I've good working relations with our PCT and Area Prescribing Committee (APC) who let me prescribe any acetylcholinesterase inhibitor (antidementia drug) that I'd care to use, for any number of patients, at any dose, for whatever duration I wish. It's glorious to have the trust and clinical freedom to do what seems best for my patients without having constraints.
The compromise is that a fourth drug called memantine (which NICE say should only be prescribed on the NHS as part of well designed clinical trials) isn't prescribed much at all. Since NICE say not too. All well and good, I've got 3 others to play with and can deliver excellent care with them.
Too, the PCT and APC are happy for me to use memantine, just not much. So every now and again I find someone with a clinical presentation that suggests memantine could be useful, the other drugs aren't, so memantine's prescribed.
My nursing colleagues and Clinical Effectiveness lead were reviewing our practice to make sure that despite our belief we use little that we really weren't giving memantine out like smarties. We're not. We also looked at MMSE and outcomes from memantine use, to ensure that it continues to be useful for patients. We struggled at this bit, since we'd stopped it in almost every patient, because it hadn't worked.
I know the drug company's got efficacy data to show it's better than placebo, but I'm really after some good effectiveness data to show that in the really real world (outside of clinical trials) it does something useful, much of the time.
The number of folk who gained benefit on memantine and remain on it can be counted on one hand.
Hardly glorious results, then.
I'm starting to feel memantine's not quite as effective as it's said to be . . .