Published: 1 June 2017

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MARC’s Remarks: March 2017 Meeting

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Prescriber Update 38(2): 24-25
June 2017

The Medicines Adverse Reactions Committee (MARC) met on 9 March 2017 to discuss a number of medicine-related safety issues.

The MARC discussed the concomitant use of opioids, benzodiazepines and other CNS depressants and the risk of serious side effects. Usage trends, deaths, over-the-counter (OTC) availability of codeine and other opioids, the amount funded by PHARMAC on prescription, prescribing practices in primary and secondary care, and information included in data sheets were discussed. Further information on the MARC’s discussion on this topic can be found on the Medsafe website (www.medsafe.govt.nz/profs/adverse/Minutes169.htm).

The MARC discussed Medsafe’s proposed monitoring for the National Immunisation Schedule change for varicella vaccine (Varilrix) against chickenpox and considered this to be adequate. Healthcare professionals are encouraged to report any suspected adverse reactions to varicella vaccines to the Centre for Adverse Reactions Monitoring (CARM).

It is also important to note that Varilrix and Varivax are varicella vaccines used to vaccinate against chickenpox and can be used in children, whereas Zostavax is a zoster vaccine used for the prevention of shingles in individuals 50 years of age and above. Further information on the differences between these vaccines can be found in a previous edition of Prescriber Update1.

The MARC discussed the use of anaesthetic and sedative agents in young children. Clinical studies conducted in humans are predominantly observational and have shown conflicting results for neurotoxicity and effects on brain development. It is not clear if the association is a true effect of anaesthetic agents, the surgery or underlying condition requiring surgical intervention, or due to uncontrolled confounding of other factors.

Overall, the MARC considered that the evidence for an association between the use of anaesthetics in young children and risk of neurotoxicity was equivocal, but that parents should be informed about this safety concern. Further information is available from the United States Food and Drug Administration (www.fda.gov/Drugs/DrugSafety/ucm532356.htm).

The MARC noted the revised dosing recommendations for use of etoricoxib for rheumatoid arthritis and ankylosing spondylitis. Healthcare professionals are reminded that the recommended dose listed in the data sheet for these indications is now 60 mg or 90 mg once daily. The minimum effective daily dose is 60 mg once daily and dose escalation to 90 mg should be considered on an individual patient basis.

Further information on this meeting can be found on the Medsafe website (www.medsafe.govt.nz/profs/adverse/Minutes169.htm).

References
  1. 2015. Varicella Zoster Virus Vaccines — Medication Errors. Prescriber Update 36(3): 40. URL: www.medsafe.govt.nz/profs/PUArticles/Sep2015/VaricellaVaccines.htm (accessed 20 April 2017).
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