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Singh et al's 1 discussion of cost-effective prescribing is timely. Small changes in prescription writing habits can produce significant savings without noticeable change in clinical practice. A clear example is that of venlafaxine modified release which is produced in both capsule and tablet form. These are bioequivalent but vary widely in cost. It has been calculated that switching from capsule to tablet would save our local healthcare economy about £148 000 a year. The only change required of doctors would be to specify tablets on the prescription, thus ensuring the more cost-effective preparation is dispensed. The twice-daily formulation is cheaper still but would require a greater degree of change and perhaps affect adherence. Fluoxetine provides another example: fluoxetine 10 mg, a dose often used in child and adolescent mental health services, is not available in tablet form in the UK. Importing a supply can result in a single prescription cost of several hundred pounds, but specifying fluoxetine syrup ensures the cost remains less than £10. 2

Clearly, significant savings are to be had without compromising patient care or clinical autonomy. With regular support from a vigilant chief pharmacist and medicines management committee, the vagaries of the drug tariff could be navigated and the drug budget spent more cost-effectively.

1 Singh, DK, Khawaja, S, Pala, I, Khaja, J, Krishnanu, R, Walker, H, et al. Awareness of the cost of psychotropic medication among doctors: a service evaluation. Psychiatrist 2010; 34: 364–6.
2 British Medical Association, Royal Pharmaceutical Society of Great Britain. British National Formulary (issue 59). BMJ Group, Pharmaceutical Press, March 2010.