12th October 2012
To
All GP Practices ABHB
All Practice Nurses ABHB
Dear Colleague
Re Prescribing of Carbocisteine
Dr Patrick Flood-Page (Consultant Respiratory Physician) has provided the
following advice concerning the use of carbocisteine. To help ensure
evidence-based, cost effective prescribing, clinicians are requested to
review the prescribing of carbocisteine.
Action Required
1. Identify all patients currently prescribed carbocisteine for
the treatment of COPD.
2. At the earliest opportunity, review patients that have been
prescribed carbocisteine for longer than 4 weeks to
determine whether they are achieving any benefit from
treatment (improved expectoration and reduced discomfort
from retained secretions).
o Stop treatment in patients in whom no benefit is
apparent.
o If sputum expectoration improves and the patient is
no longer experiencing trouble expectorating then
the drug should be stopped and used only on a
intermittent short course basis for infections
associated with thick tenacious sputum
o For patients with thick sputum all of the time and
whom benefit from carbocisteine, then consider
Bloc A, Tŷ Mamhilad
Ystad Parc Mamhilad
Pontypŵl, Torfaen
NP4 0YP
Ffon: 01873 732732
e-bost: abhb.enquiries@wales.nhs.uk
Block A, Mamhilad House
Mamhilad Park Estate
Pontypool Torfaen
NP4 0YP
Phone 01873 732732
Email: abhb.enquiries@wales.nhs.uk
Bwrdd Iechyd Aneurin Bevan yw enw g weithr edol Bwrdd Iechyd Lleol Aneurin Bevan
Aneurin Bevan Health Board is the operational name of Aneurin Bevan Local Health Board
reducing the dose from the treatment dose of 750mg
TDS to the recommended maintenance dose of
1500mg daily (e.g. 750mg BD or 375mg QDS) in
between infections
Background:
Mucolytics may reduce exacerbation frequency and the duration of
disability in people with chronic bronchitis or chronic obstructive
pulmonary disease (COPD). NICE specifically recommends mucolytic
therapy only in people with stable COPD who have a chronic cough
productive of sputum.
However, the quality of the evidence for the benefits of carbocisteine in
COPD is low, and the benefits may occur only in people who are not
receiving other maintenance treatments (for example, inhaled
corticosteroids).
The recommended starting dose of carbocisteine is 2,250mg daily given in
divided doses e.g. 750mg TDS, reducing to 1500mg daily in divided doses
(e.g. 750mg BD or 375mg QDS) when a satisfactory response is obtained,
and if still required.
Similarly, the initial dose of carbocisteine 250 mg/5 ml syrup is 15ml TDS,
reducing to 10ml TDS when a satisfactory response is obtained and if still
required. It is sometimes difficult to predict which patients will obtain
subjective improvement from treatment with carbocisteine. For this
reason, BNF 63 advises that “mucolytic therapy should be stopped if there
is no benefit after a 4-week trial”.
Over the last 12 months Aneurin Bevan Health Board has spent £319,232
on carbocisteine in primary care. Attached is some prescribing data for
practices across the Health Board. If you have any queries regarding this
or would like assistance in reviewing this area, then please do not hesitate
to contact your Medicines Management Team.
Yours sincerely
Jonathan Simms
Clinical Director of Pharmacy
0
EVANS AD (601091)
JAMES N (601103)
FAKANDE OL (601110)
MILLAR-JONES D (601019)
DONOVAN S (601077)
KING JL (601023)
JOSEPH G (601033)
BOSE MK (601035)
PRIOR G (601100)
WELLS M (601060)
HENEGHAN SJ (601099)
GRIFFITHS M (601096)
HUGHES A (601020)
HOLLAND JW (601097)
HOSSAIN SA (601005)
SYAL KG (601057)
THOMAS AJ (601093)
LOHFINK A (601025)
JAMES LLAN N (601082)
KAUSHAL SC (601132)
McEVOY JF (601021)
CARR AWR (601047)
DAS N (601102)
Caerphilly (6019002)
HORNER J (601098)
NARULA HS (601040)
JAMES TE (601042)
JONES C (601041)
ROWLANDS PJ (601022)
KUNJU MY (601029)
McGARRIGLE AP (601048)
OJHA S (601122)
WAHEED A (601008)
Torfaen (6019005)
DAS MOHAPATRA J (601044)
Blaenau Gwent (6019001)
EDWARDS DM (601051)
BAILEY DS (601090)
GRAHAM GI (601049)
Aneurin Bevan - GP (601)
DEXTER CG (601003)
LENEY J (601125)
REDMORE MJ (601039)
KHAN B (601006)
Newport (6019004)
VELUSAMI O (601080)
KHAN AU (601055)
JONES R (601095)
OSMOND DF (601056)
COLTER EF (601088)
WILLIAMS HG (601126)
AFELUMO A (601094)
JONES IR (601066)
KUGATHASAN S (601010)
PHILLIPS CW (601046)
ALI M (601071)
JONES SN (601045)
DATTA SK (601062)
DAVIES PL (601002)
TAYLOR J (601026)
JENNINGS JP (601014)
KANDHAI DS (601034)
SALEH SSA (601043)
HUSSAIN MA (601007)
LEWIS W (601011)
DAVIES K (601050)
ASHTON R (601054)
DAVIES HL (601017)
THURGOOD MC (601024)
GEDMAN JK (601018)
JONES L (601037)
LOCUM NF (601059)
HARRIES BDJ (601063)
BESWICK NF (601001)
AL-HAJ-ALI H (601086)
BODLEY-SCOTT R (601031)
Monmouth (6019003)
NARANG SK (601004)
ALLISON RJ (601016)
GODWIN C (601115)
MADDOCKS J (601028)
STANIFORTH J (601038)
TURNER D (601052)
LEWIS S (601027)
MAHTO K (601087)
MOHINDRU AC (601074)
MAHAPATRA JK (601116)
DIGGLE JH (601013)
LOCUM DB (601101)
JACKS TA (601015)
SHAW SHD (601030)
JOHNSON DA (601053)
POTTS TM (601104)
ROY CH (601085)
DOWNING J (601117)
JARRETT AG (601032)
MAHANTY TC (601089)
LOCUM P (601105)
Cost Per 1000PU
CostPer1000PUs
1200
1000
800
3
600
2.5
2
400
1.5
200
1
0.5
0
COPD Prevalence %
Carbocisteine June 11-May 12 Cost per 1000PU Vs COPD Prevalence
COPD Prevalence
5
4.5
4
3.5