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Gold, incentives and meh

Is blood test needed in using mianserin?

I was disappointed to find Professor PhilipCowen (Clinical,September 29) perpetuating the myth that blood testing is required when mianserin is used.Professor Bill Inman scotched this many years ago in his large post-marketing study performed at the Drug and Safety Research Unit when it was based at Southampton.

I remember him writing to me about it many years ago after I had queried the continuing need for caution about agranulocytosis. He was very clear in his advice that this was not associated with mianserin.

Dr Michael Blackmore

Ringwood, Hampshire

Professor Cowen replies:

People do argue about the need for blood testing when mianserin is started. However, the BNF, under the section on mianserin treatment, states: 'A full blood count is recommended every four weeks during the first three months of treatment.'

Obviously people are free to ignore a BNF recommendation ­ though they would probably have to explain to the patient that they were doing so. On balance I think it's better to do the test.

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