Drug funding withdrawals prescription for trouble, say doctors

Two prozac-like drugs will have Government funding withdrawn this week, prompting claims from psychiatrists that some patients could be at risk of relapsing into severe depression.

Celapram and Cipramil, which both contain citalopram, an antidepressant agent related to Prozac, will not be subsidised by drug funding agency Pharmac from Wednesday.

Instead, a cheaper alternative known as Arrow-Citalopram will be fully subsidised in a sole-supply agreement with the manufacturer.

The move, which is expected to save taxpayers about $2 million a year, will affect nearly 30,000 patients. More than 10,000 have already switched to the cheaper alternative and the rest will switch as their prescriptions run out.

Auckland psychiatrist Jan Reeves said she was concerned about the change because she had had one patient whose depression had already relapsed after switching to the new drug.

"There's some suggestion that it may not be as effective," she said. "It will be for some people, but for some others I don't think it will be."

Auckland consultant psychiatrist Russell Wyness is also worried by the switch. He said the relapse of a patient into depression could have far-reaching consequences, including lost employment, disrupted families, and even suicide.

Pharmac's medical director, Peter Moodie, said drug regulatory body Medsafe had found that Cipramil, Celapram and Arrow-Citalopram were equally safe and effective.

A clinical committee had also advised Pharmac that switching patients to Arrow-Citalopram would be acceptable.

However, he acknowledged that a small number of patients might find the new drug less effective.

Dr Wyness said that differences in manufacturing methods could mean that two brands of the same drug were broken down, digested and absorbed differently, resulting in different effects in the same person.

National Party health spokesman Dr Paul Hutchison said Pharmac should be very cautious about limiting drug choices, particularly in psychiatric or mental health patients.

"If you change someone's antidepressants and they get severely depressed and they're not being clinically monitored by their family, partner, caregiver, then you can get into a very risky situation."

Dr Hutchison said Pharmac had done a good job of keeping down the cost of drugs, "but I think over recent years they have become almost too sharp to the extent that occasionally patients may be put in danger." He has been calling for an independent review for 18 months.

Pharmacy Guild president Richard Heslop said the guild would make representations to Pharmac on behalf of patients if it received enough reports that patients were unhappy with the cheaper drug.


- HERALD ON SUNDAY