Rational prescribing 30 years on – August edition of Australian Prescriber

Thirty years ago there was an event that had a profound effect on the quality use of medicines in Australia. It led to the development of the National Medicines Policy, the National Medicines Handbook and the establishment of NPS MedicineWise. In the August edition of Australian Prescriber retired clinical pharmacologist Professor Rob Moulds reflects on the outcomes of this event and looks at the challenges for the quality use of medicines which remain.

The transformative event was a workshop entitled ‘Rational Prescribing: the challenge for medical educators’ which, for the first time, brought together a consumer organisation (Consumers Health Forum) and a professional organisation (the Australasian Society of Clinical and Experimental Pharmacologists) to discuss the topic which had been considered the province of health professionals.

“Antibiotic resistance is a concern that we had 30 years ago that is still relevant today,” says Professor Moulds.

“Thirty years ago, there were challenges around medicines like statins and ACE inhibitors, which were prescribed long term to treat large numbers of people. Today there are challenges around very expensive medicines, nearly all biologicals, prescribed by specialists for a small number of patients with rare diseases.

“To address these challenges it is important we explore how best to ensure essential independent drug information and therapeutic advice are available free of charge to all healthcare professionals,” said Professor Moulds.

Other articles in the August edition of Australian Prescriber:

Six potential harms of dietary supplements

Products containing vitamins and minerals are used by 47% of Australians, often to supplement their diet rather than treat disease. Dr Geraldine Moses from the School of Pharmacy at the University of Queensland gives an overview of the potential adverse effects of commonly used vitamins and minerals. She lists six possible harms, including drug interactions, cost, delay of more effective therapy, and increased medication burden.

Management of insomnia in primary care

Inadequate sleep and chronic insomnia lead to an increased risk of depression, cardiovascular disease and death, and have associated healthcare costs of $1.24 billion each year. Sleep physicians Dr Lauren Ng and Dr David Cunnington from the Melbourne Sleep Disorders Centre discuss acute and chronic insomnia, and the role of medicines and cognitive behavioural therapy in treatment.

How oral medicines can affect the eye

Its rich blood supply and small mass increase the susceptibility of the eye to medicine-related adverse effects. Pharmacist Rawan Ahmad and ophthalmologist Dr Hemal Mehta, from the Strathfield Retina Clinic and University of Sydney, give a comprehensive overview of how commonly prescribed oral medicines can adversely affect different parts of the eye, and look at what can be done to address this. While some effects are reversible, others can cause irreversible loss of vision and need to be screened for at an early stage.

Also in this issue:

New drugs: Elexacaftor/tezacaftor/ivacaftor for cystic fibrosis, tafamidis and tafamidis meglumine for amyloid cardiomyopathy, and trifarotene for acne.