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Letter to the editor

Editor, I read with interest the recent issue of Australian Prescriber and the wall chart contained within it (insert to Aust Prescr Vol. 17 No. 3 1994).

It surprised me no end to see no mention at all of renal impairment in relation to ACE inhibitors but frusemide rated such a mention.

There is abundant evidence in the literature on the effects of ACE inhibitors on renal function, and we at this hospital have at least two patients on long term haemodialysis because of uncritical use of them in patients with renal artery stenosis.

A.Z. Gyory
Professor of Medicine
Royal North Shore Hospital
St. Leonards, N.S.W.

Editor's comment

The wall chart was based on the Australian Pharmaceutical Formulary. This contains the requirements of the Pharmaceutical Society of Australia on the labelling and counselling which should be given when drugs are dispensed. Clearly, doctors have additional factors to consider when they are prescribing. The 'Other comments' column was intended to include a few of those considerations, but it was not intended to be a complete list of prescribing instructions. The column contains enough space for additional information to be included, so practitioners can add Professor Gyory's warning and any other advice they choose.

I have also been advised that the labelling for doxycycline differs slightly from the other tetracyclines. Doxycycline can cause oesophageal or gastric irritation, so it should be taken with fluids or food. The advice on the wall chart for doxycycline should be '4 (delete milk) B,D'.