Pre­scrip­tions for Stil­nox hard to track

The Weekend Australian - Travel - - Health - Adam Cress­well

Health ed­i­tor

DOC­TORS and reg­u­la­tors are ham­pered in their at­tempts to keep tabs on pre­scrib­ing of the con­tro­ver­sial sleep­ing drug zolpi­dem be­cause of its private pre­scrip­tion sta­tus.

Ex­perts from the Na­tional Pre­scrib­ing Ser­vice say that while GPs and oth­ers can con­tact the na­tional doc­tor-shop­ping hot­line to find out if pa­tients have al­ready been pre­scribed re­cent sup­plies of other drugs of po­ten­tial abuse, such as mor­phine, zolpi­dem is not cov­ered by this sys­tem be­cause it is not sub­sidised un­der the Phar­ma­ceu­ti­cal Ben­e­fits Scheme.

Na­tional Pre­scrib­ing Ser­vice CEO Lynn Weekes says the loophole — while not amount­ing to an ar­gu­ment to add zolpi­dem to the PBS— il­lus­trates some of the flaws in the cur­rent sys­tem of drug data col­lec­tion.

Zolpi­dem hit the head­lines again this week af­ter the Na­tional Drugs and Poi­sons Sched­ule Com­mit­tee of the Ther­a­peu­tic Goods Ad­min­is­tra­tion de­cided not to re­cat­e­gorise the drug as sched­ule 8, a move that would have placed it un­der the same pre­scrib­ing re­stric­tions as mor­phine.

How­ever, the TGA it­self at the same time an­nounced it was im­pos­ing a ‘‘ black box’’ warn­ing on the drug, which means a more prom­i­nent dec­la­ra­tion warn­ing of the drug’s pre­vi­ously recog­nised bizarre sleep-re­lated side ef­fects will be printed on the pre­scrib­ing in­for­ma­tion in­cluded inside the pack­ag­ing.

Zolpi­dem — of­ten re­ferred to as Stil­nox, which is the best known of var­i­ous brand name un­der which it is sold — has been con­tro­ver­sial for over a year, af­ter an avalanche of pub­lic­ity that has in­cluded cases of pa­tients sleep­walk­ing, eat­ing and even crash­ing cars dur­ing sleep. One pa­tient, in a case orig­i­nally pub­li­cised by the TGA it­self, ap­par­ently woke up with a paint­brush in hand af­ter paint­ing part of the front door.

Other brand names in­clude Dormi­zol, So­mi­dem, Stil­dem, Stil­nox­ium and Zolpi­dem.

Ex­ist­ing pre­scrib­ing in­for­ma­tion al­ready makes clear zolpi­dem should not be used for longer than four weeks, but some cases have emerged where pa­tients have ap­par­ently been pre­scribed the drug over much longer pe­ri­ods than this — a prac­tice be­lieved to in­crease the risk of side-ef­fects.

Mairead Costi­gan, a 30-year-old Syd­ney wo­man, fell to her death from the Syd­ney Har­bour Bridge nearly six months ago af­ter tak­ing zolpi­dem for more than eight months.

How­ever, she had been switched to an­other sleep­ing med­i­ca­tion, zopi­clone, six days be­fore her death, and it is also be­lieved that she had re­ceived zolpi­dem pre­scrip­tions

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