I was interested to read Dr Wright's paper on the impact of the Committee on Safety of Medicine (CSM) advice on thioridazine prescribing in general practice in Leeds in the May edition of the BJGP.1
Working in a general practice of 5500 patients in Sheffield, we have an above average number of patients in either sheltered or supported accommodation, of whom 11 were well controlled on thioridazine at the time of the CSM advice. Owing to the forceful nature of the advice we did not feel we were able to continue prescribing thioridazine and the local advice in Sheffield was to convert patients onto promazine (in retrospect, bad advice). The effect on these patients was marked; of the 11, only one remained controlled on thioridazine, the number of consultations and hospital appointments increased and there was marked distress to the patients, their families, and their carers.
I would agree with Dr Wright's suggestions for how the CSM relates urgent advice regarding medication when there is emerging evidence of poor safety profile, but I would also add that there should then be clear guidance as to what the appropriate alternatives are, with the appropriate evidence.
- © British Journal of General Practice, 2004.