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Suggested action: current prescription for doxazosin MR to be changed to normal-release doxazosin tablets. Doxazosin MR is associated with a significantly higher acquisition cost and has been named as one of products being considered by the NHS England review of Low Value Prescribing NICE Guidelines •. Is it clinically reasonable to start standard doxazosin at a lower. There are no significant clinical advantages to prescribing doxazosin modified release (MR) compared to doxazosin immediate release (IR) 3. If all patients currently prescribed modified release doxazosin were prescribed immediate release doxazosin, at the same dose (see page two for switching advice), there would be a saving of > £178,000 across the Pan Mersey locality Both IR and MR doxazosin can commonly produce postural hypotension. The patient will have been taking at least 4mg of doxazosin MR, as well as a number of other antihypertensive medications. Also consider if doxazosin is an appropriate drug choice, in line with NICE guidance and. In addition, the incidence of side effects with the modified release preparation appears to only be slightly lower than. 5mg MR Tabs should not be used routinely but may be a 2nd line option 1st line-Ramipril 1. Treatment with doxazosin has been shown to result in regression of left ventricular hypertrophy, inhibition of platelet aggregation and enhanced activity of tissue plasminogen activator If used according to NICE/BHS guidelines, doxazosin therapy is additional to other antihypertensive medications. Doxazosin has a half-life of 22 hours making it suitable for once daily dosing both for immediate release and modified release preparations. Switching to an immediate release version of doxazosin could save up to £. MR Preparations-All 1st line-Verapamil 40mg Tabs, 80mg Tabs, 120mg Tabs, 180mg MR Caps, 240mg MR Tabs Bendroflumethiazide 2. A modified release version of Doxazosin therefore offers no advantage in terms of patient compliance Doxazosin is suitable for use in patients with co-existent asthma, left ventricular hypertrophy and in elderly patients. 5/25 Tabs, 5/50 Tabs Indapamide 2. Doxazosin MR may have a slightly better tolerability in terms of first dose hypotension although the SPC for Doxazosin MR still states first dose hypotension as a common side effect. 67 Switch savings In England and Wales almost £6. Do Not Prescribe (DNP) Nifedipine MR. 5mg Caps, 5mg Caps, 10mg Caps 2nd line-Lisinopril. Caps 10mg, 20mg, 30mg, 60mg (Coracten SR or XL is the most cost-effective option). Both IR and MR doxazosin can commonly produce postural hypotension. Modified release doxazosin is significantly more expensive than immediate release doxazosin [3]. Review patients currently prescribed doxazosin MR to assess if suitable to switch to doxazosin IR. 5 million is spent on Doxazosin MR tablets annually (ePACT July to September 2017). Recommendations for clinicians Avoid initiating new patients on doxazosin MR. Characteristics (SPC) for MR Doxazosin. The MR formulation provides a more constant plasma concentration, with fewer peaks over 24 hours potentially causing fewer side effects. If all patients currently prescribed modified release doxazosin were prescribed immediate release doxazosin, at the same dose (see page two for switching advice), there would be a saving of > £178,000 across the Pan Mersey locality Doxazosin 8mg MR tablets 9. A The half-life of doxazosin modified-release (MR) and standard-release formulations are equivalent, allowing both to be given once daily.

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