Survey of services John Perrott - APPGITA

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Survey of services John Perrott - APPGITA

of evidence of differences in the effects of zaleplon, zolpidem, zopiclone and the

shorter-acting benzodiazepines, NICE recommends that doctors should prescribe the

cheapest drug, taking into account the daily dose required and the cost for each dose.

If treatment with one of these hypnotic medicines does not work, the doctor should

not prescribe one of the others. Treatment should only be changed from one of these

hypnotics to another if side-effects occur that are directly related to the medicine.

NICE confirms that there is no compelling evidence of a clinically useful difference

between zaleplon, zolpidem and zopiclone (the so called ‘Z drugs’) and shorter-acting

benzodiazepine hypnotics from the point of view of their effectiveness, adverse

effects, or potential for dependence or abuse. There is no evidence to suggest that if

patients do not respond to one of these hypnotic drugs, they are likely to respond to

another.

Risks associated with long term use of hypnotic drugs have been well recognised for

many years. Nevertheless, despite these national safety warnings and guidance,

overall prescribing of hypnotics is not decreasing.

As a result, this is one of the prescribing areas we are asking GPs to focus on in terms of

attempting to reduce inappropriate prescribing. (And has been a focus for a number of years

now) please note, this focus is on the use of these drugs as sleeping tablets (hypnotics) and

not for anxiety (anxiolytics), it is also recognised that only certain patients are suitable for

withdrawal.

Commonly, to aid the withdrawal process, patients are first transferred onto a longer acting

tranquiliser (benzodiazepine) such as diazepam. This allows a more gradual reduction in drug

concentration and can delay the emergence of withdrawal symptoms, allowing a smoother

withdrawal process.

I am currently working on adapting a rather lengthy document to aid GPs in benzo/Z drug

withdrawal and once this has been developed we plan to distribute this to GPs.

In terms of patient support, we have a number of patient information leaflets, but again

these may need updating slightly, I have attached for information.

In summary, if Mr Perrott is interested in withdrawing from his medication, he will need to

speak to his prescribing GP (Should his GP require any additional support, this can be offered

from the Medicines Management team)

In case Mr Perrott is interested, (although I must warn you it is a very large document), I

have attached the Welsh Medicines Partnership document that I plan to adapt for our local

GPs. He may find some general useful information regarding withdrawal, again, this is

something I hope to put in a patient friendly version.

I hope this helps, please do not hesitate to contact me if I can be any further assistance.

Kind Regards,

Stockport PCT NO – Misuse only, an ITA asked for help and was offered a rapid withdrawal in rehab only.

They have a reasonable guidance but this is for GPs and there is no specialist support or helpline or even

referral to the charities.

Further to my email below, please see response to each point from our Associate Director

Medicines Management and Long Term Conditions:

1. Conversion to a longer-acting benzodiazepine like diazepam.

Practices have guidance available to them from the prescribing team

http://stockportmanagedcare.co.uk/wp-content/uploads/2008/12/Guidance-onbenzodiazepines-and-z-drugs-Stockport.doc

2. Provision of withdrawal schedules.

This is defined within the guidance

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