Pharmacy News

AIHW: arthritis and osteoporosis drugs

Early use of DMARDs is now common practice in managing rheumatoid arthritis with methotrexate the most frequently recommended medication, according to a report from the Australian Institute of Health and Welfare (AIHW).

The report summarises data on the use of medications for osteoarthritis, rheumatoid arthritis and osteoporosis using information from the 2004–05 National Health Survey and the Bettering the Evaluation and Care of Health (BEACH) general practitioner surveys from 1998–99 to 2007–08.

“In the last decade, the variety of medicines available for managing arthritis and osteoporosis has expanded considerably,” said Dr Kuldeep Bhatia from the AIHW’s National Centre for Monitoring Arthritis and Musculoskeletal Conditions.

Complementary medicines were commonly used for arthritis and osteoporosis, especially by women.

“While GPs do recommend complementary medicines, the rates are much lower than for pharmaceutical medications,” Dr Bahtia added.

People with osteoarthritis and rheumatoid arthritis most commonly used NSAIDs, and GPs commonly recommended paracetamol for these conditions as well.

For RA, GPs most commonly recommended methotrexate, and for osteoporosis they prescribed bisphosphonates.

Methotrexate was estimated to cost consumers $1.1 million and the Australian Government $2.5 million in 2007, with more than 100,000 subsidised prescriptions dispensed.

More than 1.6 million subsidised prescriptions for meloxicam were dispensed in 2007, costing consumers $7.4 million and the Australian Government $36.9 million.

The report also found that the recall of rofecoxib in 2004 and lumiracoxib in 2007 led to less GP recommendation of other COX-2 inhibitors such as celecoxib, from 32 per 100 encounters in 2000–01 to 8 per 100 in 2007–08.

In 2007, alendronate, alendronate with cholecalciferol, and risedronate with calcium carbonate for the treatment of osteoporosis cost the Australian Government more than $129 million and consumers $19 million.

Drug interactions can lead to Implanon failure: TGA

Women using the Implanon etonogestrel implant are being warned to use “barrier protection” by the Therapeutic Goods Administration (TGA) following evidence of contraceptive failures when used with other medications.

In an announcement this week, the TGA said it had received 32 reports of contraceptive failure leading to unintended pregnancy due to a suspected interaction between Implanon and hepatic-enzyme inducing medicines.

The drug regulator listed a number of products that may lead to a decrease in the efficacy of the contraceptive implant, which included popular complementary medicine, St John’s wort.

“Interactions between hormonal contraceptives and other medicines leading to a decreased contraceptive effect are well recognised.

“For example, carbamazepine can reduce the effect of oral and implantable hormonal contraceptives by inducing cytochrome P450 enzymes, with increases clearance of sex hormones,” the TGA said.

The administration stressed health care professionals should tell women using Implanon to use condoms or the intrauterine device depending on the length of co-administration of a medication that may decrease the effects of the implant.

“Women taking hepatic-enzyme inducing drugs should use a barrier method in addition to Implanon during the time of concomitant drug administration and for 28 days after discontinuation.

“In women on long-term treatment with hepatic-enzyme inducing drugs, [health professionals should recommend] removing Implanon and recommend a non-hormonal method instead,” the TGA said.