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JUPITER message mixed on rosuvastatin Rosuvastatin (Crestor) reduced the incidence of major cardiovascular events in apparently healthy people with raised high‐sensitivity C‐reactive protein (CRP) levels, the JUPITER trial has shown ( N Engl J Med 2008; published online 9 November, 10.1056/NEJMoa 0807646). However, the absolute benefits were modest and associated with an increased risk of diabetes. CRP is a marker of inflammation associated with an increased risk of cardiovascular events. JUPITER randomised 17 802 healthy people without hyperlipidaemia (LDL less than 3.4mmol per litre) but raised CRP to placebo or treatment with rosuvastatin 20mg per day. The trial was terminated prematurely after a median follow‐up of 1.9 years when rosuvastatin was found to reduce the incidence of a combined end‐point of major cardiovascular events (0.77 vs 1.36 per 100 person years with placebo). However, the incidence of diagnosed diabetes was significantly increased (3.0 vs 2.4 per cent). Tamoxifen adherence Half of women prescribed tamoxifen after surgery for breast cancer do not complete the recommended five‐year course of treatment, researchers at Dundee have found ( Br J Cancer 2008; published online 4 November; doi: 10.1038/sj.bjc. 6604758). Their record linkage study of 2080 women diagnosed with breast cancer between 1993 and 2002 found that only 50 per cent completed the full course. OTC azithromycin Azithromycin 500mg is now available without prescription for the treatment of people over 16 who are asymptomatic and have tested positive for Chlamydia infection. Clamelle is available as part of a service that costs £25 for the test and £20 for the antibiotic. Xamiol gel for psoriasis Leo has introduced a combined calcipotriol 50µg per g/betamethasone dipropionate 0.5mg per g gel for mulation for the treatment of scalp psoriasis. Xamiol costs £36.50 for 60g and is applied once daily. MHRA again warns of varenicline ADRs The MHRA has once more warned of the risk of psychiatric adverse effects with varenicline (Champix). Its latest Drug Safety Update (2008;2:Issue 4) says patients, families and carers should be warned that smoking cessation may lead to depression and that varenicline may cause suicidal thoughts. It should be discontinued if agitation, depression or behaviour changes occur. The MHRA also advises that there is insufficient evidence of increased risk of cancer with ezetimibe, and reviews conflicting evidence of a possible increase in stroke and death with inhaled antimuscarinic agents. Considering recent data linking paracetamol with an increased risk of asthma, the MHRA concludes that the evidence is insufficient to change its view that paracetamol remains a safe and appropriate choice of analgesic for children. Boots offers Cervarix Ten Boots high‐street pharmacies in London are offering women a course of the HPV vaccine Cervarix (three vaccinations, £135 each). The vaccine is available to women aged 18‐26 and is being administered under a patient group direction. This age group is not included in the Government's immunisation programme. SEARCH challenges high‐dose simvastatin Low doses of a high‐intensity statin may be safer than high‐dose simvastatin for aggressive cholesterol‐lowering, the medical director of the British Heart Foundation has suggested. Professor Peter Weissberg was commenting on the SEARCH trial, which reported a higher incidence of new‐onset myopathy with simvastatin 80mg vs 20mg per day over two to seven years' follow‐up (0.8 vs 0.1 per 1000 person‐years). Most cases occurred in patients with a variant of the SLCO1B1 gene, which encodes for a polypeptide regulating the hepatic uptake of statins. NICE guidance may need to be reviewed, he added, and patients who experience unusual muscle symptoms while taking a statin should see their GP. Copyright © 2008 Wiley Interface Ltd