Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Generic prescribing is not appropriate for inhaled drugs

The UK is experiencing an explosion of new drugs and inhaler devices being licensed for people with respiratory disease, increasing the complexity of prescribing for people with asthma or chronic obstructive pulmonary disease (COPD). The management of how these new products are introduced into clinical practice is important because they may vary in type of inhaler device and licensing.

One product is DuoRespSpiromax, a cheaper “branded generic” of Symbicort Turbohaler, both containing a combination of budesonide and formoterol. It should be noted that DuoRespSpiromax is not a “generic medicine” in the traditional sense of this term because the inhaler device, Spiromax, is markedly different to the Turbohaler, requiring different operations to prime and use these two devices.

Although generic prescribing is rightly being encouraged in primary care to reduce drug expenditure, this is not appropriate for inhaled drugs. Generic prescribing leaves the brand and inhaler device that may be dispensed open to interpretation by the pharmacist and may result in variability in the type of inhaler device the patient receives. This may have negative effects on patient adherence to the inhaled therapy and on the control of their disease.

Consequently we recommend caution before switching patients to the cheaper device as a generic substitution because studies have shown that switching inhaled corticosteroid devices without a consultation may be associated with worsened asthma control[1]. Pharmacists should ensure that they have systems in place to ensure that patients are issued the same inhaler device at each dispensing episode, no matter which pharmacy they take their prescription to.

The increasing range of inhaler devices presents an opportunity for pharmacists to optimise inhaler technique and recommend or prescribe a change in inhaler device as part of a concordant asthma or COPD review, or medicines use review, where inhaler technique is assessed and patient agreement is obtained. We would urge that this is the only appropriate time to change inhaler device, and not as part of a prescription switch policy.

Over the next few years, it is expected that a number of inhaled drugs will become available as generics, but likely in alternative inhaler devices to the branded equivalents. It is important that, if these are used, people are consulted before switching inhaler devices, and their inhaler technique assessed and optimised with the new device.

To ensure that every patient with asthma or COPD is issued with the same inhaler device at every dispensing episode, we recommend that inhaled medication should only be prescribed by the brand name.

 

Toby Capstick

Lead Respiratory Pharmacist

Leeds Teaching Hospitals NHS Trust

Toby.Capstick@nhs.net

 

Hasanin Khachi

Lead Pharmacist

Respiratory Medicine

Barts Health NHS Trust

 

Anna Murphy

Consultant Respiratory Pharmacist

University Hospitals of Leicester NHS Trust

 

Grainne d’Ancona

Principal pharmacist

Guys and St Thomas’ NHS Trust

 

Helen Meynell

Consultant Pharmacist

Doncaster Royal Infirmary

 

Patrick Wilson

Senior Respiratory Pharmacist

University Hospitals of Leicester NHS Trust

 

On behalf of the UK Clinical Pharmacy Association Respiratory Group

 

DECLARATION OF INTEREST:  Mr Capstick has received payment for educational events and conference sponsorship from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Pfizer and Teva. Hasanin Khachi has received payment for educational events and conference sponsorship from Almirall, AstraZeneca, Boehringer Ingelheim, GSK, Napp, Novartis and Teva. As part of the NHS Leadership Academy Top Leaders Programme, Khachi was seconded to GSK within the Government policy team during a one-year fellowship for two days a week. Anna Murphy has received payments for educational events and conference sponsorship from Almirall, AstraZeneca, Cheisi, GSK, Pfizer, Teva; and research funds from Almirall, GSK, Napp. Grainne d’Ancona has received payment for respiratory educational events and conference sponsorship from Almirall, Boehringer Ingelheim, GSK and Napp in the past five years. Helen Meynell as received payment for educational events from Almirall, AstraZeneca, Boehringer Ingelheim, GSK, McNeil, Napp and Novartis. Patrick Wilson has received payment for educational events from Chiesi, and research funds from Gilead.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20067456

Readers' comments (3)

  • I wonder how much behind the scenes nudging from Astra Zeneca occurred before this article was written

    Unsuitable or offensive? Report this comment

  • We would like to assure Mr Dishman that all recommendations in our letter are our own, and declarations of interest are available on request.

    Our concerns are founded on a clear evidence base that is recognised by most expert practitioners specialising in respiratory conditions, as outlined in our letter.

    Unsuitable or offensive? Report this comment

  • In response to a number of questions on social media, our concerns surround the inappropriate switching of inhaler devices without assessing inhaler technique.

    If inhaler technique is assessed as part of a dedicated asthma/COPD review or MUR etc, and an alternative device is preferred by the patient and they have better technique with this, then it would be appropriate to switch. But the prescriber should be informed and prescription updated with brand and device.

    For those who have asked, as lead author my Conflicts of Interest are as follows (and apologies for not declaring at the original submission):

    In alphabetical order, I have received payment for educational events and conference sponsorship from: Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Pfizer, and Teva.

    Unsuitable or offensive? Report this comment

  • Mr Capstick's declaration of interest was added to the letter on 14/01/2015 - Benedict Lam, editor, opinion and blogs

    Further declarations of interest from the other co-authors were added to the letter on 20/01/2015 - Benedict Lam, editor, opinion and blogs

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Drugs of Abuse

    Drugs of Abuse

    A concise, easy-to-read guide for healthcare professionals who encounter drug abuse.

    £38.00Buy now
  • Pharmaceutical Toxicology

    Pharmaceutical Toxicology

    Explains the methodology and requirements of pre-clinical safety assessments of new medicines. Includes registration requirements and pharmacovigilance.

    £40.00Buy now
  • Prescribing Adult Intravenous Nutrition

    Prescribing Adult Intravenous Nutrition

    A practical guide to the principles and practice of adult intravenous nutrition. With numerous illustrations and case studies.

    £40.00Buy now
  • Drugs and the Liver

    Drugs and the Liver

    Drugs and the Liver assists practitioners in making pragmatic choices for their patients. It enables you to assess liver function and covers the principles of drug use in liver disease.

    £38.00Buy now
  • Clarke's Analysis of Drugs and Poisons

    Clarke's Analysis of Drugs and Poisons

    Clarke's Analysis of Drugs and Poisons is the definitive reference source of analytical data for drugs and poisons.

    £535.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.