Community Pharmacy
Contract
2011/12 to 2012/13
All Wales
Multi-Disciplinary Audit
Service Specification
Essential Service 8 – Clinical Governance
This audit was endorsed by the All Wales Medicines Strategy Group
(AWMSG) at their meeting on the 16th March 2011.
Please send the Pharmacy details, audit sheets, issues log and the
reflective action plan to your local Medicines Management team on or
before the date specified by your Health Board.
Your Medicines Management team will compile the local information and
forward to the Welsh Medicines Partnership (wmp@wales.nhs.uk) who
will provide a national perspective.
Contents
Page
Introduction
3
Background
4
General Prescribing Points / Good Practice Guidance
4
References
8
Overall Aim
9
Method
9
Preparation
10
Reporting
10
Pharmacy Details
11
Audit Sheets
12
Issues Log
16
Reflective Action Plan
18
Appendix A
19
Appendix B
21
2
Introduction
By auditing elements of your practice you can assess current performance
against identified standards and acknowledge any shortfalls that require
attention. Audits can also help to educate and inform professionals, staff
and patients about the standards associated with the subject of the audit,
especially where the audit requires their participation. Audits have been
shown to promote changes to practice because of this.
Under the terms of the New Pharmacy Contract under Essential
Service 8 – clinical governance, every pharmacy should participate in
one practice-based audit and one multidisciplinary audit each year.
The subject of the multidisciplinary audit is determined by the Local Health
Board (LHB) and will involve elements of auditing your own and other health
care professionals’ practice, and may include other health care
professionals auditing your practice as well. For the year 2011-12 / 2012-13
the LHB has decided that a multidisciplinary audit of proton pump inhibitor
(PPI) prescribing should be carried out by community pharmacists.
The objectives of the audit are:

To help identify and subsequently address the key prescribing issues in
PPI use in primary care.

To increase awareness of community pharmacists with regard to these
issues.

To provide pharmacists with the opportunity to identify ways in which
they can support local GP practices in educating patients about the use
of PPIs, and identify concordance issues.

To raise GP/practice staff awareness of the support that pharmacists
can provide in the management of patients on PPIs.

To reduce the inappropriate prescribing of PPIs and minimise waste.
3
Background
Dyspepsia is defined as any symptom of the upper gastrointestinal tract,
present for four weeks or more, including upper abdominal pain or
discomfort, heartburn, acid reflux, nausea or vomiting1. It is estimated that
around 40% of the adult population will have symptoms of dyspepsia 1, the
most common causes being gastro-oesophageal reflux disease (GORD),
peptic ulcer and non-ulcer (or functional) dyspepsia, with a large proportion
of these patients being prescribed a PPI.
PPI use is continuing to increase across Wales. One possible explanation
for this is that they are continued when they are no longer indicated 2, as for
many indications, such as peptic ulcer disease, treatment courses are
intended for short term use only1. It has also been suggested that a
reduction in cost, together with reduced concerns of their safety has led to a
more liberal use of PPIs for a wide variety of upper gastrointestinal
symptoms with a substantial proportion, if not majority, of patients now
prescribed PPIs having no true indication for treatment3.
The All Wales Medicines Strategy Group (AWMSG) has introduced two
National Indicators for PPIs for the financial year 2011/12 which look at both
the overall PPI usage and the choice of PPI4.
General Prescribing Points / Good Practice Guidance

Is there a legitimate indication for a PPI?



PPIs should only be started or continued where there is a valid
documented indication. The use of PPIs for mild or vague
symptoms and any ‘diagnostic’ use must be short term2.
Can the PPI be stopped? For example, has the treatment course
finished or has a non-steroidal anti-inflammatory drug (NSAID)
been discontinued therefore prophylaxis will no longer be
necessary.

Many patients presenting with dyspepsia are diagnosed as having
non-ulcer dyspepsia.
Initial therapeutic strategies for
uninvestigated dyspepsia include testing and treating for
Helicobacter. pylori or a one month full-course of a PPI.

All patients on a long term PPI should have an annual review to
discuss continuing need for medication and/or stepping down
treatment, unless there is an underlying condition or
co-medication that necessitates ongoing treatment1.
Has the patient been tested and treated for H. pylori where
appropriate?

Up to 95% of duodenal ulcers and 80% of gastric ulcers are
associated with H. pylori1. Eradication of H. pylori can prevent the
4
recurrence of peptic ulcers and reduce the need for long term
acid-suppression therapy1.


Could any medications that can cause dyspepsia be withdrawn?


PPIs are the first line therapy for GORD. Once initial symptoms
are controlled treatment should be stepped down. If long term
treatment with a PPI is required, the lowest possible dose to
control symptoms should be used. On demand or intermittent use
of medication is encouraged1.
When stepping down or stopping therapy, consider prescribing
antacid/alginate for rebound acid hypersecretion.


National Institute for Health and Clinical Excellence (NICE)
recommends that a PPI (with the lowest acquisition cost) should
be co-prescribed in patients treated with an oral NSAID/COX-2
inhibitor6. However, before using an NSAID which requires
concurrent use of a PPI, it should be established whether all other
strategies to optimise pain control have been considered 7.
Where a PPI needs to be continued can the dose be reduced?


Some medications can contribute to the symptoms of dyspepsia
(examples include calcium antagonists, nitrates, theophyllines,
bisphosphonates and NSAIDs)1. Existing medication should be
reviewed and if a causative medication identified withdrawal
should be considered5.
Have other strategies to optimise pain control been considered
before using an NSAID that requires concurrent use of a PPI?


There is currently no evidence that H. pylori should be
investigated in patients with GORD1.
PPI withdrawal may induce rebound acid hypersecretion 2,8. This
may explain the continued use of PPIs in patients and the inability
to discontinue treatment. Patients should therefore be informed of
this potential risk when both stepping down and stopping therapy.
Consideration should also be given to implementing strategies
that may reduce it such as intermittent dosing (where clinically
appropriate), or the use of antacid / alginate therapy7.
Have lifestyle measures been discussed and patient advised to
avoid precipitating factors?

Lifestyle advice should include1:
 Healthy eating and avoidance of food/drink which exacerbate
symptoms.
 Avoiding reclining or lying down shortly after meals, and large,
late meals.
5





Potential risks are associated with PPIs particularly in patients with
multiple risk factors for fractures, hospital and community-acquired
pneumonia or Clostridium difficile infection (CDI).

In general PPIs are well tolerated. However, there have been a
number of recent reports which have documented concerns
relating to possible adverse events relating to their use. These
include a small increase in the risk of both hospital-acquired and
community-acquired pneumonia9,10 and possible increase in
fracture risk11. This should be taken into consideration when
prescribing a PPI in those patients with other risk factors for these
conditions7.

The Health Protection Agency and Department of Health
Guidance on managing CDI recommends that PPIs should only
be used when there is a clear clinical indication 12. They also state
that consideration should be given to stopping PPIs in recurrent
cases of CDI.
The combination of clopidogrel and omeprazole or esomeprazole,
should be avoided unless considered essential.


Weight reduction (if overweight or obese).
Smoking cessation.
Moderation of alcohol consumption.
Current evidence regarding interactions between clopidogrel and
PPIs is not consistent. However, the MHRA has advised that the
combination of clopidogrel and omeprazole or esomeprazole
should be avoided unless considered essential13.
Where it is necessary to continue on treatment with a PPI, is the
patient on the most cost-effective, appropriate PPI?

NICE recommendations state that the least expensive PPI should
be used1. There is no evidence that there is any difference in
clinical efficacy between PPIs at equivalent doses5, although
prescribers should be aware that there are some slight variations
in the indications for use, interactions and cautions 14. Generic
omeprazole and lansoprazole capsules or pantoprazole tablets
should be used as first line therapies.
Community pharmacists are ideally placed to offer advice and support to
patients with dyspepsia. The NICE dyspepsia guideline includes a flowchart
outlining the potential role of community pharmacists in the management of
dyspepsia1.
Community pharmacist involvement could include:

Advice on lifestyle choices, such as healthy eating and weight reduction.
6

Smoking cessation.

Advice on the use of over-the-counter medication for symptom relief

Referring patients to their GP, for instance where ALARM signs may be
present or medication has not provided adequate symptom relief.

ALARM signs include dyspepsia with gastrointestinal bleeding,
difficulty in swallowing, unintentional weight loss, abdominal
swelling and persistent vomiting1.

Advice about medication that could cause dyspepsia.

Medicines Use Review – advice on how to adjust medication to control
symptoms.
7
References
1. North of England Dyspepsia Guideline Development Group. Dyspepsia:
managing dyspepsia in adults in primary care. Full Clinical Guideline No. 17.
2004. Available at http://guidance.nice.org.uk/CG17. Accessed Sept 2010.
2. WeMeReC Bulletin. Stopping medicines – proton pump inhibitors. Online
content. October2010. Available at:
http://www.wemerec.org/Documents/enotes/StoppingPPIsenotes.pdf.
Accessed Nov 2010.
3. McColl KEL, Gillen D. Evidence that proton-pump inhibitor therapy induces the
symptoms it is used to treat. Gastroenterology 2009; 137: 20-39.
4. All Wales Medicines Strategy Group. National Prescribing Indicators 2011/12.
http://www.wales.nhs.uk/sites3/Documents/371/Indicator%20paper%202011%
2D12%20website.pdf Accessed Mar 2011.
5. National Prescribing Centre. The management of dyspepsia in primary care.
MeReC Briefing. 2006. Issue number 32. Available at
http://www.npc.co.uk/ebt/merec/therap/dysp/resources/merec_briefing_no32.pd
f. Accessed Nov 2010
6. National Institute of Health and Clinical Excellence. Osteoarthritis. The care
and management of osteoarthritis in adults. Clinical Guideline 59. 2008.
Available at http://www.nice.org.uk/CG59. Accessed Nov 2010.
7. Thompson A. Emerging Concerns with PPI therapy. The Pharmaceutical
Journal 2010; 285:239-240. www.pjonline.com
8. Reimer C, Søndergaard B, Hilsted L et al. Proton–pump inhibitor therapy
induces acid-related symptoms in healthy volunteers after withdrawal of
therapy. Gastroenterology 2009; 137:80-87.
9. Herzig SJ, Howell MD, Ngo LH et al. Acid-suppressive medication use and the
risk for hospital-acquired pneumonia. Journal of the American Medical
Association 2009; 301:2120-2128.
10. Sarkar M Hennessy S, Yang YX. Proton-pump inhibitor use and risk for
community-acquired pneumonia. Ann Intern Med 2008; 149:391-398.
11. U.S Food and Drug Administration (FDA). FDA Drug Safety Communication.
Possible increased risk of fractures of the hip, wrist and spine with the use of
proton pump inhibitors. May 2010. Available at
http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatient
sandproviders/ucm213206.htm. Accessed Nov 2010.
12. Health Protection/Department of Health. Clostridium difficile infection: how to
deal with the problem. 2009. Available at
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1232006607827.
Accessed Nov 2010.
13. Drug Safety Update April 2010, vol 3 issue 9: 4. Available at
http://www.mhra.gov.uk/home/groups/plp/documents/publication/con076503.pdf. Accessed Nov 2010.
14. British National Formulary. BNF 60. September 2010.
8
Overall Aim
To assess current prescribing and use of PPIs with reference to the NICE
guideline and the AWMSG key priorities.
Method

Identify 20 patients receiving prescriptions for high acquisition cost
(HAC) PPIs. This is to try and ensure that patients requiring a PPI are
prescribed the most cost-effective preparation according to NICE
guidelines. However, if you find that you do not have enough patients on
HAC PPIs to complete the audit for 20 patients, for the remainder you
may use patients receiving prescriptions for low acquisition cost (LAC)
PPIs. For a definition of HAC and LAC PPIs see Appendix B.

Complete data collection for each patient. This may be as part of a
Medicines Use Review (MUR) if you wish. You may find that you will not
be able to answer all the questions for every patient, but part of the
purpose of the audit is to identify gaps in the management of these
patients, which can then be addressed by a multidisciplinary approach.
If you do not know the answer to any of the audit questions then please
indicate this on the audit form.

Retain the patient details record at the pharmacy.

Return anonymised data collection sheets to the LHB by the return date.
Similar audits will also be taking place in GP practices. The information
gained from the audits will help the LHB to assess what resources are
needed, and how best to manage these patients. This will help the LHB
comply with NICE guidance and AWMSG key priorities.
All dispensary staff should be made aware of the audit to help recognise
when an appropriate PPI prescription is presented and to alert the audit
team.
To avoid duplication you will need to assign each PPI patient an ID number.
We suggest giving the first patient presenting a prescription for a PPI the
number 1 and noting the patient details, such as name, address, Patient
Medication Record PMR ID number or NHS number, against their ID
number on the appropriate sheet in Appendix A. Assign number 2 to the
next different patient to be included in the audit and continue sequentially
until the audit is completed.
Appendix A should be retained in the pharmacy at the end of the audit.
9
Preparation
Take time to read the audit forms and appendices thoroughly, then plan who
needs to be involved and what needs to happen, including what you want
them to do. For example:






Will the pharmacist need to complete the audit forms or can they be
delegated to support staff with the pharmacist supporting them and
checking the content?
Communicate the process to those who need to know e.g. reception
staff, dispensers, healthcare assistants, etc.
Decide the period over which you will carry out the audit.
How will you review the results and develop the action plan?
Who will be responsible for posting the forms once the audit is
completed?
How will you audit delivery patients or care home patients?
A grid format has been designed to minimise the workload associated with
the survey of prescriptions. If you have any questions regarding the
process please contact the Medicines Management Team at the LHB.
Reporting
When you have finished the audit:
1. Copy the audit.
2. Send the original audit to the Health Board including the reflective action
plan by 01/04/12.
3. Retain Appendix A in the pharmacy at the end of the audit - this will
contain patient information on which MUST be retained in the pharmacy.
Failure to participate in this audit will constitute a breach of the terms
of service of the New Pharmacy Contract i.e. this audit is a
requirement of the New Pharmacy Contract.
10
COMMUNITY PHARMACY MULTIDISCIPLINARY
AUDIT
PPI 2011/2012
Pharmacy Name
Pharmacy Address
Pharmacy Tel. No.
Local Health Board
Local Health Board Contact
PLEASE RETURN THE FOLLOWING COMPLETED FORMS TO THE
MEDICINES MANAGEMENT TEAM AT THE LHB:




Pharmacy Details
Multidisciplinary Audit Sheets
Issues Log
Reflective Action Plan
11
COMMUNITY PHARMACY CONTRACT: MULTIDISCIPLINARY AUDIT 2011/2012 – PPIs
SHEET 1
PATIENT AUDIT ID NO.
1
2
3
4
PRESCRIPTION/PATIENT MEDIATION RECORD
(PMR) REVIEW
NAME OF PPI PRESCRIBED
DOSE AND DIRECTIONS
LENGTH OF TREATMENT AT CURRENT DOSE
RECORD OF STEP-DOWN OR GAPS IN
TREATMENT? (Y/N)
RECORD OF ANY OTHER PREVIOUS PPI
PRESCRIPTION? (PLEASE STATE)
RECORD OF ANY OTHER (PREVIOUS OR
CURRENT) DYSPEPSIA TREATMENT? (PLEASE
STATE)
CONCOMMITENT TREATMENT WITH AN
NSAID/ASPIRIN? (STATE WHICH)
CONCOMMITENT TREATMENT WITH
CLOPIDOGREL? (Y/N)
RECORD OF OTHER MEDICATIONS THAT
COULD CAUSE DYSPEPSIA? (Y/N)
PATIENT CONSULTATION
DOES THE PATIENT KNOW THE INDICATION
FOR THE PPI? (PLEASE STATE)
ARE THE PATIENT’S SYMPTOMS
CONTROLLED? (Y/N)
DOES THE PATIENT KNOW HOW TO
RECOGNISE ALARM SYMPTOMS? (Y/N)
HAS THE PATIENT HAD A MEDICATION
REVIEW TO DICUSS THEIR PPI IN THE PAST 12
MONTHS?
DOES THE PATIENT UNDERSTAND ABOUT
HEALTHY EATING/LIFESYLE FACTORS? (Y/N)
HAS THE PATIENT HAD A PPI LEAFLET? (Y/N)
ACTIONS
HAVE YOU IDENTIFIED ANY ISSUES FROM
THIS AUDIT? (Y/N)
WHAT ACTION HAVE YOU TAKEN (IF ANY) –
E.G. MUR/GP REFERRAL/PATIENT
EDUCATION?
IF YOU DO NOT KNOW THE ANSWER TO ANY OF THE QUESTIONS PLEASE STATE ‘NOT KNOWN’
12
5
COMMUNITY PHARMACY CONTRACT: MULTIDISCIPLINARY AUDIT 2011/2012 – PPIS
SHEET 2
PATIENT AUDIT ID NO.
6
7
8
9
PRESCRIPTION/PATIENT MEDIATION RECORD
(PMR) REVIEW
NAME OF PPI PRESCRIBED
DOSE AND DIRECTIONS
LENGTH OF TREATMENT AT CURRENT DOSE
RECORD OF STEP-DOWN OR GAPS IN
TREATMENT? (Y/N)
RECORD OF ANY OTHER PREVIOUS PPI
PRESCRIPTION? (PLEASE STATE)
RECORD OF ANY OTHER (PREVIOUS OR
CURRENT) DYSPEPSIA TREATMENT? (PLEASE
STATE)
CONCOMMITENT TREATMENT WITH AN
NSAID/ASPIRIN? (STATE WHICH)
CONCOMMITENT TREATMENT WITH
CLOPIDOGREL? (Y/N)
RECORD OF OTHER MEDICATIONS THAT
COULD CAUSE DYSPEPSIA? (Y/N)
PATIENT CONSULTATION
DOES THE PATIENT KNOW THE INDICATION
FOR THE PPI? (PLEASE STATE)
ARE THE PATIENT’S SYMPTOMS
CONTROLLED? (Y/N)
DOES THE PATIENT KNOW HOW TO
RECOGNISE ALARM SYMPTOMS? (Y/N)
HAS THE PATIENT HAD A MEDICATION
REVIEW TO DICUSS THEIR PPI IN THE PAST 12
MONTHS?
DOES THE PATIENT UNDERSTAND ABOUT
HEALTHY EATING/LIFESYLE FACTORS? (Y/N)
HAS THE PATIENT HAD A PPI LEAFLET? (Y/N)
ACTIONS
HAVE YOU IDENTIFIED ANY ISSUES FROM
THIS AUDIT? (Y/N)
WHAT ACTION HAVE YOU TAKEN (IF ANY) –
E.G. MUR/GP REFERRAL/PATIENT
EDUCATION?
IF YOU DO NOT KNOW THE ANSWER TO ANY OF THE QUESTIONS PLEASE STATE ‘NOT KNOWN’
13
10
COMMUNITY PHARMACY CONTRACT: MULTIDISCIPLINARY AUDIT 2011/2012 – PPIS
SHEET 3
PATIENT AUDIT ID NO.
11
12
13
14
PRESCRIPTION/PATIENT MEDIATION RECORD
(PMR) REVIEW
NAME OF PPI PRESCRIBED
DOSE AND DIRECTIONS
LENGTH OF TREATMENT AT CURRENT DOSE
RECORD OF STEP-DOWN OR GAPS IN
TREATMENT? (Y/N)
RECORD OF ANY OTHER PREVIOUS PPI
PRESCRIPTION? (PLEASE STATE)
RECORD OF ANY OTHER (PREVIOUS OR
CURRENT) DYSPEPSIA TREATMENT? (PLEASE
STATE)
CONCOMMITENT TREATMENT WITH AN
NSAID/ASPIRIN? (STATE WHICH)
CONCOMMITENT TREATMENT WITH
CLOPIDOGREL? (Y/N)
RECORD OF OTHER MEDICATIONS THAT
COULD CAUSE DYSPEPSIA? (Y/N)
PATIENT CONSULTATION
DOES THE PATIENT KNOW THE INDICATION
FOR THE PPI? (PLEASE STATE)
ARE THE PATIENT’S SYMPTOMS
CONTROLLED? (Y/N)
DOES THE PATIENT KNOW HOW TO
RECOGNISE ALARM SYMPTOMS? (Y/N)
HAS THE PATIENT HAD A MEDICATION
REVIEW TO DICUSS THEIR PPI IN THE PAST 12
MONTHS?
DOES THE PATIENT UNDERSTAND ABOUT
HEALTHY EATING/LIFESYLE FACTORS? (Y/N)
HAS THE PATIENT HAD A PPI LEAFLET? (Y/N)
ACTIONS
HAVE YOU IDENTIFIED ANY ISSUES FROM
THIS AUDIT? (Y/N)
WHAT ACTION HAVE YOU TAKEN (IF ANY) –
E.G. MUR/GP REFERRAL/PATIENT
EDUCATION?
IF YOU DO NOT KNOW THE ANSWER TO ANY OF THE QUESTIONS PLEASE STATE ‘NOT KNOWN’
14
15
COMMUNITY PHARMACY CONTRACT: MULTIDISCIPLINARY AUDIT 2011/2012 – PPIS
SHEET 4
PATIENT AUDIT ID NO.
16
17
18
19
PRESCRIPTION/PATIENT MEDIATION RECORD
(PMR) REVIEW
NAME OF PPI PRESCRIBED
DOSE AND DIRECTIONS
LENGTH OF TREATMENT AT CURRENT DOSE
RECORD OF STEP-DOWN OR GAPS IN
TREATMENT? (Y/N)
RECORD OF ANY OTHER PREVIOUS PPI
PRESCRIPTION? (PLEASE STATE)
RECORD OF ANY OTHER (PREVIOUS OR
CURRENT) DYSPEPSIA TREATMENT? (PLEASE
STATE)
CONCOMMITENT TREATMENT WITH AN
NSAID/ASPIRIN? (STATE WHICH)
CONCOMMITENT TREATMENT WITH
CLOPIDOGREL? (Y/N)
RECORD OF OTHER MEDICATIONS THAT
COULD CAUSE DYSPEPSIA? (Y/N)
PATIENT CONSULTATION
DOES THE PATIENT KNOW THE INDICATION
FOR THE PPI? (PLEASE STATE)
ARE THE PATIENT’S SYMPTOMS
CONTROLLED? (Y/N)
DOES THE PATIENT KNOW HOW TO
RECOGNISE ALARM SYMPTOMS? (Y/N)
HAS THE PATIENT HAD A MEDICATION
REVIEW TO DICUSS THEIR PPI IN THE PAST 12
MONTHS?
DOES THE PATIENT UNDERSTAND ABOUT
HEALTHY EATING/LIFESYLE FACTORS? (Y/N)
HAS THE PATIENT HAD A PPI LEAFLET? (Y/N)
ACTIONS
HAVE YOU IDENTIFIED ANY ISSUES FROM
THIS AUDIT? (Y/N)
WHAT ACTION HAVE YOU TAKEN (IF ANY) –
E.G. MUR/GP REFERRAL/PATIENT
EDUCATION?
IF YOU DO NOT KNOW THE ANSWER TO ANY OF THE QUESTIONS PLEASE STATE ‘NOT KNOWN’
15
20
ISSUES LOG
Patient ID
number
1
Issue Identified
Action Taken
2
3
4
5
6
7
8
9
10
16
Patient ID
number
11
Issue Identified
Action Taken
12
13
14
15
16
17
18
19
20
THIS SECTION MUST BE COMPLETED AND RETURNED WITH THE AUDIT
17
REFLECTIVE ACTION PLAN
Did you identify any areas in your practice where you can make changes to help improve the management and care of patients on
PPIs?
Yes
No
If yes, what changes will you make in the future?
Did you identify areas in the practice of others, such as GPs, nurses, pharmacists or hospital doctors/nurses, where they can make
changes to help improve the management and care of patients on PPIs?
Yes
No
If yes, how will you communicate this to them?
What help, if any, do you need from the LHB to achieve this?
Has your practice or knowledge of this therapeutic area improved as a result of this audit?
Yes
No
REMINDER - YOU MAY WANT TO CONSIDER THIS AUDIT ACTIVITY AS AN ENTRY IN YOUR RPSGB CPD PORTFOLIO.
18
Appendix A – Use this form to allocate an Audit ID No. to each PPI patient.
Multidisciplinary audit 2011/2012
Patient’s Audit ID No.
Patient Details e.g. name and address or NHS Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
19
Patient’s Audit ID No.
Patient Details e.g. name and address or NHS Number
15
16
17
18
19
20
DO NOT INCLUDE THIS FORM IN ANY RETURNS BUT RETAIN IN THE PHARMACY FOR CONTRACT VALIDATION
PURPOSES.
THE LHB CLINICAL GOVERNANCE TEAM MAY NEED TO ACCESS THE INFORMATION AT SOME STAGE FOR FOLLOW
UP PURPOSES.
20
Appendix B – Definition of HAC and LAC PPIs
Low Acquisition Cost PPIs
Lansoprazole Capsules 15mg and 30mg
Omeprazole Capsules 10mg and 20mg
Pantoprazole Tablets 20mg and 40mg
High Acquisition Cost PPIs
Esomeprazole (Nexium®) - all formulations/strengths
Rabeprazole (Pariet®) - all formulations/strengths
Pantoprazole Liquid Special all strengths
Protium® - all formulations/strengths
Lansoprazole Gran Sach 30mg
Lansoprazole Orodispersible Tablets 15mg and 30mg
Lansoprazole Liquid Special – all strengths
Zoton® FasTab® 15mg and 30mg
Omeprazole capsules 40mg
Omeprazole Liquid Special all strengths
Omeprazole Dispersible tablets 10mg, 20mg and 40mg
Omeprazole tablets 10mg, 20mg and 40mg
Losec® – all formulations/strengths
Omeran® – all strengths
Zanprol® – all strengths
Mepradec® – all strengths
21