Update
In response to all the feedback, Lundbeck has decided to reverse their decision to stop distribution of Redomex® and Nortrilen® in Belgium. Both products will remain available for further use.
Open letter
Dear colleagues
As you probably have heard, the pharmaceutical company Lundbeck decided to stop the distribution of the tricyclic antidepressants and neuromodulators Redomex® and Nortrilen® in Belgium. Both drugs are known as tricyclic antidepressant, but they have also demonstrated effects on neuropathic pain. In the field of gastroenterology, these drugs have proven efficacy in the management of pain associated with disorders of gut-brain interaction, such as irritable bowel syndrome and functional dyspepsia.
The Belgian Society of Neurogastroenterology and Motility (BSNM) deeply regrets this unilateral decision of a pharmaceutical company. It leaves many patients without an alternative for treating their debilitating symptoms. BSNM therefore adheres to the open letter of the associations of psychiatrists, pain specialists and hospital pharmacists to condemn this decision.
While awaiting further reactions from the company as well as the resigning minister of public health, BSNM wants to advise you on how to help your patients. Several options are available depending on the situation of your patient:
- If Redomex® or Nortrilen® are effective in managing your patient’s symptoms, the pharmacist can order those drugs from abroad. This requires an “artsenverklaring”/”déclaration du médecin” as mentioned on the BCFI.be/ CBIP.be website. However, this implies that no reimbursement will be attributed. This will cost the patient about €15 per month (+postage).
- If the symptoms are insufficiently controlled by these tricyclic antidepressants, you could consider an SNRI such as duloxetine as an alternative. However, this class of antidepressants has no consistent effect on stool pattern in contrast to the constipating effect of tricyclics, which may require additional therapy to improve the stool pattern according to the clinical context.
- You can also consider an SSRI in case of anxiety as the main driver of your patient’s symptoms.
- Data on the use of pregabalin or gabapentin are limited in this population but their use can be an option in selected patients.
Take note that discontinuation of tricyclics requires a tapering schedule over a few weeks, depending on the dose (not necessary for lower dosage)
BSNM members remain available to help you provide the best possible care to your patients suffering from DGBI, whether they are affected by this decision or not. Feel free to reach out to members of our board to help you in adapting to these changing circumstances.