[What information is given on adverse drug reactions from new drugs?]

BACKGROUND

It is not known to what extent information on previously unknown adverse reactions is communicated to doctors after the approval of a new drug.

MATERIAL AND METHODS

We included seven drugs, approved between 1982 and 1995 and the first in their class to be approved in Norway. We recorded the number of adverse reactions listed in the annual editions of the Norwegian physicians' desk reference(Felleskatalogen) from the first edition that included the drug and up until the 2001 edition.

RESULTS

Only 51 % of the adverse reactions listed in the 2001 edition were included in the first post-approval edition. On average, 1.6 new adverse reactions were added for each drug every year. By contrast: in a group of 12 drugs approved before 1970, 0.14 new adverse reactions were added for each drug every year between 1989 and 2001.

INTERPRETATION

With a new drug it is to be expected that many adverse reactions are not acknowledged as such. Caution is warranted because of the fact that even though it is not listed in the physicians' desk reference, any event appearing in a patient exposed to a new drug may be an adverse reaction.

[Computerized decision support in drug prescribing II: A national database to provide up-to-date and unbiased information]

Prescribers today encounter increasing demands for up-to-date knowledge of medical advances and drug therapies, and for a straightforward dialogue with patients. Cost-effective drug treatment calls for fast and intuitive access to information about drugs, treatment strategies and patient data. There are several computer-based drug-prescribing systems in Sweden. Information independent of the drug industry is wanting, as are uniform national standards for medical content and functionality. Decision-support systems must facilitate decisions about therapy, drug distribution and intake, as well as quality work, i.e. support the entire process which defines an effective drug therapy. A very important feature is access to a patient's drug list showing all current drugs. This joint initiative by county councils aims at drawing up a national Swedish specification of requirements for a suitable decision-support system and at creating a national entity responsible for distributing unbiased information from a unique database to a range of computerized medical records systems.

[Drug regulation: theory and practice]

Regulation of drugs from the public administration is an activity which is produced in different countries independently from the sanitary model they own. In the field of public financing of drugs there have been several measures to improve the efficiency of their use. However, the analysis of the impact of these measures is complex and this may justify the shortage of objectivable results, especially at long term. The objective of this study is to perform a systematic review of such measures due to the need to have information about the different alternatives before making a decision. The introduction of an isolated measure is in many cases compensated by other changes in other regulating or aiding fields which suggests the creation of an integral strategy which affects different fields (supply/demand of drugs and prescribers). It seems necessary to suggest a social debate taking as a basis the scientific information available at the moment and promote the taking of decisions which lead to a rational use of the available pharmacological resources.

[Presence of excipients in pharmaceutical products in 3 sources of therapeutic information]

OBJECTIVE

To evaluate the level of agreement between information compiled from the Vademecum, the Pharmaceutical Catalogue and instruction leaflets on the four excipients most commonly used to prepare pharmaceutical products (saccharin, saccharose, lactose and ethanol).

DESIGN

Descriptive study.

SETTING

Primary care.

PATIENTS AND OTHER PARTICIPANTS

658 orally administered preparations of pharmaceutical products were chosen. Their composition formulas in the Vademecum, Pharmaceutical Catalogue and instruction leaflets were compared with a theoretical model constructed as the most reliable source of information on excipients.

RESULTS

Saccharin and saccharose were the most frequently described and quantified excipients, and lactose the least. Saccharin was quantified in 97.3% of cases in which it was used as an excipient, saccharose in 95%, ethanol in 91.4% and lactose in 17.5%. Saccharin is also the excipient which coincided most in the three sources examined, followed by saccharose, lactose and ethanol. The Vademecum did not state the presence of saccharose in 62% of preparations and of lactose in 39.7%. Instruction leaflets were the source with the lowest rate of failing to state the excipients.

CONCLUSIONS

Saccharose and lactose are excipients frequently omitted from the composition of orally taken pharmaceutical products in the Vademecum. Instruction leaflets provide the most reliable source out of the three analysed. The need to make available for doctors simple texts, contributing more reliable and up-to-date information, is underlined.