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INFORMATION FOR PATIENTS
Esomeprazole (Nexium®)/ rabeprazole (Pariet®) therapeutic switch
Issue date: Review date: Page: File reference:
5th January 2011 5th January 2012 1 of 5
K:\MEDICINES MANAGEMENT\SOPS\CLINICAL\Website Patient Info
NICE recommend that the least expensive. the original manufacturers of omeprazole and lansoprazole have since lost their exclusive right to produce these medicines (their patent has expired). On this basis generic omeprazole. from esomeprazole or rabeprazole to either pantoprazole. it is highlighted that the PPI’s most recently marketed on the NHS (esomeprazole and rabeprazole) offer no advantage in clinical effectiveness over established PPI’s.£18. (NICE 2004) (Dyspepsia: Management of dyspepsia in primary care.08 for 28 capsules This compares to the cost of rabeprazole and esomeprazole as follows: Esomeprazole 20mg tablets .19 for 28 tablets Rabeprazole 10mg tablets . This is why the Primary Care Trust (PCT) and the Medicines Management Team is so keen to perform this initiative.42 for 28 tablets Lansoprazole 15mg capsules .) Itemised below is how much the NHS currently pays for PPI’s: Omeprazole 20mg capsules .£11.£1. Recently.Esomeprazole (Nexium®) and rabeprazole (Pariet®) tablets The background information to your tablets Esomeprazole or rabeprazole are tablets that have been prescribed to you to help decrease acid production in your stomach to reduce the symptoms and complications from conditions such as indigestion and ulcers.£1.£2. equivalent doses. who are felt suitable for the switch. and they have subsequently become available from many different manufacturers. pantoprazole and lansoprazole are currently suitable choices. omeprazole or lansoprazole. again the price of this drug has also fallen rapidly. Furthermore. it just means we want to pay for medicines which are the best value for money whilst achieving effective treatment of medical conditions. The total cost of PPI’s prescribed in Primary Care on the Isle of Wight in 2009/10 was around £453. the Isle of Wight PCT could save around £118. The current financial climate means we have to look at every area to ensure value for money without compromising the care and treatment we provide to patients.50 for 28 tablets Pantoprazole 40mg tablets . if prices continue at the same level. This does not mean that we are choosing medication that is less effective. The competition from these alternative manufacturers have driven prices for lansoprazole and omeprazole down markedly compared to the newer drugs esomeprazole and rabeprazole.£25. Highlighted nationally for many years. 2 . Clinical guideline No 17. plus there is also less evidence of long-term safety. appropriate.50 for 28 tablets Esomeprazole 40mg tablets . in England and Wales. but because they’ve been available for prescribing for a much longer period.56 for 28 tablets Rabeprazole 20mg tablets .000.£19.55 for 28 tablets By switching as many patients as possible. According to guidelines from the National Institute for Health and Clinical Excellence (NICE) there is currently no reason to use expensive PPI’s in preference to any of the other PPI’s available when compared at appropriate.£1.£2.000 per year. PPI should be used. Omeprazole and lansoprazole are medicines which are similar to esomeprazole and rabeprazole.68 for 28 capsules Pantoprazole 20mg tablets . the prescribing of PPI’s is one area where significant efficiencies could be made by carefully considered changes in prescribing practice.37 for 28 capsules Lansoprazole 30mg capsules . We are sure you would agree this money could be better reinvested in supporting other NHS services. At present the NHS spends over £100 million every year on this class of medicines. the sole manufacturer of pantoprazole also lost its right to exclusively market this product and therefore can now be produced from other manufacturers. called Proton pump inhibitors (PPI’s). To summarise.
If you have any concerns. we would like to hear from you. Members of the Medicines Management Team are available to help answer any queries you may have about your medicines. pharmacy technicians and experienced nurses. Whilst we recognise that these medication changes may cause some anxieties and concerns.The Medicines Management Team consists of dedicated pharmacists. or you have an unanswered question. we try to minimise any risks that may be caused. Please do not hesitate to contact us on telephone number 01983 534271. Pharmacists are experts in medicines and are highly trained in all aspects of medicines and healthcare. We work closely with GP colleagues and hospital specialists and would like to reassure you that these professionals have been involved in the decision making process to change this medication. 3 . On pages 4 and 5 we have detailed the process by which this medication switch has been carried out.
THE PROCESS Stage 1: Identify patients taking esomeprazole and rabeprazole tablets using Vision® (this is the GPs computer system where your notes are held) • We use a system called Vision® to identify patients currently receiving a repeat prescription for esomeprazole or rabeprazole. • The Medicines Management Team are responsible for making information available on the PCT website for patients to refer to. Stage 3: Exclusion criteria Patients that should not be switched: • Patients with an intolerance/ adverse reaction to the proposed new medication. Patients who meet the exclusion criteria are not suitable for the switch. would be disadvantaged by the switch for any reason. • To inform patients of the change to their treatment. usually the Lead GP for prescribing. • To change the medications safely and efficiently. PREPARATION • Each GP Practice Manager and Lead GP will be contacted outlining the details of the proposed switch programme accompanied by its Standard Operating Procedure. 4 . Stage 2: Review Medical History • Patient’s drugs and medical history will be reviewed to find out if there is any reason they should be excluded from the change. must authorise the work to be carried out in the Practice. Pharmacies are then in a good position to advise patients who have had their medication changed. • A date to perform the switch on the GP Practice’s computer held records. and provide them with the necessary information to allow them to continue receiving safe. effective treatment for their medical condition. RESPONSIBILITIES • A GP at each GP Practice. and who are suitable to be switched to a more cost-effective PPI. except for those patients who are classified in the exclusion criteria (see below). • The Medicines Management Team are responsible for identifying patients. • Each GP Practice will agree a patient letter explaining the reason for the change to their medication. A written reply approving the switch must be obtained before starting ‘THE PROCESS’ detailed below. and any clinics considered necessary will then be agreed.OBJECTIVES • To identify all patients who have esomeprazole and rabeprazole on their repeat prescription. A report may be sent to the GP Practice indicating the number of patients currently prescribed the medication and potential savings if the switch is undertaken. • Local pharmacies will be notified in advance to enable them to review stock levels. • Patients whom by the judgement of the clinician undertaking the change. sending letters. so as to minimise the risks of the medication not being stocked. as and when required. whilst trying to minimise any risks and problems caused by the switch. SCOPE • To include all patients prescribed esomeprazole and rabeprazole tablets. • GP Practice staff should be made aware of this initiative so they can provide information to patients. record keeping and holding any relevant patient clinics.
Stage 7: Follow up • Patients should not notice any difference when changing over to the other PPI’s recommended. plus the rationale for change on the letter. or finally omeprazole 20mg capsules – 2 daily. Stage 6: Prepare the letter to the patient • A personalised letter is sent to each patient. 5 . Stage 5: Remove the old medication • The dose and quantity of the new medication is checked carefully before deleting the old medication. then advice from the GP should be sought. or pantoprazole 40mg tablets – 1 daily. • Great care is taken to make sure we highlight the name of the old medication and the new medication. however. • Changes to medication are entered into patient’s notes only when all of above criteria are met. Stage 4: Authorise the change and add new medication • An entry will be made into the Vision® medical records for each patient outlining the change of medication agreed with the GP Practice. o Esomeprazole or rabeprazole 20mg tablets to be changed to lansoprazole 30mg capsules – 1 daily. checking the dose and quantity of tablets are appropriate. and the identities of the Medicines Management Team members carrying out the change. or pantoprazole 20mg tablets – 1 daily. For patients taking esomeprazole and rabeprazole the following alternatives will be considered: o Esomeprazole 40mg tablets to be changed to omeprazole 20mg capsules – 2 daily. advising of the reason for the change to their medication. o Rabeprazole 10mg tablets to be changed to lansoprazole 15mg capsules – 1 daily. if it is felt this change has caused any new side-effects or has caused their condition to become less well controlled. • The name of the new medication is added to the repeat prescription of the patient’s medical record. • Patients are invited to attend a clinic or contact the team with any concerns or questions they may have.• Patients who have been previously been initiated on the proposed medication and who have not had a therapeutic response. or omeprazole 20mg capsules – 1 daily. In doing this it helps to reduce the workload of the GP Practice staff.
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