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Latest Updates

Tamoxifen with fluoxetine, paroxetine or duloxetine – again!

The accompanying editorial suggests there is a good pharmacological reason why fluoxetine and paroxetine may make tamoxifen less effective – they are potent inhibitors of the enzyme (CYP2D6) that...

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How should we assess and manage terminally ill patients with low mood?

A 2012 article in the Annals of Internal Medicine recommended the use of a PHQ9 or HADS score to assess patients with low mood persisting for more than 2w for depression.

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Women who have had gestational diabetes need follow-up for the rest of their lives

Studies have shown that this is an area in which we are not performing well. Is annual follow-up happening in your practice? Might this be a good audit to undertake? (Remember, the diagnostic...
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Aspirin and PPIs: more on this drug dilemma


We feel that the risks of PPIs are small in someone over 75y on aspirin. However, the risk–balance pendulum may swing in the other direction in someone taking PPIs so they can down their...

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Bone metastases

X-rays too can be normal. Bone scans can miss lytic lesions, and cannot distinguish between metastases and other conditions such as osteoarthritis. Bone pain should be treated with analgesia. If...

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