Prescribing of the antidepressant duloxetine: Can local clinical audit findings facilitate medicines management decisions?

Introduction. Discussions regarding the inclusion of a new antidepressant within local formulary lists and prescribing guidelines may be facilitated by audits of local prescribing practice, conducted some months after the drug first becomes available for clinical use. Method. Development of five audit standards and retrospective case-note review of prescribing recommendations for the serotonin-noradrenaline reuptake inhibitor duloxetine, made in five local outpatient clinics. Results. Follow-up data were available for audit in 27 of 43 sets of medical notes. In the majority of patients (84%), the primary diagnosis was recurrent unipolar depressive disorder, the current episode having proven resistant to treatment with two other antidepressants. Where comments were made, notes indicated that 81% of patients that received duloxetine had improved and 94% had tolerated it without reported problems. Conclusions. In this sample, duloxetine prescribing in the first months after it became available appeared to occur within an appropriate patient group. Prospective evaluations in other clinical samples are warranted.