Treatment with high-dose glucocorticoids seemed to be associated with increased risk for cardiovascular disease.

Objective-To determine the rate of patients not redeeming their prescriptions (primary noncompliance) and assess the factors influencing this.Design Main outcome measures-The rate of nonredemption ofprescriptions.Results-Seven hundred and two patients (14X5%) did not redeem 1072 (5X20/) prescriptions during the study period, amounting to 11X5% of men and 16X3% of women. Non-redemption was highest in women aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29] (27.6% of women) and men aged [40][41][42][43][44][45][46][47][48][49] (18.3% of men). Of prescriptions issued to women for oral contraceptives 24-8% were not redeemed during the study period. In those who redeemed prescriptions 17% were not exempt from prescription charges compared with 33% of patients who failed to redeem them. The non-redemption rate was highest for prescriptions issued at the weekends, although this was a small proportion of all prescribing. Prescriptions issued by trainee general practitioners were also less likely to be redeemed.Conclusions-Non-redemption varies with age, sex, general practitioner, exemption status, and with day ofthe week the prescription was written. Observational studies of drug exposure can be more accurately estimated from dispensing rather than prescribing data.

Objective: To examine whether allopurinol is associated with any alteration in mortality and hospitalisations in patients with chronic heart failure (CHF). This hypothesis is based on previous data that a high urate concentration is independently associated with mortality with a risk ratio of 4.23 in CHF. Design: Retrospective cohort study. Setting: Medicines Monitoring Unit, Ninewells Hospital, Dundee, UK. Patients: 1760 CHF patients divided into four groups: those on no allopurinol, those on long term low dose allopurinol, those on short term low dose allopurinol, and those on long term high dose allopurinol. Main outcome measures: Total mortality, cardiovascular mortality, cardiovascular hospitalisations, cardiovascular mortality or hospitalisations. Results: Long term low dose allopurinol was associated with a significant worsening in mortality over those who never received allopurinol (relative risk 2.04, 95% confidence interval (CI) 1.48 to 2.81). This may be because low dose allopurinol is insufficient to negate the adverse effect of a high urate concentration. However, long term high dose (> 300 mg/day) allopurinol was associated with a significantly better mortality than longstanding low dose allopurinol (relative risk 0.59, 95% CI 0.37 to 0.95). This may mean that high dose allopurinol can fully negate the adverse effect of urate and return the mortality to normal. Conclusions: Long term high dose allopurinol may be associated with a better mortality than long term low dose allopurinol in patients with CHF because of a dose related beneficial effect of allopurinol against the well described adverse effect of urate. Further work is required to substantiate or refute this finding.