Low value prescribing - doxazosin modified release

We divide the number of defined daily doses (DDDs) of doxazosin modified release tablets by the total number of DDDs of doxazosin immediate release and modified release tablets and then multiply that by 100 to obtain a percentage each month.

NHS England guidance identifies a number of items which provide low value when prescribed. This guidance has mainly been aimed at primary care but we think it is important to also monitor a selection of these in hospitals - read more about why in our blog.

NHS England guidance states:

Doxazosin is an alpha-adrenoceptor blocking drug that can be used to treat hypertension and benign prostatic hyperplasia. There are two oral forms of the medication (immediate release and prolonged release) and both are taken once daily.

Prolonged-release doxazosin costs approximately six times more than doxazosin immediate release.

NICE guidance on hypertension recognises that doxazosin should be used in treatment but does not identify any benefits of prolonged release over immediate release.

NICE guidance recommends doxazosin as an option in men with moderate to severe lower urinary tract symptoms. It does not identify benefits of prolonged release over immediate release.

Due to the significant extra cost of prolonged-release doxazosin and the availability of once daily immediate-release doxazosin, the joint clinical working group considered prolonged-release doxazosin suitable for inclusion in this guidance.

For guidance on when prescribing may be appropriate in some exceptional circumstances, please see the full NHS England guidance document.