Pregabalin

In February it was noted that pregabalin (Lyrica) was linked with infrequent reports of severe respiratory depression, including some cases without the concomitant use of opioid medicines. Patients with respiratory disease, neurological disease, renal impairment, those using concomitant CNS depressants and people older than 65 years are considered at higher risk, so adjustments in dose or dosing regimen may be necessary.

Levothyroxine

In May, the MHRA advised that some patients may need prescribing a specific thyroxine product rather than a generic version.⁹ This is because some patients report persistent symptoms when switching between different levothyroxine tablet formulations. Nearly 260 million packs of levothyroxine were dispensed between January 1, 2016 and December 31, 2020, and during 2015-2019 there had been 335 Yellow Card reports (47 from healthcare professionals) received by the MHRA. 

Associated symptoms were mostly consistent with hypothyroidism or hyperthyroidism, and included fatigue, headache, malaise, anxiety, palpitations, pruritus, nausea, myalgia, dizziness, arthralgia, feeling abnormal, alopecia, depression, abnormal weight gain and insomnia. Underlying causes are unclear. A thyroid function test should be considered if a patient reports symptoms after a switch and, if a specific brand is known to be well tolerated, prescribers must select the correct product on their prescribing system. 

In the EPS, the specific brand should appear in the prescription drug name field – the information cannot be free-typed, otherwise the pharmacy will be left out of pocket. Also, if there is poor control of thyroid function or symptoms persist (despite adhering to a specific brand), then an oral solution can be considered.