�The medicated pain relief plaster,
(Versatis) is now approved by the Scottish Medicines Consortium (SMC) for
restricted use within NHS Scotland for patients hurt pain following
shingles(1) http://www.scottishmedicines.org.uk/smc/5850.hypertext markup language. This
reversal of the previous SMC decision (issued in February 2007) for
Versatis (5% lidocaine medicated plaster) is based on significant new
clinical and cost-effectiveness comparative data and brings prescribing
availability of the treatment in line with England and Wales. These modern
data on Versatis will be presented for the first time at the International
Association for the Study of Pain (IASP) Congress in Glasgow (17-22 August
2008).
The pain that persists for more than trey months later on the onset of
the shingles roseola is called Post-herpetic Neuralgia (PHN) (2). PHN affects
approximately cc,000 people in the UK(3). PHN can be described as an
never-ending burning, stabbing or shot pain. The pain canful start several
weeks or even months after the shingles rash has kaput and can continue for
weeks, months or years(4).
Licensed in the UK in 2007, Versatis offers sustained pain relief
associated with PHN(5). Versatis is an innovative combining of local
analgesic lidocaine and a soft hydrogel plaster. Application of the plaster
to the hide releases an appropriate level of lidocaine into the skin to
impair the transfer of signals which would be associated with the
perception of painful sensation.
Based on clinical trial data, Versatis is secondhand as a continuous
once-daily 12 hours on/12 hours off application schedule for 2-4 weeks and
provides rapid and continuous pain relief from 30 minutes after
application(6).
Dr Michael Serpell, Consultant and Senior Lecturer in Anaesthesia,
Glasgow says: "The new recommendation from the SMC is to be welcomed. New
data supporting the role of Versatis in post-herpetic neuralgy will
further establish that such a novel, non-systemic treatment attack offers
meaning benefits in the old patient grouping who suffer co-morbidities
and consequential polypharmacy".
Heather Wallace, Chairman of Pain Concern commented: "The SMC is to be
congratulated on its revised decision for Versatis. They've taken a huge
stair forward in extending options for pain relief for people living with
neuropathic pain. This decision will alleviate a lot of suffering".
The risk of developing PHN increases with age - it is most common in
people aged over 50. About half of shingles cases affecting multitude of the
age of 65 will cause PHN(7,8).
Prescribing Information
Versatis 5% medicated plaster. Refer to the Summary of Product
Characteristics (SPC) for full details on position effects, warnings and
contra-indications before prescribing. Presentation: Versatis is a
medicated plaster (10cm x 14cm) containing 700 mg (5% w/w) of lidocaine in
an aqueous adhesive base. Indication: Treatment of neuropathic painful sensation
associated with previous herpes zoster infection (post-herpetic neuralgy,
PHN). Dosage and method of governance: Adults and elderly patients: Use
up to ternary plasters for up to 12 hours, followed by at least a 12 hour
plaster-free interval. Cover painful area once daily. Apply the plaster to
intact, dry, non-irritated skin (after healing of the shingles). Remove
hairs in affected area with pair of scissors (do not shave). Remove the plaster
from sachet and its surface ocean liner before applying immediately to the tegument.
Plasters may be edit to sizing. Patients under 18 days: Not recommended.
Contra-indications: Hypersensitivity to active substance, whatever excipients,
or local anaesthetics of amide type (e.g. bupivacaine, etidocaine,
mepivacaine and prilocaine). Warnings and precautions: Do not apply to
ablaze or injured skin (e.g. active herpes shingles lesions, atopic
dermatitis or wounds), mucose membranes or the eyes. Plasters contain
propylene ethylene glycol which may cause skin irritation, methyl group
parahydroxybenzoate and propyl parahydroxybenzoate which may cause allergic
reactions. Use with caution in patients with severe cardiac deadening,
severe renal impairment or severe hepatic impairment. Interactions: No
clinically relevant interactions have been observed in clinical studies.
Absorption of lidocaine from the skin is low. Use with caution in patients
receiving Class I antiarrhythmic drugs (e.g. tocainide, mexitil) or
other local anaesthetics. Pregnancy and lactation: Do not habit during
maternity or nursing. Undesirable personal effects: Very common (greater than
or equalize to 10%): administration internet site reactions (e.g. erythema, rash,
pruritus, burning). Uncommon (>0.1%-less than or equal to 1%): skin injury,
skin lesion. Very rare (less than or equal to 0.01%) but potentially
serious: anaphylaxis, hypersensitivity. Adverse reactions were
predominantly of mild and moderate chroma. Systemic contrary reactions
are unlikely. See SPC for full details. Overdose: Unlikely. If suspected,
remove plasters, provide supportive treatment (see SPC). Legal
classification: POM. Marketing Authorisation number, pile sizes and basic
NHS cost: PL 21727/0016, 30 plasters (GBP 72.40). Marketing Authorisation
Holder: Grunenthal Ltd, Regus Lakeside House, 1 Furzeground Way, Stockley
Park East, Uxbridge, Middlesex, UB11 1BD, UK. Date of school text: June 2008.
V0138
References:
1) Scottish Medicines Consortium, NHS Scotland, internet site:
http://www.herpes.org.uk/shingles/index.hypertext markup language
2) Cunningham, A. and Dworkin, R. (2000) The Management of
post-herpetic neuralgy. BMJ 321, 778-779
3) Shingles Support Society. Bowsher D. Treatment of post-herpetic
neuralgia in the elderly. Available at:
http://www.herpes.org.uk/shingles/index.hTML
4) Herpes Viruses Association. Available at: http://www.herpes.org.uk
5) Versatis Summary of Product Characteristics
6) Baron R et al. Abstract presented at the Congress of the
European Federation of IASP Chapter, Istanbul 2006
7) Shingles Support Society. Bowsher D. Treatment of post-herpetic
neuralgy in the elderly. Available at:
hypertext transfer protocol://www.herpes.org.uk/shingles/index.html
8) http://cks.library.nhs.
