Co‐Dispensing of Contraindicated Drugs with Cisapride

Aim To measure the rate of co‐dispensing of contraindicated drugs with cisapride 12 months prior to and 12 months after a period of publicity; and to assess the impact of the publicity, the ‘Dear Healthcare Professional letters‘, changes to the product information and pharmaceutical benefits subsidy restrictions. Method Medicare Australia's Pharmaceutical Benefits Scheme database was searched to identify a cohort of patients who had been dispensed both cisapride and a contraindicated drug in a 12‐month period before and after a period of publicity. Results The number of patients dispensed cisapride fell from 42 319 in 1998 to 2849 in 2001 after the publicity, and significantly after the restriction was placed on cisapride as a pharmaceutical benefit in 2000. In 1998, 11% of patients were dispensed a contraindicated drug 30 days after cisapride dispensing and this figure fell to 9.7% in the 2001 cohort. When the analysis was restricted to the dispensing of the specific drugs that had been named in the publicity letters (‘named’ drugs), a contraindicated drug was dispensed to 3.3% in 1998 and 2.7% in 2001. Conclusion The large fall in the use of cisapride from 1998 to 2001 was more likely due to the pharmaceutical benefits subsidy restrictions rather than the publicity or regulatory actions during 2000. While the proportion of patients who were dispensed a contraindicated drug showed a small fall, it was unlikely to be clinically significant. When the analysis was restricted to patients who were dispensed only a ‘named’ drug, the reduction from 1998 to 2001 was small and statistically insignificant. Sponsor‐initiated communication failed to ensure optimal prescribing and dispensing of drugs.