General Information on Drug Treatment

Where Can I get the Best Information on Medicines?

Australia is fortunate in having NPS, formerly known as the National Prescribing Service. This is a government funded but independent organisation whose function is to improve the health of Australians through better use of medicines. It has many functions including providing educational material for doctors, but also has a service providing information for patients. It is unique in that being independent from drug companies its information is guaranteed to be accurate and unbiased.

You can access information either through their website or by ringing their medicines helpline:

• http://www.nps.org.au/
• Medicines helpline (1300 633 424)

Also through their website, you can access the doctors prescribing information (although, of course, this is written in technical language) and the patient information leaflet.

Your pharmacist or doctor are also people to speak to if you have concerns about any particular medication.

I Can't Find the Names of the Medicines I Use Here

Throughout this document I generally used the generic name of medicine. You note that such names do not start with a capital letter. When I do use a brand name it starts with a capital and I put the name in italics. A good explanation of the difference between a generic and brand name is on the NPS website:

http://www.nps.org.au/consumers/publications/medicines_talk/mt21/generic_medicines_explained)

One other type of consumer product that is generic is vehicle fuel.  We tend to buy on convenience and price rather than brand.

There is similar logic regarding medicines. It is the active ingredient that is important, not the brand. One of the advantages for patients using the generic names is that by convention drugs of a similar action class end in similar letters. For example all beta-blockers end in “-olol”; all tricyclic antidepressants end in “-triptyline”. This way you can see whether the medicines are similar or different in action to the ones that you have had before. Drug companies of course would like you to use the brand name to try to get you to stick to their particular brand of medicine. The regulator has checked that different medicines with the same active ingredient at the same dose and in the same formulation produce similar blood levels and hence should be interchangeable. For painkillers available without prescription, because this is such a large market, companies often heavily promote specific features which may not be scientifically based. I successfully complained to the Australian regulator about one widely used painkiller which has misleading advertising in claiming that it is “targeted” to the site of pain. So you should not get too obsessed with the brand name of the medicine and its reputation and advertising but you should look carefully at the active ingredients. If it has the same active ingredients as a medicine you have already tried, it is unlikely to produce a substantially different result.

There may, however, be some differences between formulations generally related to the speed or duration of absorption. For example, I wrote above that paracetamol may be absorbed quite slowly in migraine. There are formulations in which there are additional ingredients which have been proven to result in faster absorption of paracetamol: e.g. “Panadol Rapid”. Again, for the same active ingredient, there is another slowly released formulation, “Panadol Osteo”, which is of course designed to give a steady trickle of drug for patients with chronic pain and would not be suitable for use to treat acute painful episodes of headache.

Please note that different drugs from the same class should not be regarded as generic, for example, propranolol and atenolol as beta-blockers. Drugs of the same class might have general similar effects but as they have different active ingredients they may cause different effectiveness and safety in individual patients.

"Off-Label"

To understand this concept you need to understand how medicines are regulated in Australia. Before any Therapeutic Goods Administration to demonstrate the drug is adequately safe and effective for the stated purpose. If the TGA gives a positive opinion, then the drug can be marketed. However, at this stage a patient will have to pay the full price of a drug, which can be very high.

When a drug is approved, it is approved for the purpose requested at the dosage schedule specified. Use for other purposes or different doses not reviewed or approved by the regulator is called “off-label”.  For a doctor to suggest such use there should be reasonable evidence that the drug might be effective at this dose and purpose generally through published clinical trials. You might wonder why the companies don’t apply to have the drug approved for such purposes and there may be financial reasons for that. However, the category “off-label” includes drugs which there is substantial evidence of benefit and goes all the way to categories where there is very little evidence of benefit. When the doctor prescribes a drug “off-label” the patient is not protected by the regulatory review and generally any manufacturer would not regard themselves as legally liable. Legal liability would rest with the doctor. At the Royal Adelaide Hospital, unless there is very substantial evidence to support a drug’s use in an off label situation, doctors would apply to the Drug Committee of the Royal Adelaide to justify its use and get permission for the cost. This acts to protect patient safety by making sure there is a very good reason for them being given the drug.

As part of its National Medicines Policy, Australia also has the pharmaceutical benefits system in which patients make a maximum contribution to the cost of the drug irrespective of how expensive it is. Drugs do not automatically get on the PBS once they have been approved by the TGA. It may be that the PBS considers the drug to be too expensive or the benefit too modest. If the drug is not on the PBS scheme, either you will have to pay the full price, or it may be available through a hospital through a separate system.