NPS news : Rivaroxaban (Xarelto) for treatment of deep vein thrombosis and pulmonary embolism, and for prevention of venous thromboembolism recurrence

    Aug , 01  2103


    Reference :

    • An alternative to INR-adjusted warfarin with initial heparin for the treatment of symptomatic DVT (without symptomatic PE) or PE.
            Efficacy and safety were studied in people with acute, symptomatic proximal DVT without PE, and in people with acute symptomatic PE with or without DVT, over 3, 6 or 12 months.
    • Rivaroxaban is non-inferior to enoxaparin plus warfarin for preventing VTE (DVT or PE) recurrence.
            In trials VTE recurrence, major or clinically relevant non-major bleeding, and mortality were similar with rivaroxaban compared with enoxaparin plus either warfarin or acenocoumarol.a
    • For initial treatment of acute DVT or PE the dose is rivaroxaban 15 mg twice a day for the first 3 weeks then 20 mg once a day.
                Continue treatment for as long as the risk of VTE recurrence persists, balancing benefits and harms and patient preference.        
    • For continuing treatment in people with a history of VTE the dose is 20 mg once a day.
            In trials rivaroxaban reduced recurrence of VTE in these people, but increased incidence of bleeding compared with placebo.
    • There is no antidote to the anticoagulant effects of rivaroxaban and no readily available and validated method of monitoring its activity in a primary care setting.
            Routine coagulation monitoring is not possible but routine clinical monitoring is essential. Advise patients to seek urgent medical attention for unexplained bruising, blood in the urine or black stools.
    • Bleeding risk may be higher in people with renal impairment.
            Very few people with renal impairment were included in trials. Do not use in people with severe renal impairment (CrCl < 30 mL/min).
    aAcenocoumarol is not marketed in Australia.    

    NPS news : New reporting mechanism for antipsychotic use in aged care

    Aug 12 , 2013

    Reference :

    NPS MedicineWise and Webstercare have collaborated for the first time on a project to assist in the review of antipsychotic medicine use in residential aged care facilities.

    The new functionality in the Webstercare Medication Management Software (MMS) allows pharmacists to produce a report on the use of antipsychotic medicines in each residential aged care facility for which they supply medicines.

    NPS MedicineWise CEO Dr Lynn Weekes AM says that evidence suggests there is extensive off label use of antipsychotics for dementia patients in residential aged care.

    “While they can occasionally be effective for short term aggression and psychotic symptoms – we see them being used too often, for too long at high doses and in dangerous combinations,” says Dr Weekes.

    “Incorrect use of these medicines can have serious consequences including an increased risk of falls, hip fractures and even death.”

    The new reporting mechanism will enable pharmacists to provide information to staff working in residential aged care facilities and aid them in understanding, analysing and effectively managing the appropriate use of antipsychotic medicines for their residents.

    Dr Weekes says that the new, in-depth quality use of medicines (QUM) report in the Webstercare software provides staff with objective measurements that enable them to establish a baseline and identify patterns of use over time, and even compare their antipsychotic medicine use with published studies.

    “By partnering with Webstercare on this project, we hope to ensure a more appropriate use of antipsychotics in residential aged care facilities in the long term,” she says.

    Webstercare CEO Mr Gerard Stevens AM says that NPS MedicineWise and Webstercare are committed to supporting the aged care industry in its endeavour to ensure the safe use of antipsychotics and to improve care in line with evidence-based guidelines.

    “The QUM report identifies residents who may benefit from a medicine review from their doctor,” says Mr Stevens.

    “It will provide valuable data for the local Medicine Advisory Committees within residential aged care facilities to review at their regular meetings. The residential aged care facilities that were part of the pilot program received it very positively, saying that the report has the capability of changing practice.

    “The report could also help a residential aged care facility meet the Accreditation Standards for Residential Aged Care in areas such as continuous improvement, medication management and behavioural management.”

    The QUM reports are available as part of pharmacies’ latest software update of Webstercare’s Professional and Professional Plus Medication Management Software (MMS).


    What your patients need to know about diet and prostate cancer

    No specific food can cause or cure cancer, but some may be associated with its development. Various dietary factors have been suggested to influence prostate cancer risk, but currently there is not sufficient evidence to support a direct causative association. In the future specific recommendations may be available to reduce prostate cancer risk, but for now people should adopt a healthy diet and maintain a healthy weight.

    Practice points

    • There is no proven association between any specific diet and prostate cancer risk.
    • There is no evidence to support recommendations for any dietary supplements to reduce prostate cancer risk.
    • A healthy diet with a high intake of vegetables and fruits, a moderate intake of fat, and which avoids high energy foods and excessive meat and dairy products, is recommended. Although conclusive evidence on the effectiveness of this in reducing cancer risk is limited.1

    Food and cancer

    The food we eat can influence our risk of developing certain types of cancer – both directly and indirectly. In general high energy and high fat diets can lead to obesity and are thought to increase risk for some cancers. A healthy diet, high in fresh fruits, vegetables and wholegrain foods may reduce cancer risk.1

    Evidence supports a link between some common cancers and specific food groups. For example, eating red and processed meats increases the risk of colorectal cancer.2 Based on this evidence, the World Cancer Research Fund advises to limit red meat intake (< 500 g per week) and avoid processed meats.3

    However, more research is required to clearly understand the role of specific aspects of the diet to cancer risk, including prostate cancer.

    Influence of lifestyle factors on prostate cancer

    The only well-established risk factors for prostate cancer are non-modifiable – older age, race and family history.4 Some modifiable lifestyle factors may increase risk, but the extent to which they do so is yet to be determined.

    One of the key indicators that risk of prostate cancer may be influenced by lifestyle factors, including diet, is the wide global variation in incidence (Figure 1). More than a 25-fold difference in age-adjusted incidence exists between countries, with Australia and New Zealand among the highest and South-Central Asia the lowest.5 Additional support for the influence of lifestyle factors comes from migration studies where men moving from low-risk to high-risk countries had increased rates of prostate cancer compared to those in their native countries.6,7

    Some of the increased incidence may be explained by differences in prostate cancer screening practices, as this can lead to diagnosis of a significant proportion of otherwise latent prostate cancers.4

    Read more information about testing for prostate cancer.

    Figure 1. Estimated prostate cancer incidence worldwide in 20085

    Lifestyle risk factors may contribute to prostate cancer risk

    Several lifestyle factors are suggested to influence the risk of developing prostate cancer, including diet, obesity, smoking and physical activity. However, the evidence is not sufficient to estimate the benefit gained by modifying these factors. 

    • The relationship between obesity and the incidence of prostate cancer is complex, but there is consistent evidence that obesity is associated with worse outcomes and increased mortality, especially in aggressive disease.8
    • There is no consistent evidence that physical activity protects against prostate cancer, but several studies have reported that being active may reduce the risk of advanced disease and reduce mortality from prostate cancer.9,10
    • Smoking is known to increase risk of developing some cancers, but the link to prostate cancer risk is not consistent. In men with prostate cancer, smoking is associated with increased cancer mortality, with more recent smoking being more strongly associated.4

    The contribution of diet to prostate cancer risk is less clear, but several foods have been investigated as being potentially protective or harmful. The dietary components that have received the greatest attention are: dietary fat, antioxidants (carotenoids) and dietary supplements including vitamin E, vitamin D, calcium and selenium.11

    Dietary fat intake and prostate cancer risk

    A diet with high fat intake

    A high fat diet comprising mostly animal fat sources (such as dairy products and fatty meats) is suggested to increase the risk of developing prostate cancer and prostate cancer mortality.12,13 However, the overall findings are not consistent and many trials have not found evidence of a link.14-16

    Polyunsaturated fatty acids

    Several investigations have identified particular types of dietary fat that alter prostate cancer risk. Some studies suggest that a diet with a low omega-6 to omega-3 fatty acid ratio may reduce prostate cancer, but the evidence is not consistent.17,18 More recent evidence suggests that high blood concentrations of omega-3 polyunsaturated fatty acids is associated with increased prostate cancer risk.19

    Prospective clinical trials have not reported a link between risk for prostate cancer and dietary fatty acid intake.20 However, data about plasma phospholipid levels may provide a greater insight into prostate cancer risk. The Melbourne Collaborative Cohort Study involving over 41,000 people suggested that people with high plasma phospholipid concentrations of saturated fatty acids were at increased risk of developing prostate cancer.20

    Given the weakness of the association and reported inconsistencies, it has been suggested that it is unlikely that dietary fat is an important contributor to prostate cancer risk.20 However, given recent results 19 consider the potential risk of excessive plasma concentrations of omega-3 polyunsaturated fatty acids before recommending a diet high in omega-3 fatty acids.

    Read more evidence about the recommended use of fish oil supplements containing omega-3 for secondary prevention of cardiovascular disease.

    Are antioxidants beneficial?

    In recent years, antioxidants have received much attention as potential anti-cancer compounds. Antioxidants reduce oxidative stress which may damage molecules including proteins and DNA, and has been implicated in carcinogenesis.4

    Several dietary antioxidants, including isoflavones, selenium, vitamin E and lycopene have been investigated as nutritional factors with potential to protect against the development of prostate cancer.4 However there is little evidence from clinical trials to support this proposition.

    Antioxidants are provided by a healthy diet that includes a variety of fruits and vegetables. A diet high in vegetables (soy, in particular) is thought to decrease the risk of prostate cancer or benign prostatic hyperplasia.21 Prostate problems are reportedly less frequent or less severe in areas in which a plant-based diet is predominant.12

    Selenium and vitamin E

    Vitamin E is a fat-soluble antioxidant found in many foods, such as nuts, seeds and vegetable oil. Selenium is a trace element that is naturally present in many foods, including seafood, meat and cereals.22 These two antioxidant supplements have attracted a great deal of attention as having a possible preventive role against prostate cancer.

    However, evidence from a large clinical trial suggests that selenium or vitamin E, alone or in combination, do not prevent prostate cancer in relatively healthy men.23 The SELECT clinical trial that was planned for 7–12 years was stopped after 5.5 years due to lack of efficacy for risk reduction.23 The data did reveal a trend that suggests there may be an increased prostate cancer risk among men receiving 400 IU/day of vitamin E.23


    Lycopene is a potent antioxidant found in tomatoes, tomato-based products, watermelon and strawberries that is proposed to reduce the risk of prostate cancer. Many trials have investigated the role of tomatoes in prostate cancer risk, but the association remains controversial. A meta-analysis showed that high levels of tomato in the diet may play a role in the prevention of prostate cancer.24 However, at present the data do not support the clinical use of lycopene in a preventive setting.25

    Tea and coffee

    Tea contains polyphenol compounds which are antioxidants proposed to play a role in cancer prevention. Consumption of tea, particularly green tea, is suggested to reduce prostate cancer risk.26,27 Most of the evidence comes from epidemiologic studies and few clinical trials have been conducted. Overall the results are inconsistent and it is not known if consumption of tea will reduce risk of prostate cancer.

    Coffee contains many biological compounds that have potent antioxidant activities that are suggested may reduce risk of prostate cancer. A recent prospective clinical trial of almost 48,000 men demonstrated a small reduction in prostate cancer risk in men who consumed 6 or more cups per day.28 However, the results are not consistent and other trials have not shown an altered risk profile with coffee consumption.26

    Soy isoflavones

    Isoflavones are organic compounds that occur naturally in some foods, especially legumes such as soybeans. It is proposed that the high intake of soy-derived food products and the metabolism of the isoflavones they contain is one of the factors which accounts for the significant difference in the incidence of prostate cancer between Asian and European/North American populations.29 Epidemiological studies suggest that increasing soy intake decreases prostate cancer risk.30 But there is little evidence from clinical trials to suggest that dietary isoflavones can alter the risk of prostate cancer.31

    Dietary supplements

    Supplements should not be relied on to compensate for a poor diet. Antioxidant supplements do not appear to offer additional benefits in preventive prostate cancer over a well-balanced diet, possibly because of the choice of the substances tested or of an excessive dosage.32 The majority of studies investigating antioxidant supplements do not show a variation in general mortality or cancer incidence.32

    Fish oil supplements are one of the most commonly used medicines. For example, a national census of medicines use in Australia estimated that 1 in 4 people over 50 years of age regularly take omega-3 fish oil supplements.33 Bearing in mind the data recently reported on potential increase in prostate cancer risk in men with high blood concentrations of omega-3 polyunsaturated fatty acids,19 additional research is required to determine how fish oil supplements may impact on prostate cancer risk.

    Healthy advice for life

    To date publications about the effect of diet on prostate cancer risk have been highly heterogeneous and variable in quality and design. More robust, high quality randomised controlled clinical trials are needed to improve the understanding of the complex relationship between diet and prostate cancer.

    There are many ongoing clinical trials focusing on particular aspects of the diet that may allow future recommendations for risk prevention. But for now, advise men to eat a well-balanced diet including fruit and vegetables, maintain a healthy weight and undertake regular physical exercise.

    Why be medicinewise? Ask your doctor the right questions

    Reference :

    Jul , 17  2013

    During Family Doctor Week (15-21 July 2013), NPS MedicineWise is highlighting the importance of asking your doctor the right questions about your medicines and medical tests.

    GP and clinical adviser at NPS MedicineWise, Dr Andrew Boyden, says that being an active partner in your own health care is the best way to get medicinewise and make the most of your visit to the doctor.

    “Asking your doctor questions will help you get better results from your medicines, avoid side effects , understand the risks and benefits of medical tests, and enjoy better health – which is something we all want,” says Dr Boyden.

    “Of course, if you don’t have a GP or a medical practice you visit regularly – a GP home where you and your medical history are well known – it may be more difficult to ask the right questions about your health, your medicines and medical tests.

    “Being prepared and talking openly with your health professional is so important. Make sure you tell your doctor if you have any concerns, about your treatment options and their risks and benefits. It’s also important to discuss any side effects or problems you’re having with the medicines you are taking.”

    To help people prepare for a visit to the doctor, NPS MedicineWise has produced an easy-to-use online tool that allows you to create personalised questions to ask your doctor.

    Suggested questions cover the brand name and active ingredient of any prescribed medicines; how to take the medicine; expected benefits of taking the medicine; possible side effects; and whether there are any other treatment options available.

    The online tool also includes specific questions about medical scans and X-rays as well as illnesses like respiratory tract infections including colds. It also allows people to include their own questions about specific health concerns and space to write down notes during their appointment.

    Dr Boyden suggests printing the questions generated by the tool and taking them along when you visit your doctor.

    “Preparing your medicinewise questions in advance and taking them along to your appointment will help you to remember what you wanted to ask and to get the information you need.

    “It’s also important to remember some of the answers might also be available from other reliable medicine sources such as the consumer medicine information (CMI) leaflet for your medicine that your doctor or pharmacist can print off for you or you can download from the NPS MedicineWise website.

    The question-building tool is available free on the NPS MedicineWise website.

    For information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, people can call NPS Medicines Line on 1300 MEDICINE (1300 633 424) for the cost of a local call (calls from mobiles may cost more). Hours of operation are Monday–Friday 9am–5pm AEST (excluding public holidays).

    NPS News : Order of Australia honours for NPS MedicineWise CEO Dr Lynn Weekes

    Reference :

    Jun.12 , 2013

    The board and staff of NPS MedicineWise congratulate our CEO Dr Lynn Weekes on receiving an award in the 2013 Queen’s Birthday honours.

    Appointed a Member of the Order of Australia, Dr Weekes has been recognised for significant service to Australian community health through the promotion of quality use of medicines.

    She was appointed CEO of what was then known as the National Prescribing Service on its establishment in 1998; an organisation with an initial focus on activities that improved the quality of prescribing by general practitioners.

    Chair of NPS MedicineWise Dr Janette Randall says that over the past 15 years NPS MedicineWise has grown into a large and very successful organisation under Dr Weekes’ leadership.

    “Our scope of work has increased to include a range of programs and services that improve the way medicines and medical tests are used in Australia, and the organisation has shifted from being a health professional focused organisation to one that puts consumer and public needs at the fore,” says Dr Randall.

    “The work of NPS MedicineWise is comprehensive and provides enormous benefits to the Australian community and Lynn’s leadership and vision have been critical to this growth. She is a passionate advocate for quality use of medicines, and always keeps the consumer at the centre of decision making.

    “Lynn is modest about her own contributions and is driven by a deep and unwavering commitment to make the lives of Australian consumers better through improved cost effectiveness and more appropriate and safe use of medicines and tests. There is no doubt that her efforts have improved the lives of many, and made our health system safer and more effective.”

    Current programs underway by NPS MedicineWise include a five-year campaign to fight antibiotic resistance as well as educational programs on best practice in oral anticoagulants and preventive activities in general practice.

    NPS News : Pharmacists key to promoting safe use of oral anticoagulants

    Reference :


    Jun, 20  2013

    With increased public awareness about newer oral anticoagulants, and large numbers of people still taking warfarin, NPS MedicineWise has launched a new educational activity for pharmacists to help guide their conversations with patients.

    The latest Pharmacy Practice Review Oral anticoagulants: Promoting safe use is now available online.

    NPS MedicineWise clinical adviser Dr Philippa Binns says the Pharmacy Practice Review helps provide clarity around the newer oral anticoagulants, putting them into context with warfarin.

    “People who take anticoagulants often rely on their pharmacist to help them take the medicine correctly, so this is an interactive and useful way to keep up to-date with the latest evidence,” says Dr Binns.

    The new Pharmacy Practice Review provides access to resources to help guide patient counselling, including:

    • Medicinewise tips for pharmacists to share with patients
    • A checklist to guide ongoing counselling
    • The new NPS MedicineWise Warfarin Dose Tracker (to help patients keep track of their dose, INR results and record any changes)
    • A Living well with warfarin patient fact sheet

    As part of the Pharmacy Practice Review, pharmacists create individualised patient management plans to guide ongoing counselling for people using anticoagulants.

    The review provides immediate individual results compared to best practice and aggregate results for peer comparison. An expert commentary on the results helps pharmacists to implement best practice.

    After completing the activity pharmacists will be able to:

    • explain the purpose of and differences between the oral anticoagulants
    • outline the potential adverse effects of oral anticoagulants (including the newer agents)
    • assess for adverse effects and identify who needs referral, and
    • discuss the need for individualised clinical monitoring with patients and explain how often monitoring is required.

    With the CPD year ending on 30 September 2013 pharmacists can earn up to 40% of their CPD requirements. Completion of the Pharmacy Practice Review earns 8 hours of Group 2 CPD (or 16 CPD credits) and participation is free at

    Other available topics for Pharmacy Practice Reviews include CVD risk and type 2 diabetes.

    NPS News : Managing blood pressure – part of the diabetes trifecta World Hypertension Day, 17 May 2013

    Reference :,-17-May-2013

    13 May 2013

    This World Hypertension Day, NPS MedicineWise is urging people with diabetes to manage their blood pressure and cholesterol in concert with managing their blood glucose (sugar) levels.

    NPS Clinical Adviser Dr Philippa Binns says that a growing body of research confirms that managing diabetes should not focus exclusively on glucose levels.

    “Current research shows that people with diabetes who have good blood pressure and cholesterol control are less likely to have strokes and heart attacks than people who lower their blood glucose alone,” says Dr Binns.

    “This means that managing blood pressure and cholesterol is equally as important as managing blood glucose levels.”

    For example, studies that followed people with diabetes over a five year period showed that more than three times as many cardiovascular events (strokes and heart attacks) were prevented when the focus was on cholesterol and blood pressure-lowering compared with reducing glucose levels alone.

    “Diabetes can affect your body and your health in different ways. Having regular check-ups, making healthy lifestyle choices and using your medicines can help you manage your diabetes and prevent complications,” says Dr Binns.

    This means that to stay healthy and prevent complications, people with diabetes need to keep track of several different health check ups and targets – including managing their glucose, blood pressure and cholesterol.

    To help people with diabetes stay in control and better manage their health, NPS MedicineWise has produced two new resources that individuals, doctors, diabetes educators, pharmacists, other health professionals and community groups can order for free.

    “Our new guide, Keeping track of your diabetes — it’s not just about glucose, explains why managing blood pressure and cholesterol are just as important as managing blood glucose levels to prevent diabetes-related complications.

    “It also covers the different health checks and medical tests recommended for people with diabetes and the role of medicines in managing these conditions,” says Dr Binns.

    “The Diabetes Health Tracker is a tool that people can use to record and keep track of both their medicines and the medical tests and check-ups that are part of the Diabetes Annual Cycle of Care.

    “We encourage people to show this to their health professional at each visit, and to take an active role in their diabetes management.”

    The Diabetes Health Tracker and the brochure are available to download in English, Italian, Greek, Vietnamese and Chinese – simplified and traditional. People can order copies from the NPS MedicineWise website at

    For more information about how to manage diabetes visit

    For more information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, call NPS Medicines Line on 1300 MEDICINE begin_of_the_skype_highlighting 1300 MEDICINE end_of_the_skype_highlighting (1300 633 424 begin_of_the_skype_highlighting 1300 633 424 end_of_the_skype_highlighting) for the cost of a local call (calls from mobiles may cost more). Hours of operation are Monday–Friday 9am–5pm AEST (excluding public holidays).

    NPS News : Lifestyle and warfarin

    Reference :

    May 2013

    While the thought of living with warfarin seems daunting at first, many people are able to take warfarin without experiencing problems. Understanding what can affect warfarin and blood clotting, and keeping these in mind in your day to day life, or when planning activities such as travel, will help you to live safely with warfarin.

    Know what can affect your INR

    If you are taking warfarin, changes to your diet, alcohol intake, illness, other medicines and travel can all affect your INR, and may result in a change to your dose of warfarin.

    Limit your alcohol intake

    Don’t make major changes to your diet or alcohol intake — consistency is the key. Limit your alcohol intake to no more than two standard drinks per day.

    Find out more about alcohol and warfarin.

    Eat consistent amounts of green leafy vegetables

    You can eat green leafy vegetables if you are taking warfarin. But it’s important to eat the same amount of these foods each week to help keep your INR stable. This is because green leafy vegetables (e.g. spinach, broccoli, Brussels sprouts) are rich in vitamin K, which can affect your INR.

    Don’t avoid vitamin K-rich foods completely. Studies show that eating regular, consistent amounts of vitamin K-rich foods is better for maintaining a stable INR, than not eating them at all, or eating varying amounts.

    Find out more about diet and warfarin.

    See a doctor if you are ill

    See your doctor if you experience any unusual symptoms or if you feel unwell while taking warfarin, even if you don’t think it’s caused by your medicine.

    Seek urgent medical advice if you notice:

    • unusual bruising or bleeding
    • any unusual symptoms
    • vomiting or diarrhoea
    • fever or infection
    • loss of appetite
    • yellowing of the skin or whites of the eyes (jaundice).

    Check before you start or stop a new medicine

    Always check with a health professional before you start or stop taking a new medicine. This is because warfarin interacts with many common medicines including vitamins, prescription, over-the-counter and complementary medicines. This means that taking one of these medicines could affect the way warfarin works.

    Find out more about the medicines that can interact with warfarin.

    Visit your doctor before travelling

    Visit your doctor well before you leave for your holiday as you may need an INR test before you go. You may also need to have your INR checked while travelling, especially if:

    • your INR is not in your target range before you leave
    • you have just started taking warfarin
    • you start or are already taking another medicine known to affect your INR or warfarin.

    Ask your doctor if you will need to test your INR while away, and if so how to go about it.

    Also ask for advice about when to take your dose of warfarin if you are travelling in different time zones.

    Find our more about INR tests and travelling with warfarin.

    Take precautions to prevent injuries

    Whether you are at home or away on holidays, avoid any activities or sports that put you at risk of injuries or falls that might cause bleeding — or take precautions to limit your risk. For example, if you’re cycling, wear protective clothing such as gloves, cycle helmets, knee padding and non-slip supportive shoes.

    Make adjustments around your home to reduce your risk of cuts or injury. For example:

    • take care with sharp objects like knives
    • wear gloves when gardening
    • use a non-slip bathmat for the bath or shower
    • use an electric shaver
    • use a soft bristled or electric tooth brush.

    Find out more about warfarin, who can take warfarin, and the side effects and interactions of warfarin.

    Download our Living well with warfarin fact sheet — for people who’ve been prescribed warfarin, or their carers, to help you live safely with warfarin.