According to the SmPC of bisoprolol this drug is usually given only once daily, which is possible because of pharmaceutical form of bisoprolol (and long half life). However, in real clinical practice bisoprolol is often prescribed two times daily. In my point of view this is not necessary and this is one soft possible inappropriate prescribing, because drugs which are taken two times daily are often forget to take (more than once daily).
I did not know that. From which countries does the evidence come from? This illustrates how weak prescribing controls are. Why does the pharmacist not question? What does the PIL say? Why doesn't that patient say anything? If you have references please share
As a registered pharmacist, I have not found this kind of bisoprolol use. Bisoprolol's half-life is 9-12 hours & its duration is approx 24 hours. As far as I know all of evidence-based up-to-date drug information monographs always note that bisoprolol is used for once daily. In my opinion yes it may be addressed as inappropriate prescribing.
I also ask the same questions with Mr. Edwards, where is the pharmacist and why he/she did not address this problem?
http://www.slcsn.nhs.uk/files/prescribing/betablocker/betablocker-initiation-titration-guidance-092012.pdf
According to the latest guidelines bisoprolol should be used ones daily there are no evidence that dosing twice have any difference, only could lead to side effect .
Yes, I highly agree with you! However, in real clinical practice as clinical pharmacist consultant I see many prescriptions with bisoprolol twice daily. In my point of view i ask myself what pharmacists do in this process, because they should establish appropriate communication BEFORE this drug is dispensed and administered to the patient. However, this process is lacking in many European countries and many patients are treated with this kind of inappropriate medication. If every prescription is checked by clinical pharmacists this mistake will be solved. This 'black box' topic has not been discussed very well in many countries and people who report these mistakse are often ignored.
So what your saying is there is no mechanism for reporting these medication errors especially as they have not caused harm when it is 'too late'. Currently industry only has to discuss medication errors (without ADRs) in the PSURs so we do get to hear about them necessarily. We need away of having these errors reported in public so all can see and judge. They can be completely anonymous but unless we have evidence how can we act? Who will do this? Even here in UK I know NHS England collects medication error reports but I do not know where I can access the data to peruse.
No there are no way which I know of to report that kind of medication prescribing behavior.In my opinion as Pharmacologist and Pharmacist in that particular case these should be discussed with the primary caring doctor to reduce the dose to one's daily, because there are no evidence as we all agree that twice daily dosing is better.
Yes Brian You are right, in many EU countries there are still no mechanism for reporting these medication errors. In real clinical practice is smth very hard to discuss about inappropriate prescribing (the way of communication, time etc ...). These systems are quite bad and I do not know why the governments do not support clinical pharmacy more deeply. The pharmaceutical care in many ex-Eastern European countries is still not next to the patients' beds, which is very bad (against patient oriented clinical pharmacy). Risk assessment programs should be involved in every hospital and the most important step is establish appropriate communication between prescriber and pharmacist on case-by-case basis. If this systems will be established the percentage of medication errors should be minimized. Often nurses and prescribers think that they do not need clinical pharmacists and therefore they still do not have a collaborative care, which produces the best clinical and safety outcomes.
Who will do this? Thanks Brian, this is very good question and my answer is clinical pharmacist, although they should be supported by payers and patients. There is no important if somebody need clinical pharmacist, but the most important is to protect patients and also payers.
I think pharmacist should take a responsibilities to resolve this medical error, because patients who take 2daily medication have more chances to be discontinued than patients who take once daily. Another important data are clinical trials, where this medication was given once daily. Pharmacists dispense medications and they should make an agreement before medication has been dispensed to the patients.
This is not a small problem in Vietnam, not only bisoprolol but also many other medications. Many businesses for Vietnamese clinical pharmacist to deal with. Thanks to ideas from all members. They makes me feel more confident about what I know.
Bisoprolol is often prescribed twice daily for a very good reason: in clinical practice the cardiac rate control and systolic blood pressure control of bisoprolol often does not last 24 hours. Many patients will be blocked adequately (e.g., to a target rate of 60) for 12 - 14 hours, but will break through with resting tachycardia to 100 or more after that time. Systolic blood pressure behaves similarly. Until we can identify genetic markers that determine the physiologic response of an individual patient and use those to make personalized dosing recommendations, it is best to leave the prescribing to the clinicians.
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