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Generics drive 'raising risk of GI side-effects'

By Lilian Anekwe

A Government drive to increase GP prescribing of generic alendronate for osteoporosis is putting patients at risk of gastrointestinal harm, experts are warning.

Figures obtained by Pulse show the proportion of generic prescriptions dispensed for alendronate leapt by 15% between April 2007 and March 2008 – followingan NHS-wide drive to increase cost-effectiveness of prescribing.

But the sharp increase has raised alrm among muscular experts after a new study found patients who were stable on risedronate but switched to alendronate experienced a rise in gastrointestinal side-effects.

The UK study of 14,520 patient records in the Health Improvement Network, taken between March 2005 and June 2007, found that half of patients on risedronate were switched to alendronate in 2007.

But among patients switched to alendronate, the risk of any upper GI event leapt by 39%, compared with those who stayed on risedronate. Among patients switched from alendronate to ridronate, the risk of GI events went up too, but only by 10%

The study was presented at the International Osteoporosis Forum's congress in Bangkok, Thailand, earlier this month.

Study leader Professor Stuart Ralston, professor of rheumatology at the Western General Hospital in Edinburgh, told Pulse: ‘These drugs are similar but they are not the same and this research suggests there's a difference in their side effect profile.

‘I have sympathy for GPs under pressure to meet prescribing targets, but if a patient did have a GI history and was doing OK on risedronate I would advise keeping them on it.'

The proportion of alendronate prescriptions, as a proportion of all bisphosphonates dispensed in England, rose from 58.3% in April 2007 to 66.9% in March 2008, the latest statistics show.

Dr Adam Bajkowski, a GP in Wigan and chair of the Primary Care Rheumatology Society, said switching patients who were stable on risedronate risked losing the patient's confidence.

‘I do not think it is our job to lose the patient's confidence in a particular treatment which works by suggesting they take something else because the Government want to save money. Would you swap your Kellogg's cornflakes for Tesco's own brand?'

Prescribing of Alendronate has risen markedly as a result of generics targets Prescribing of Alendronate has risen markedly as a result of generics targets Alendronate as a proportion of bisphosphonates dispensed

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