Pill switch causing heartache

By MARTIN JOHNSTON health reporter

Switching nearly 50,000 patients onto different heart and stroke drugs will put some at risk of dying, says a leading heart specialist.

Some 38,000 of the patients are already facing the upheaval of a switch to a different and controversial brand of felodipine, which treats angina and high blood pressure, as Government agency Pharmac moves to reduce subsidies on December 1.

Now they are also at risk of supply disruptions - and 10,000 other patients, who take a smaller version, face switching to different chemicals - because the miffed supplier of the Plendil pills has abruptly stopped supplying all sizes.

Dr Harvey White, president of the Cardiac Society of Australia and New Zealand, said yesterday the changes would be a nightmare for patients and doctors.

Settling patients on this type of medication, called a calcium channel blocker, took a lot of effort.

"Chopping and changing, you will find some patients can't be bothered and drop out of taking the pills. [They will be at] risk of stroke, heart attack and dying."

Drug maker AstraZeneca stopped supplying 2.5mg, 5mg and 10mg Plendil last Wednesday. It expected to lose $9 million to $10 million revenue a year on the larger pills, although the smaller ones would have continued to be fully subsidised.

Pharmac is now scrambling to avoid a crisis before stocks of Plendil run out.

It wants to advance the funding changes and is relying on Pacific Pharmaceuticals to start distributing its fully-subsidised brand, Felo, in the 5mg and 10mg sizes this week.

Pharmac is considering switching patients on 2.5mg Plendil to the drugs amlodipine or nifedipine, which are different types of calcium channel blockers.

It says patients switching to these pills will need a new doctor's prescription - but it will not pay - and it is concerned at the disruption of stable patients.

Felo struck problems last November.

Patients had to switch back to Plendil after the Health Ministry ordered a recall of Felo because its effectiveness was questioned.

In September, it permitted 5mg and 10mg Felo back on the market after officials were convinced it was as effective as other brands of felodipine.

But they were not satisfied about the 2.5mg pills, which remain banned.

Dr White, a Green Lane Hospital cardiologist, said Felo had a far higher rate of reported bad side-effects in patients.

In the year until the Felo recall, there were 118 reports about it - many of low blood pressure fainting - compared with 66 about Plendil in the preceding 14 years.

Astra and Pharmac are trading criticisms over Plendil's withdrawal.

Pharmac chief executive Wayne McNee said he had known of Astra's threat to withdraw its 2.5mg pills after December 1, but was shocked that it had suddenly stopped supplying all sizes last week.

He said Astra had let patients down, but the company's general manager, Lance Gravatt, said final responsibility lay with Pharmac.

Matters of the heart

Calcium channel blockers are used to treat angina, hypertension and irregular heartbeat.

They help to decrease the work of the heart in pumping blood.

They also improve circulation of blood through the heart muscle.