Changing meds---equivalences.

[johnep]

We are all familiar with the change to simva from ator. Yesterday saw letter to pt from practice saying changing from perindopril 4mg to 2.5mg ramipril.

This seems a bit low to me, What is the equivalence perindopril:ramipril?
johnep

[kemzero]

I think that is about right 2.5mg titrated up to 5mg if need be

I wonder what the rationale behimd this might be , as perindopril is now off patent and prices are likely to come tumbling down this year

[Jeff]

Originally Posted by kemzero

I think that is about right 2.5mg titrated up to 5mg if need be

I wonder what the rationale behimd this might be , as perindopril is now off patent and prices are likely to come tumbling down this year

To upset the patients - and let them know who is boss. And if the patients have the audacity to complain the GP's can say they've tried perindopril and ramipril and then feel justified in putting them on something much more ex(pensive/perimental) *delete as appropriate.

Jeff

[Pharmanaut]

Originally Posted by Jeff

To upset the patients - and let them know who is boss. And if the patients have the audacity to complain the GP's can say they've tried perindopril and ramipril and then feel justified in putting them on something much more ex(pensive/perimental) *delete as appropriate.

Jeff

Has someone at the PCT got a bee in their bonnet?

[Titch]

Originally Posted by kemzero

I think that is about right 2.5mg titrated up to 5mg if need be

I wonder what the rationale behimd this might be , as perindopril is now off patent and prices are likely to come tumbling down this year

Perindopril been off patent a while and prices yet to go down significantly - did drop slightly in last couple of months.

Work as practice pharmacist part of week and have held of switching perindopril to another ACE for the very reason quoted above.

Could see some being switched for licensing reasons - some ACEIs licensed for more indications that others. Most likely due to PCT pressure but not sure if it is a logical step to take. I'd be focusing on reviewing patients on sartans who have not tried an ACEI.

[Pharmanaut]

Originally Posted by Titch

Perindopril been off patent a while and prices yet to go down significantly - did drop slightly in last couple of months.

Work as practice pharmacist part of week and have held of switching perindopril to another ACE for the very reason quoted above.

Could see some being switched for licensing reasons - some ACEIs licensed for more indications that others. Most likely due to PCT pressure but not sure if it is a logical step to take. I'd be focusing on reviewing patients on sartans who have not tried an ACEI.

The logic of some of the PCTs is quite hard to follow.
I wonder if someone has gone round touting a branded generic of peridopril on the grounds of consistent quality?

[Steve G]

The logic of some PCTs is very hard to follow - changing between generic PPIs, using branded generics and using ventolin as it is cheaper than the tarrif price for salbutamol inhalers.

Regarding switching of ACE inhibitors there is some information on NeLM: http://www.nelm.nhs.uk/Record%20View...aspx?id=574588
but I agree with Titch, it makes more sense to review sartans.

[johnep]

Ok. I am on irbesartan 300mg/hydrochlothiazide and would like to have something a bit more potent so mgm dose could be reduced. What do I suggest to my GP?
johnep

[Titch]

Originally Posted by johnep

Ok. I am on irbesartan 300mg/hydrochlothiazide and would like to have something a bit more potent so mgm dose could be reduced. What do I suggest to my GP?
johnep

Are you on it for hypertension?

Need indication to pick right alternative - don't want to suggest an unlicensed indication!!

Also - are you bothered about combined product?

And, finally - any problems with an ACEI since you are on a sartan?

[johnep]

After initial diagnosis following a prolonged nosebleed and three nights in hospital was started on 75mg irbesartan, raised to 150mg, then 300, then hydrochlorthiazide added, plus (at the time atenolo) and indapamide.

I have tried to get reasessment and perhaps changed to a calcium antagonist but Drs won't change while BP controlled.

If irbesartan much more expensive then that could be a reason for change.
johnep