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Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine
Author(s) -
Acheampong Paul,
Cooper Gill,
Khazaeli Behshad,
Lupton David J.,
White Sue,
May Margaret T.,
Thomas Simon H. L.
Publication year - 2013
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12130
Subject(s) - quinine , medicine , confidence interval , medical prescription , toxicity , pharmacology , malaria , immunology
Aims To ascertain the effects of the M edicines and H ealthcare products R egulatory A gency's ( MHRA ) safety update in J une 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 E ngland and quinine prescribing volume for individual P rimary C are T rusts in the N orth E ast of E ngland from 2007/8 to 2011/12 obtained from the ePACT .net database. We also analysed quinine toxicity enquiries to the N ational P oisons I nformation S ervice ( NPIS ) via T oxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and P earson'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 E ngland declined from 6.0 to −0.6% following the MHRA update [difference −0.04 (95% confidence interval −0.07 to −0.01) quinine prescriptions per 100 patients per quarter, P = 0.0111]. Much larger reductions were observed in P rimary C are T rusts that introduced comprehensive prescribing reviews. The previously increasing trend in T oxbase® quinine searches was reversed [difference −19.76 (95% confidence interval −39.28 to −9.20) user sessions per quarter, P = 0.0575]. T elephone enquiries to NPIS for quinine have declined, with stabilization 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.