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Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine

Lookup NU author(s): Professor Simon Thomas


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Aims: To ascertain the effects of the Medicines and Healthcare products Regulatory Agency's (MHRA) safety update in June 2010 on the volume of prescribing of quinine and on indices of quinine toxicity. Methods: We analysed quarterly primary care total and quinine prescribing data for England and quinine prescribing volume for individual Primary Care Trusts (PCTs) in the North East of England from 2007/8 to 2011/12 obtained from the database. We also analysed quinine toxicity enquiries to the National Poisons Information Service (NPIS) via Toxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and Pearson's correlation tests were used to ascertain changes in trends in prescribing and indices of toxicity, and associations between prescribing and indices of toxicity respectively. Results: Total prescribing continued to increase, but annual growth in quinine prescribing in England declined from 6.0% to -0.6% following the MHRA update (difference -0.04 [95% CI -0.07 to -0.01] quinine prescriptions/ 100 patients /quarter, p=0.0111). Much larger reductions were observed in PCTs which introduced comprehensive prescribing reviews. The previously increasing trend in Toxbase® quinine searches was reversed (difference -19.76 [95% CI -39.28 to -9.20] user sessions /quarter, p=0.0575). NPIS telephone enquiries for quinine have declined with stabilisation of the proportion of moderate to severe cases of quinine poisoning since the update. Conclusions: The MHRA advice was followed by limited reductions in the growth in quinine prescribing and in indicators of quinine overdose and toxicity. Quinine prescribing, however, remains common and further efforts are needed to reduce availability and use.

Publication metadata

Author(s): Acheampong P, Cooper G, Khazaeli B, Lupton DJ, White S, May MT, Thomas SHL

Publication type: Article

Publication status: Published

Journal: British Journal of Clinical Pharmacology

Year: 2013

Volume: 76

Issue: 6

Pages: 973-979

Print publication date: 01/12/2013

Online publication date: 20/11/2013

Acceptance date: 04/04/2013

ISSN (print): 0306-5251

ISSN (electronic): 1365-2125

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/bcp.12130


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