• SSRIs and SNRIs: risk of persistent pulmonary hypertension in the newborn
• Antidepressants: risk of fractures
• Carbapenems: concomitant use with valproic acid not recommended
• Oral tacrolimus products: measures to reduce the risk of medication errors
• Simvastatin: increased risk of myopathy at high dose (80 mg)
• Panitumumab (Vectibix): serious hypersensitivity reactions

Although mention of IFIS during cataract surgery is made in the special warnings and precautions for use in the summary of product characteristics (SPC) for Flomax Relief MR, and is referred to in the patient information leaflet as a very rare side effect affecting less than 1 in 10,000 people, this is far from what is seen in clinical practice.

Since the syndrome was first reported, there have been many publications confirming the association between IFIS and tamsulosin treatment. In a review of this association published in 2009, Leibovici et al3 report the occurrence of IFIS in patients exposed to tamsulosin to be between 57 and 100 per cent compared with 0 to 5 per cent in those not exposed to the drug.

The age group of men suffering from BPH and that of those undergoing cataract surgery are similar and therefore we would expect a substantial number of patients treated with tamsulosin to present for cataract surgery. Pharmacists recommending over-the-counter tamsulosin to men who present with symptoms of BPH need to emphasise the importance of avoiding starting tamsulosin where cataract surgery is likely to be scheduled in the near future.

Whether bought OTC or obtained on prescription, it is vital that ophthalmologists are made aware that a patient is taking or has taken tamsulosin so that cataract surgery can be assigned to a surgeon experienced in dealing with IFIS as the syndrome has been reported after as short a period as two days of taking tamsulosin

• Yasmin: update on risk of venous thromboembolism
• Clopidogrel and proton pump inhibitors: interaction – updated advice
• Intravenous zoledronic acid: adverse effects on renal function
• Parenteral amphotericin B: fatal overdose risk due to confusion between lipid-based and non-lipid-based formulations
• Rifadin infusion (rifampicin): new solvent formulation and changes to compatible diluents
• Becaplermin (Regranex) for diabetic ulcers: contraindicated in patients with any known current cancer
• MHRA conference for doctors in training
• Patient information leaflet of the month: Methotrexate Tablets

• Natalizumab (Tysabri): risk of progressive multifocal leukoencephalopathy increases after two years of therapy.
• Fluoxetine: possible small risk of congenital cardiac defects, similar to that with paroxetine.
• Sirolimus: different immunoassays for therapeutic drug monitoring—risk of incorrect dose adjustment.
• Drug Safety Update gains NHS Evidence accreditation.
• MHRA conference for doctors in training.
• Patient Information Leaflet of the month: Human Varicella-Zoster Immunoglobulin vaccine.

• Tacrolimus: new oral liquid (Modigraf); formulations not interchangeable without careful therapeutic monitoring.
• Yellow Card Scheme update
• Problem with postal delivery of Yellow Cards.
• Swine flu portal update
• Suspected adverse reactions to flu antivirals and vaccines confirm recognised safety profile.
• Orlistat safety update.
• Nicotine replacement therapy and harm reduction.
• Sibutramine: suspension of EU licenses recommended as evidence indicates risks outweigh benefits.
• Off-label intraocular use of recombinant tissue plasminogen activator: risk of intraocular lens opacification.
• Please report suspected adverse reactions associated with intra-articular use of local anaesthetics.

The European-wide review of the anti-obesity drug sibutramine (Reductil) has concluded and an opinion reached recommending the suspension of the licence for the medicine across Europe.

Evidence suggests that there is an increased risk of non-fatal heart attacks and strokes with this medicine that outweighs the benefits of weight loss, which is modest and may not be sustained in the long term after stopping treatment.

Prescribers are advised not to issue any new prescriptions for Reductil and to review the treatment of patients taking the drug.

Pharmacists are asked to cease dispensing the medicine. People who are currently taking Reductil are advised to make a routine appointment with their doctor to discuss alternative measures to lose weight. There are no health implications if people wish to stop treatment before seeing their doctor.

The EMEA document [PDF] and Questions and Answers [PDF]

HLA-B*1502 may be associated with an increased risk of developing SJS in individuals of Thai or Han Chinese ethnic origin when treated with phenytoin. If these patients are known to be HLA-B*1502-positive, phenytoin should be avoided when alternative therapy can be given. Use of phenytoin should only be considered if the benefits are thought to outweigh the risks

• In the Caucasian and Japanese population, the frequency of HLA-B*1502 is extremely low, and thus it is not possible at present to conclude on risk association. Adequate information about risk association in other patients of other ethnic origin is currently not available

as well as, gadolinium-containing contrast agents, and methylphenidate in children.

Report here: http://www.yellowcard.gov.uk

• Ceftriaxone: incompatibility with calcium-containing solutions—updated advice
• High-dose cyproterone acetate: potential risk of (multiple) meningiomas
• Yellow Card Scheme update
• Human papillomavirus (HPV) immunisation programme—first year safety review
• Smoking and smoking cessation: clinically significant interactions with commonly used medicines
• Aspirin: not licensed for primary prevention of thrombotic vascular disease
• Varenicline and suicidal behaviour: cohort study provides some reassurance

Readers may also be interested in the World Health Organisation briefing note on the use of anti-virals during the current pandemic, which do not support the routine use of anti-virals in either children or adults experiencing mild symptoms of H1N1 infection.

Adults:

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.

For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.

As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.

Children:

WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.

Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.

Remember, adverse effects suspected to be related to anti-virals (oseltamivir or zanamivir) used to treat H1N1 influenza should be reported at the MHRA’s Swine Flu portal: http://swineflu.mhra.gov.uk.