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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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]

Re: Changing meds---equivalences.

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

[Titch]

Re: Changing meds---equivalences.

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

Based on current prices you can have a year of amlodipine 10mg for less than one month of irbesartan 300mg.

Assuming from your post you are actually on individual irbesartan, hydrochlorothiazide and indapamide?
If yes - what strengths for the latter 2 - cannot consider switch suggestions without all info....

[Jeff]

Re: Changing meds---equivalences.

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

Eh? You mean that you would be happier taking 30mg of something different rather than 300mg of irbesartan just because it's a lower number?

So that means that diclofenac 50mg is preferable to paracetamol 500mg?

I don't get it

Jeff

[johnep]

Re: Changing meds---equivalences.

Hydrochlorothiazide content in co-aprovel is 12.5mg. indapamide dose is 2.5mg . Whatever they do to my BP, neither seem to act as diuretics as frequently stay at dispensing bench all morning.

Theory that lower dose might be fewer side efects based on the idea that side effects can be due to therapeutic action or simply to the actual molecule.

Eg the original diuretic Saluric was a 500mg dose and closely related to the sulphonamides with associated side effects, hydrosaluric was 50mg dose and standard dose of bendro was originally 5mg. Along the way the sulphonamide side effects were lost.

That is why I got changed from 50mg atenolol to 5mg bisoprolol.

weight for weight frusemide has fewer side effects than bumetanide but as the dose of bumetanide is 1mg, then side effects due to the actual molecule are very much reduced.

With regard to paracetamol and diclofenac, then different things entirely.

Classic example of a side effect that developed into different area was the observation that pts became euphoric on isoniazide. The tuberculostatic iproniazide 'marsilid' was an early MAOI. Roche developed this into isocarboxazide 'Marplan', but this was superceded by phenelzine 'Nardil' which is only surviving MAOI left.

I have forgotten the details, but the progression from antihistamines to the tricyclics and amitryptyline was a similar process I believe.

All known as 'molecular manipulation' in the old days.

consider the following: nicotinamide (vitamin), nicotinic acid (vasodilator)
isonicotinyl acid hydrazide (isoniazide tuberculostatic), iproniazide (tuberculostatic and maoi), isocarboxazide (maoi), procarbazine (cytotoxic)

all related chemically. I expect the molecular chemists can give other examples.
johnep