestyle modifications and options for stepping down therapy,” says Dr Yoo.
The program advocates the optimal use of PPIs, and focuses on when and how to review therapy:
* Review patients taking a PPI long term to evaluate if the indication persists—daily, long-term use is only recommended in selected groups of patients.
* Consider risks of PPI use particularly in higher-risk groups such as older people.
* Discuss with patients the expected initial duration of PPI therapy and plans for stepping down.
* Consider stepping down PPI therapy in GORD patients once symptoms are well controlled.
* Review the use of concomitant medicines and advise patients about those that may exacerbate heartburn or reflux symptoms.
* Encourage lifestyle modifications appropriate to the patient.
The suite of resources and tools for the 2015 PPIs program includes:
* MedicineWise News: PPIs – too much of a good thing?
* Interactive online case study: PPIs in uncomplicated GORD
* Clinical e-Audit: PPIs: Too much of a good thing (register your interest now)
* Symptomatic Management Pad for GORD (download or order at www.nps.org.au/hporders)
* Online knowledge hub with detailed information for health professionals and consumers on PPIs and their use in GORD.