Drug switch makes work for practices

A nationwide medication switch for patients on a contaminated antihypertensive has created one more burden on overworked general practices.

Pfizer’s product Accuretic, which contains quinapril and hydrochlorothiazide, is contaminated with nitrosamine, a type of chemical believed to raise a small cumulative risk of cancer when taken long term.

Prescribers are being asked to switch their patients to alternative treatment before supplies run out in September.

RNZCGP medical director Bryan Betty says the exercise will require GPs to hold consultations with the estimated 36,000 patients affected.

And a review, either by telephone or face to face, is often needed when patients change BP-lowering medication, says the Wellington specialist GP.

The burden is “not huge but it’s not insubstantial, especially when we’re under such heavy workload and [patient] demand”, he says. Dr Betty hopes Pharmac will acknowledge that patient consultations connected with the drug switch should be free.

In a media release, the medicines funding agency says it will cover the cost of “the” GP clinic visit and prescription fees, suggesting it will fund only one GP visit for each patient that needs to come off the medication.

Pfizer says it has detected levels of nitrosamines (N-nitroso-quinapril) in Accuretic above the acceptable daily intake.

It is disrupting supplies of Accuretic 10/12.5mg and 20/12.5mg tablets to New Zealand until the issue is resolved. The affected batches were supplied within the last three years and are yet to expire.

Medsafe has advised there is a very low risk to people taking Accuretic. They should continue with their treatment because the risk associated with suddenly halting blood pressure medication exceeds that presented by the contaminant.

Director of operations Lisa Williams says, "People taking Accuretic will need to consult their doctor about an alternative treatment when next due for a prescription.

“There is currently no acceptable direct chemical substitute for New Zealanders taking this medicine.

“Our expert clinical advice is that losartan with hydrochlorothiazide would be an appropriate, currently funded and Medsafe approved, alternative for most patients.”