Table 4 The PROMPT criteria

Gastro-Intestinal System

[15]

Other than for opioid-induced constipation, stimulant laxatives (e.g. bisacodyl, senna) should not be prescribed as first-line treatment in constipation for greater than four weeks.

Stimulant laxatives are not suitable for continuous long-term use, other than for opioid induced constipation.

[14]

Proton pump inhibitors (PPIs) (e.g. esomeprazole, omeprazole) should not be prescribed at doses above the recommended maintenance dosage for greater than eight weeks.

A dose reduction or discontinuation is indicated since there is no therapeutic benefit observed with the use of higher doses of PPIs long-term (unless treatment is indicated for rare conditions e.g. Zollinger-Ellison syndrome).

Added by Project Steering Group[21]

Esomeprazole or omeprazole should not be used in combination with clopidogrel.

Esomeprazole and omeprazole may reduce the anti-platelet effect of clopidogrel and therefore should not be used in combination with clopidogrel. Other proton pump inhibitors or H ₂ -receptor antagonists are available which do not have the same potential for interaction.

Cardiovascular System

[9],[10],[13]

The use of alpha-adrenoceptor blocking drugs (e.g. doxazosin, prazosin) as monotherapy for hypertension, should be avoided.

Alpha-adrenoceptor blocking drugs increase the risk of orthostatic hypotension.

[14]

Aspirin doses should not exceed 150 mg/day for anti-platelet therapy.

Doses exceeding 150 mg/day show no evidence for increased efficacy and will increase the risk of bleeding.

[11],[14]

Cardio-selective calcium-channel blockers (e.g. verapamil, diltiazem) should not be used in combination with beta-adrenoceptor blocking drugs.

Concomitant use increases the risk of atrioventricular block and myocardial depression.

[9],[14]-[16]

The use of oral short-acting dipyridamole should not be used as monotherapy in antiplatelet treatment.

Oral short-acting dipyridamole may cause orthostatic hypotension; more effective alternatives available.

Respiratory System

[9]-[11],[14],[15]

First generation antihistamines (e.g. chlorphenamine, promethazine) should not be used as first-line agents for greater than seven days.

First generation antihistamines may cause addiction and/or exert anticholinergic properties causing unwanted side-effects e.g. constipation, drowsiness, psychomotor impairment.

[11],[14]

Theophylline should not be used as monotherapy for asthma or chronic obstructive pulmonary disease.

Theophylline is associated with an increased risk of arrhythmias.

[14]

A concomitant bisphosphonate should be prescribed if oral corticosteroids are used long-term (greater than three months).

Long-term use of an oral corticosteroid increases the risk of osteoporosis and subsequent bone fracture.

Added by Project Steering Group[22]

Mucolytic agents (e.g. carbocisteine, mecysteine) should not be used routinely in stable chronic obstructive pulmonary disease.

There is little benefit from the use of mucolytic agents in stable chronic obstructive pulmonary disease.

Central Nervous System

[12]

Selective serotonin reuptake inhibitors (e.g. citalopram, fluoxetine) should not be used in combination with venlafaxine.

Concomitant use may lead to the development of serotonin syndrome.

[9]-[13],[15]

Tricyclic antidepressants (TCAs) (e.g. amitriptyline, nortriptyline) should not be used as first-line in treatment of depression.

TCAs are associated with unwanted peripheral anticholinergic side-effects e.g. constipation, dry mouth and central anticholinergic side-effects e.g. drowsiness.

[9]-[16]

Benzodiazepines (e.g. nitrazepam, temazepam) should not be used long-term (greater than four weeks).

Long-term use of benzodiazepines increases the risk of dependency. Benzodiazepine related adverse effects include daytime sedation, cognitive impairment, agitation, irritability.

[9],[10]

Non-benzodiazepine hypnotics (zolpidem, zaleplon, zopiclone) should not be used long-term (greater than 4 weeks).

Non-benzodiazepine hypnotics have adverse events similar to those of benzodiazepines with minimal improvement in sleep latency and duration.

[11]

Carbamazepine should not be used in combination with clarithromycin or erythromycin.

Clarithromycin and erythromycin inhibit the metabolism of carbamazepine therefore increasing the risk of adverse effects e.g. headache, drowsiness, nausea.

[12],[14]

Strong opioids (e.g. buprenorphine, diamorphine, fentanyl, morphine, oxycodone) should not be prescribed without the co-prescribing of laxatives.

Strong opioids are likely to cause constipation.

Infections

[9],[10],[15]

Nitrofurantoin should not be prescribed for greater than 7 days for the management of uncomplicated lower urinary-tract infections.

Potential for pulmonary toxicity; safer alternatives available.

Endocrine System

[9],[14],[15]

In relation to the management of diabetes, the use of oral long-acting sulfonylureas (glibenclamide) should be avoided.

Oral long-acting sulfonylureas have a prolonged half-life and can cause prolonged hypoglycaemia or syndrome of inappropriate antidiuretic hormone (ADH) secretion.

Musculoskeletal System

[9],[10],[13],[14],[16]

Non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. celecoxib, diclofenac, naproxen) should not be used long-term (greater than three months).

Long-term NSAID treatment should be reviewed periodically due to increased risk of thrombotic effects, and the lowest effective dose should be prescribed for the shortest period.

[11]-[13]

Unless adequate gastro-intestinal protection is provided with either a proton pump inhibitor or H ₂ -receptor antagonist, non-steroidal anti-inflammatory drugs should not be used in combination with:

Concomitant use increases the risk of gastro-intestinal bleeding.

  a. Low-dose aspirin.

  b. Selective serotonin re-uptake inhibitors.

Duplication of drug classes

[11],[12],[14],[15]

The use of two or more drugs from the same pharmacological class should be avoided, unless used for additive effects in line with current clinical guidelines.

Possible unwanted duplication of effect, increasing risk of side effects and adverse events.

For example: Avoid duplication of opioid analgesics, non-steroidal anti-inflammatory drugs, benzodiazepines.

An example of an exception includes: duplicate beta ₂ agonists (provided one is short-acting and one is long-acting) for the management of asthma or chronic obstructive pulmonary disease.