Discover and read the best of Twitter Threads about #prescribing
Most recents (18)
Great to see my #review on #pharmacogenomics in @NatureRevGenet. rdcu.be/c4iur
@BritPharmSoc @LivUni @pandtuol @CDSS_Liverpool @pgrnhub @pharmgkb @nwgmsa @LivUniISMIB
Key messages:
@BritPharmSoc @LivUni @pandtuol @CDSS_Liverpool @pgrnhub @pharmgkb @nwgmsa @LivUniISMIB
Key messages:
A. Wider definition of #pharmacogenomics
B. Pharmacogenomic #variation is common, we are exposed to many #drugs which require pharmacogenomic #guidance
C. There is increasing #evidence of #clinical #utility of #PGx
B. Pharmacogenomic #variation is common, we are exposed to many #drugs which require pharmacogenomic #guidance
C. There is increasing #evidence of #clinical #utility of #PGx
D. We need more studies on #diversity in #PGx
E. The time is right for #implementation of #PGx #personalised #prescribing
bps.ac.uk/getmedia/b43a3…
E. The time is right for #implementation of #PGx #personalised #prescribing
bps.ac.uk/getmedia/b43a3…
🧵 How well do you know your dopamine antagonists? 💊💊
1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood
👉🏽ti.ubc.ca/letter139
#MedEd #prescribing #deprescribing #medsafety
1/ Using these drugs safely requires that clinicians & patients appreciate their important #AdverseEffects, which are not always well understood
👉🏽ti.ubc.ca/letter139
#MedEd #prescribing #deprescribing #medsafety
2/ #AdverseEffects may include:
⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss
⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)
👉🏽Pt videos: ti.ubc.ca/letter139
⚠️ Drug-induced #Parkinsonism
-↘️ or slowed movements, rigidity/tremor/unsteadiness, facial expression loss
⚠️ #Akathisia
-intense internal restlessness or desire to move (which may be mistaken for anxiety)
👉🏽Pt videos: ti.ubc.ca/letter139
3/ #AdverseEffects may include:
⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm
⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline
👉🏽Pt experience videos: ti.ubc.ca/letter139
#MedEd #ptsafety #drugsafety
⚠️Acute dystonic reaction
-sudden, involuntary, often painful muscle spasm
⚠️Dyskinesia
-repetitive, involuntary movements...can be associated with cognitive decline
👉🏽Pt experience videos: ti.ubc.ca/letter139
#MedEd #ptsafety #drugsafety
🧵 Reducing #PrescribingCascades ⬇️
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
1/ What are #Prescribing Cascades?
1⃣ A drug is prescribed 💊
2⃣ #AdverseEvent occurs but is misinterpreted as a new medical condition ⚠️
3⃣Another drug is prescribed for the drug-induced adverse event 💊💊
ti.ubc.ca/letter138 #MedEd
2/ Anticholinergics ➡️ cognitive dysfunction ➡️ drugs for #dementia
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
#Anticholinergic 💊 block acetylcholinergic neurotransmission in the brain, impairing cognition & memory
Can lead to new Rx or ↗️ acetylcholinesterase inhibitor doses
ti.ubc.ca/letter138 #MedEd #FOAMed
3/ Drugs for #dementia ➡️ incontinence ➡️ anticholinergics
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
Conversely, AChE-I can cause urinary or fecal incontinence, that may "cascade" to prescription of an #anticholinergic
👉🏽 full Letter here: ti.ubc.ca/letter138
#MedEd #PrescribingCascades #MedTwitter
THREAD: #Prescribers, how do YOU respond to Conflicts of Interest (COI)? 👀
1/8 This thread looks at the issues highlighted in our TI Therapeutics Letter on COI
👉🏼Full Letter: ti.ubc.ca/letter136
#ConflictofInterest #MedEd #MedicalEthics
1/8 This thread looks at the issues highlighted in our TI Therapeutics Letter on COI
👉🏼Full Letter: ti.ubc.ca/letter136
#ConflictofInterest #MedEd #MedicalEthics
2/8 Kirsten is a clinical pharmacist attending a primary care conference👩🏽⚕️
When a keynote speaker reports financial relationships💰with several drug companies, Kirsten takes note🤨
Find out why she prefers #MedEd free of commercial sponsorship: ti.ubc.ca/letter136
When a keynote speaker reports financial relationships💰with several drug companies, Kirsten takes note🤨
Find out why she prefers #MedEd free of commercial sponsorship: ti.ubc.ca/letter136
3/8 Key Opinion Leaders (KOLs)
It's common practice to cultivate “expert” KOLs who are crucial to market success💵of a new drug
Payments to KOLs are reported in USA but similar disclosure does NOT exist in Canada
go.nature.com/39XdVVq
#FinancialInterests #ConflictofInterest
It's common practice to cultivate “expert” KOLs who are crucial to market success💵of a new drug
Payments to KOLs are reported in USA but similar disclosure does NOT exist in Canada
go.nature.com/39XdVVq
#FinancialInterests #ConflictofInterest
THREAD: Bring it down safely! ↘️💊
1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics
👉🏾 Full Letter: ti.ubc.ca/letter134
#MedEd #medsafety #prescribing #BetterPrescribing
1/6 6⃣tweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics
👉🏾 Full Letter: ti.ubc.ca/letter134
#MedEd #medsafety #prescribing #BetterPrescribing
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)
👉🏾ti.ubc.ca/letter134
#MedEd #ptsafety #BetterPrescribing #prescribing
✅#Cyclobenzaprine (at best 1/4)
✅#Duloxetine (at best 1/6)
✅#Gabapentin / #Pregabalin (at best 1/6)
👉🏾ti.ubc.ca/letter134
#MedEd #ptsafety #BetterPrescribing #prescribing
3/6 Gabapentin, pregabalin, duloxetine:
A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)
👉🏾ti.ubc.ca/letter134
#MedEd #BetterPrescribing #deprescribing
A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as ≥30% reduction in pain or pain & function)
👉🏾ti.ubc.ca/letter134
#MedEd #BetterPrescribing #deprescribing
THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?
1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021
Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133
#MedEd
1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021
Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133
#MedEd
2/8 Lower #BloodPressure not the Main Goal
#Antihypertensives lower various measures of blood pressure (BP) 💊
But... not all BP lowering drugs are proven to reduce both morbidity & mortality
👉🏾ti.ubc.ca/letter133
#MedEd #prescribing #hypertension
#Antihypertensives lower various measures of blood pressure (BP) 💊
But... not all BP lowering drugs are proven to reduce both morbidity & mortality
👉🏾ti.ubc.ca/letter133
#MedEd #prescribing #hypertension
3/8 The importance of clinical outcomes
Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes
Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133
#MedEd #prescribing #hypertension
Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes
Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133
#MedEd #prescribing #hypertension
THREAD: #ExercisePrescriptions
1/5 The TI’s Dr. Josh Levin asks:
Clinicians, can you help your patients be more active? 🏃🏾♀️🏊🏾♂️ 🚶🏾♂️
👉🏾Watch Dr. Levin’s recent presentation: bit.ly/3nLCEje 👨🏾💻
#Exercise #prescribing #twitterRx
1/5 The TI’s Dr. Josh Levin asks:
Clinicians, can you help your patients be more active? 🏃🏾♀️🏊🏾♂️ 🚶🏾♂️
👉🏾Watch Dr. Levin’s recent presentation: bit.ly/3nLCEje 👨🏾💻
#Exercise #prescribing #twitterRx
2/5 #ExercisePrescriptions: How much activity should people get? It depends on their age.
👉🏾See the Canadian Society for Exercise Physiology activity guidelines for different age groups: csepguidelines.ca 🏊🏾♂️🏃🏾♀️🚶🏾
#Exercise #prescribing #twitterRx #BetterHealth
👉🏾See the Canadian Society for Exercise Physiology activity guidelines for different age groups: csepguidelines.ca 🏊🏾♂️🏃🏾♀️🚶🏾
#Exercise #prescribing #twitterRx #BetterHealth
3/5 Below is an example of an #ExercisePrescription 🏊🏾♂️🏃🏾♀️🚶🏾♂️
#Exercise #prescribing #twitterRx #BetterPrescribing
#Exercise #prescribing #twitterRx #BetterPrescribing
What’s the deal w/ people in #pain using #opioids? (Read entire thread.) We are not “drug addicts.” We are physically DEPENDENT on our meds, which we need to function w/out pain (i.e, to function). Physical dependence occurs on heart meds & #antidepressants too. #ThisIsUs
And I am not trying to stigmatize #addiction here. But rly, let’s talk; chronic pain patients (#CPPs) have been forced to KILL themselves due to untreated pain, due to bad #policy, due to the #stigma, foolishness & financial incentives of others. This has a name: opiophobia…
If you took me off ALL opioids, I (like most #painpatients) would go through ugly opioid #withdrawals (and make sure to poop/puke on YOU for causing them)! 😂
And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…
And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…
THREAD: Evidence for oseltamivir for #influenza prevention
1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention
✅Flu guidelines bit.ly/3wwGJei
✅Systematic review of Tamiflu safety pubmed.ncbi.nlm.nih.gov/27246259
1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention
✅Flu guidelines bit.ly/3wwGJei
✅Systematic review of Tamiflu safety pubmed.ncbi.nlm.nih.gov/27246259
2/6 #Oseltamivir for prevention reduces ↘️ symptomatic influenza by 3%, (NNT=33) with an uncertain effect on asymptomatic #influenza
It likely has a central symptom reducing effect but may not reduce viral transmission
pubmed.ncbi.nlm.nih.gov/27246259
#Tamiflu #prescribing
It likely has a central symptom reducing effect but may not reduce viral transmission
pubmed.ncbi.nlm.nih.gov/27246259
#Tamiflu #prescribing
3/6 #Oseltamivir won’t reduce the risk of developing influenza-like illness though it can make people feel better (i.e. fewer symptoms) and reduces ↘️ fever
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259
THREAD:5⃣things to know from 5 recent TI Therapeutics Letters👩🏽🔬
1/5: How to choose a good #mirtazapine dose? 🤔
Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E
#MedEd #deprescribing #ptsafety
1/5: How to choose a good #mirtazapine dose? 🤔
Mirtazapine has a dose response 💊for harm but NOT for efficacy: harm ↗️ after 30mg/day but efficacy doesn't: bit.ly/361LU9E
#MedEd #deprescribing #ptsafety
2/5: Want to learn about recent @GovCanHealth #medsafety or international warnings for medications?
Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊
#drugsafety #SegPac #ptsafety
Read our Therapeutics Letter on international drug safety advisories: bit.ly/3wc0ar8 ⚠️ 💊
#drugsafety #SegPac #ptsafety
3/5: Do you like receiving feedback on your #prescribing?👩🏽⚕️💊
Read about Personal Prescribing Portraits: bit.ly/3hkf8WO
#MedEd #deprescribing
Read about Personal Prescribing Portraits: bit.ly/3hkf8WO
#MedEd #deprescribing
THREAD - What if we could track and record repeat Adverse Drug Events? 🤔 💊
1/6: Register for our May 12 #BestEvidence webinar, as @corinne_hohl talks about Assessing the Impact of Information Continuity on Health Outcomes: bit.ly/3ap4FGO #MedEd
1/6: Register for our May 12 #BestEvidence webinar, as @corinne_hohl talks about Assessing the Impact of Information Continuity on Health Outcomes: bit.ly/3ap4FGO #MedEd
2/6: Why do Adverse Drug Events (ADEs) matter?
Each year in British Columbia, ADEs account for:
👉240,000 emergency dept (ED) visits
👉480,000 days in hospital
👉approx. 1 in 9 adult ED visits
More here: bit.ly/2Q7UGi8
#drugsafety #ptsafety #MedEd
Each year in British Columbia, ADEs account for:
👉240,000 emergency dept (ED) visits
👉480,000 days in hospital
👉approx. 1 in 9 adult ED visits
More here: bit.ly/2Q7UGi8
#drugsafety #ptsafety #MedEd
3/6: In Canada, adverse drug events 💊 cause or contribute to almost 2⃣million emergency department visits annually 😯 🆘
See publication list here: actionade.org/referenced-art…
#MedEd #ptsafety #prescribing
See publication list here: actionade.org/referenced-art…
#MedEd #ptsafety #prescribing
THREAD: Tamiflu for #influenza prevention – the evidence
1/6 In 2019 21,000 BC citizens were prescribed Tamiflu (oseltamivir), many to prevent the flu. Flu prevention guidelines. AMMI Canada ammi.ca/?ID=171
Systematic review of Tamiflu safety: pubmed.ncbi.nlm.nih.gov/27246259/
1/6 In 2019 21,000 BC citizens were prescribed Tamiflu (oseltamivir), many to prevent the flu. Flu prevention guidelines. AMMI Canada ammi.ca/?ID=171
Systematic review of Tamiflu safety: pubmed.ncbi.nlm.nih.gov/27246259/
2/6 Tamiflu for prevention ↘️ symptomatic flu (by 3%, NNT=33) with uncertain effect on asymptomatic flu.
One likely explanation is that Tamiflu has a central symptom lowering effect but may not ↘️ viral transmission.
pubmed.ncbi.nlm.nih.gov/27246259
#influenza #flu #tamiflu
One likely explanation is that Tamiflu has a central symptom lowering effect but may not ↘️ viral transmission.
pubmed.ncbi.nlm.nih.gov/27246259
#influenza #flu #tamiflu
3/6 Tamiflu doesn't reduce risk of developing flu-like illness though it can make people feel better (i.e. fewer self-reported symptoms) & reduces fever.
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259/
There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259/
THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/u8dN378QAe
#MedEd
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/u8dN378QAe
#MedEd
3/6 ACEIs over ARBS when considering HARMS 🤔
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
THREAD: Are we using ACEIs & ARBs properly? A TI Tweetorial
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
1/6: British Columbia doctors give 4.5m scripts/year for ACE inhibitors (ACEIs) & angiotensin receptor blockers (ARBs) to control bp. Goal is to ↘️ mortality & morbidity, not simply to ↘️ bp.
#MedEd #hypertension
2/6 BEST EVIDENCE on ARBs & ACEI for #hypertension
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/NCl1dfCCAO
#MedEd
3⃣@CochraneHTN systematic reviews:
ACEs v ARBs for htn bit.ly/34vS0hu
BP lowering efficacy of ACEIs for htn bit.ly/30YNIOX
BP lowering efficacy of ACEIs for htn https://t.co/NCl1dfCCAO
#MedEd
3/6 ACEIs over ARBS when considering HARMS 🤔
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
Both ACEIs & ARBs ↘️ blood pressure to similar extents.... BUT only ACEIs have evidence for a reduction in risk of morbidity & mortality. So they’d be your first choice 🥇
#MedEd #medsafety #ptsafety
THREAD: Ten Commandments for patient-centred treatment 🧾
1/11 A TI Tweetorial on the “Ten Commandments’ of the New Therapeutics
Revisiting timely words of medical wisdom from the BMJ
bjgp.org/content/65/639…
#MedEd #prescribing
1/11 A TI Tweetorial on the “Ten Commandments’ of the New Therapeutics
Revisiting timely words of medical wisdom from the BMJ
bjgp.org/content/65/639…
#MedEd #prescribing
2/11 1st Commandment:
Thou shalt have no aim except to HELP patients, according to the GOALS they wish to achieve 👩⚕️
bjgp.org/content/65/639…
Shared decision-making lessons from @LessIsMoreMed: lessismoremedicine.com/hands-on
#MedEd #TreatmentGoals
Thou shalt have no aim except to HELP patients, according to the GOALS they wish to achieve 👩⚕️
bjgp.org/content/65/639…
Shared decision-making lessons from @LessIsMoreMed: lessismoremedicine.com/hands-on
#MedEd #TreatmentGoals
3/11 2nd Commandment:
Thou shalt always seek knowledge of BENEFITS, HARMS, COSTS of treatment & share this knowledge at all times
bjgp.org/content/65/639…
Try these:
ti.ubc.ca/therapeutics-l…
@thenntgroup
medi-mouse.com
pac.bluecross.ca/pharmacycompass
#MedEd #ptsafety
Thou shalt always seek knowledge of BENEFITS, HARMS, COSTS of treatment & share this knowledge at all times
bjgp.org/content/65/639…
Try these:
ti.ubc.ca/therapeutics-l…
@thenntgroup
medi-mouse.com
pac.bluecross.ca/pharmacycompass
#MedEd #ptsafety
THREAD: High blood pressure (hypertension) – what does the best evidence say❓
1/13 A practical tweetorial for clinicians, patients and carers
#hypertension #HTNevidence #MedEd 🩺👩⚕️
1/13 A practical tweetorial for clinicians, patients and carers
#hypertension #HTNevidence #MedEd 🩺👩⚕️
2/13 What is #Hypertension❓
Hypertension (high blood pressure) is a very common condition, and is associated with increased 📈 risk for strokes, heart attacks and premature death, so it's worth asking some questions 🤔
#HTNevidence #MedEd #prescribing
Hypertension (high blood pressure) is a very common condition, and is associated with increased 📈 risk for strokes, heart attacks and premature death, so it's worth asking some questions 🤔
#HTNevidence #MedEd #prescribing
3/13 What about SCREENING for #hypertension❓
Screening for high blood pressure might not be that helpful 😯 and early🕗detection of mild hypertension may not significantly impact health‐related costs in the long term nor improve health outcomes: bit.ly/35P2mcz
Screening for high blood pressure might not be that helpful 😯 and early🕗detection of mild hypertension may not significantly impact health‐related costs in the long term nor improve health outcomes: bit.ly/35P2mcz
THREAD: High blood pressure (hypertension) – what does the best evidence say❓
1/13 A practical tweetorial for clinicians, patients and carers
#hypertension #HTNevidence #MedEd 🩺👩⚕️
1/13 A practical tweetorial for clinicians, patients and carers
#hypertension #HTNevidence #MedEd 🩺👩⚕️
2/13 What is #Hypertension?
Hypertension (high blood pressure) is a very common condition, and is associated with increased📈 risk for strokes, heart attacks and premature death 💀, so it's worth asking some 🤔👩🏾💻
#TIevidence #MedEd #prescribing
Hypertension (high blood pressure) is a very common condition, and is associated with increased📈 risk for strokes, heart attacks and premature death 💀, so it's worth asking some 🤔👩🏾💻
#TIevidence #MedEd #prescribing
3/13 What about SCREENING for #hypertension?
Screening for high blood pressure might not be that helpful 😯 and early 🕗 detection of mild hypertension may not significantly impact health‐related costs in the long term nor improve health outcomes: bit.ly/35P2mcz
Screening for high blood pressure might not be that helpful 😯 and early 🕗 detection of mild hypertension may not significantly impact health‐related costs in the long term nor improve health outcomes: bit.ly/35P2mcz
Series 8 starting today #ramipril Day 1:The concept for the 1st angiotensin converting enzyme inhibitor (ACEI) was derived from snake venom in the 1950s. An orally active version was eventually found & captopril was licensed in 1981 for hypertension & heart failure #prescribing
Day 1 #ramipril (cont): Improved ‘me too’ ACEI versions followed, such as #ramipril, approved in the UK in 1989. Captopril now out-moded, but still used in paediatrics #prescribing
Day 2: Long-acting, high affinity ACEIs, e.g #ramipril, highly successful in cardiovascular and renal space, re h-tension, heart failure, post-MI prophylaxis & nephropathy. Ramipril one of the most prescribed ACEI in UK: Jan 2019 total CCG items ~ 2.5 mill & cost >3m #prescribing
