News in brief: Smoking cessation drug unavailable; Zolpidem add-on for OSA treatment; Hospital doctors bullied to discharge patients early


30 Jun 2021

Smoking cessation treatment Champix unavailable

The smoking cessation treatment varenicline will be unavailable for some time due to a global halt in distribution by manufacturer Pfizer over concerns about nitrosamine impurities.

The TGA has listed varenicline on its Medicines Shortage information site, stating that the product – brand name Champix –  will not be available until at least September 2021.

According to UK authorities, the pause is due to low levels of the potential carcinogenic nitrosamines

The Medicines and Healthcare products Regulatory Agency advice to clinicians is that “patients currently prescribed varenicline will require review and switching to nicotine replacement therapy (NRT) unless contraindicated.”

Elevated levels of nitrosamines have been found in other pharmaceutical products recently and led to the recall of drugs such as valsartan, metformin and ranitidine.

A spokesperson for Pfizer told Reuters: “The benefits of [Champix] outweigh the very low potential risks, if any, posed by nitrosamine exposure from varenicline on top of other common sources over a lifetime.”

Zolpidem add-on for OSA treatment

The hypnotic zolpidem may be a useful add-on therapy for atomoxetine-oxybutynin (Ato-Oxy) in the treatment of obstructive sleep apnoea (OSA) because it can counteract the decrease of wake-promoting properties of atomoxetine in the combination, an Australian study has shown

Researchers at the Adelaide Institute for Sleep Health, Flinders University, conducted a trial in 12 patients with OSA who received 10 mg zolpidem or placebo in addition to Ato-Oxy (80-5 mg, respectively) or prior to overnight in-laboratory polysomnography.

They showed that the addition of zolpidem increased sleep efficiency by 9% and the respiratory arousal threshold by 17% compared to placebo. Zolpidem did not worsen next-day sleepiness but did reduce next-morning objective alertness on a driving simulator task.

More information: Respirology

Hospital doctors bullied to discharge patients early

More than 60% of hospital doctors feel coerced to discharge patients before they are medically ready, according to a survey conducted by the SA Salaried Medical Officers Association.

Almost 40% of doctors said the pressure to discharge patients came from hospital executives and half said the early discharges negatively impacted on care, according to report In Daily.

The survey supports a “Time to Care” campaign by SASMOA which says that medical care is being compromised by lack of staff numbers to meet demand and lack of time to provide appropriate medical care for patients.

“Medical decisions should be made by doctors based on a medical assessment of patient need and not based on cutting costs,” the Association said.

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