Compliance with guidelines results in appropriate ondansetron prescribing at Christchurch Hospital.

AIM: To assess compliance with established consensus derived guidelines for ondansetron therapy and to estimate the cost of any non-guideline use. METHODS: All inpatients (including paediatric patients) at Christchurch Hospital who received ondansetron during August 1993 were identified by daily review of medication charts. Outpatients who received ondansetron prescriptions were identified from pharmacy records. All patients' medical records were then examined and ondansetron therapy was compared with the guideline recommendations for indication and dosage. The total cost of ondansetron for each patient was also calculated. RESULTS: Ondansetron was prescribed for 64 patients (41 female, 23 male) during the one month period. Fifty patients received ondansetron therapy in accordance with all indication and dosage aspects of the guidelines. The main guideline indication for use was highly emetogenic chemotherapy with 28 patients. Fifteen patients received ondansetron because of failure of standard antiemetic therapy and nine because they were paediatric chemotherapy patients. Of the 12 patients who received ondansetron outside the guidelines indications, nine had received 'moderately highly' emetogenic chemotherapy (whereas the guidelines state 'highly' only), two had severe asthma, one received radiotherapy. Two patients did not comply with the dosage recommendations as they received ondansetron more than 24 hours after the initial cytotoxic dose. Total ondansetron expenditure for the period was $12,789 (inpatient $8492 outpatient $4297). Expenditure related to the nonguideline usage was $536 (4.2% of the total monthly ondansetron expenditure). CONCLUSION: There was high compliance with the guidelines. This supports the use of guidelines in encouraging appropriate prescribing.

Moclobemide in chronic neuropathic pain: preliminary case reports.

OBJECTIVE: This trial aimed to study moclobemide, a reversible, Type-A selective monoamine oxidase inhibitor, in patients with chronic neuropathic pain. DESIGN: Pain clinic patients suitable for antidepressant therapy were treated for 2 months in an open label, uncontrolled trial with moclobemide 150-600 mg/day. OUTCOME MEASURES: Visual analog scores of pain and affective symptoms, a side-effect checklist, and clinical global impressions of efficacy and tolerability. RESULTS: The trial was terminated after assessment of seven patients; partial analgesic activity was discernible only in one, and beneficial mood effects notable in two others. Significant adverse effects, particularly insomnia and GI disturbance, were reported by the majority of patients. CONCLUSION: Moclobemide appears to have limited efficacy in the treatment of neuropathic pain.