6 NEWS
6 NEWS
Is mirtazapine the new go-to ?
Use of the drug has been ‘ increasing steadily ’. |
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Rachel Carter AN upcoming PBAC review of antipsychotic prescribing will consider whether risperidone restrictions in aged care are behind the increasing use of other chemical restraints .
In response to the Royal Commission into Aged Care Quality and Safety , since 2020 , doctors have been barred from prescribing risperidone beyond 12 weeks without an authority script .
While the overall use of the drug as a chemical restraint has
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declined , the PBAC ’ s Drug Utilisation Sub-Committee ( DUSC ) says its use in residential aged care facilities has gone up .
Its latest report also suggests that the use of other antipsychotics — such as aripiprazole and olanzapine — to manage the behavioural and psychological symptoms of dementia has increased .
In addition , it found the use of the antidepressant mirtazapine in aged care was “ increasing steadily ”, with 1500 new patients per quarter and
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some 27,000 prevalent patients in the first three months of 2023 .
Meanwhile , quetiapine use had remained steady , with 1000 new initiations per quarter and fewer than 8000 prevalent patients per quarter , the DUSC report said .
The DUSC has been monitoring the use of the drugs in aged care since last year after the PBAC rejected a recommendation from the royal commission to restrict antipsychotic initiation to geriatricians and psychiatrists .
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“ It may be beneficial for DUSC to conduct a future analysis of patients switching between mirtazapine , quetiapine , risperidone and benzodiazepines to determine if the limitations on the risperidone restriction have caused an increased uptake of other medications with the potential for chemical restraint ,” the PBAC said .
This will form part of the planned review into antipsychotic prescribing , although the time line is yet to be confirmed .
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PAXLOVID has provisional approval for the treatment of coronavirus disease 2019 ( COVID-19 ) in adults 18 years of age and older , who do not require initiation of supplemental oxygen due to COVID-19 and are at increased risk of progression to hospitalisation or death . 1
Before initiating PAXLOVID , patients will need to withhold treatment with any contraindicated medications where it is clinically appropriate to do so , and observe an appropriate washout period . 1
Standard dose of Paxlovid is 300 mg nirmatrelvir and 100 mg ritonavir tablets taken together orally every 12 hours for 5 days . Reduce dose to nirmatrelvir / ritonavir 150 mg / 100 mg every 12 hours for 5 days for patient with moderate renal impairment ( eGFR ≥30 to < 60 mL / min / 1.73m 2 ). 1
PBS information : Authority Required ( STREAMLINED ). Category : GENERAL - General Schedule ( Code GE ). For verified SARS-CoV-2 infection . Treatment must be initiated within 5 days of symptom onset . Refer to PBS Schedule for full authority information .
Reference : 1 . PAXLOVID Product Information .
© 2023 . Pfizer Australia Pty Ltd . Sydney , Australia . All rights reserved . This information is intended only for healthcare professionals . www . pfizer . com . au . Medical Information : 1800 675 229 . www . pfizermedicalinformation . com . au . PP-PAX-AUS-0580 . 07 / 23 . PFIZ4881 .
Gandhi MacIntyre PBS eligible ≥ 70 year old no risk factors required
I ’ M PRO FIGHTING COVID-19 I ’ M ANTI-VIRAL
BEFORE PRESCRIBING , PLEASE REVIEW FULL PRODUCT INFORMATION AVAILABLE BY SCANNING THE QR CODE OR VISITING https :// www . pfi . sr / paxlovid-pi
Warning : Nirmatrelvir with ritonavir has significant drug-drug interactions . Prescribers and dispensers should carefully review a patient ’ s concomitant medications .
This medicinal product is subject to additional monitoring in Australia . This will allow quick identification of new safety information . Healthcare professionals are asked to report any suspected adverse events at www . tga . gov . au / reporting-problems .
Alternatively , any adverse events which are experienced with PAXLOVID can be reported to Pfizer on 1800 675 229 or by email to AUS . AEReporting @ pfizer . com
Healius fined $ 1.65m
Heather Saxena HEALIUS Pathology has been handed a $ 1.65 million fine for paying inflated rents for colocated collection sites at two dermatology practices .
The Federal Court of Australia said the company rented a 4.8 sq m room for $ 150,000 a year plus GST under a 2015 agreement with three doctors in Castle Hill , Sydney .
That same year , the corporate agreed to pay two other doctors $ 200,000 a year plus GST for an 8.4 sq m room at their practice in Kingswood , Sydney .
This was in breach of the Health Insurance Act , which bans pathology and imaging providers from offering inducements to doctors to use their services .
Justice Angus Stewart said the breaches warranted “ significant penalties ” given senior Healius staff had approved of the leases despite the company having the capacity to assess the true market value of the rental spaces .
There was “ very real public interest ” in the case because patients were unlikely to recognise inappropriate pathology referrals , he said .
Four expert reports suggested the true market rental value of the Castle Hill room was $ 30,000- $ 35,000 per annum at the time of the original lease and that the market rent for the room at the Kingswood practice was $ 75,000- $ 82,500 per annum .
Last month , the Federal Court revealed that Healius had agreed to pay a $ 375,000 fine for each original lease and a $ 450,000 fine for each lease renewal — $ 1.65 million total — plus $ 200,000 in legal costs . The maximum penalty per breach was $ 1.26 million , putting Healius at risk of a $ 5 million sanction . However , in deciding the penalty , Justice Stewart acknowledged that Healius had not engaged in similar conduct before and had co-operated with the proceedings .