I will be publishing a short summary of a new guideline every week or two.
Constipation (women) – Prucalopride – Technical Appraisal
This guidance advises the use of prucalopride in ‘laxative refractory chronic constipation’ after at least 2 drugs have been tried at maximum dose for at least 6m. It’s expensive. Review the woman at 4/52. If it’s not worked by then, it’s unlikely to work at all.
Vascular Disease, clopidogrel and dipyridamole – Technical Appraisal
This guideline increases the indications for which generic clopidogrel can be used first line. As the price has come down, so it’s cost-effectiveness has increased. Aspirin isn’t mentioned as an alternative 1st line choice, but this is implied.
- Ischaemic stroke: 1st line – clopidogrel or aspirin, 2nd line – MR dipyridamole + aspirin, 3rd line – MR dipyridamole alone
- Peripheral vascular disease or ‘multivascular disease’: clopidogrel or aspirin
- TIA: 1st line – MR dipyridamole + aspirin (the 2 yr time limit has been removed, so this should be continued indefinitely), 2nd line – MR dypridamole alone