The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of April 2025. This month there are two guidelines that impact upon primary care.
The Suspected cancer: recognition and referral guideline has been updated. It covers identifying children, young people and adults with symptoms that could be caused by cancer. It outlines appropriate investigations in primary care, and selection of people to refer for a specialist opinion. This update has amended the recommendations on initial testing for myeloma.
The Falls: assessment and prevention in older people and in people 50 and over at higher risk guideline has been published. It covers assessing risk of falling and interventions to prevent falls in all people aged 65 and over, and people aged 50 to 64 who are at higher risk of falls. It aims to reduce the risk and incidence of falls, and the associated distress, pain, injury, loss of confidence, loss of independence and mortality.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published a second Drug Safety Update for April 2025.
This update reminds healthcare professionals and patients of the risk of severe asthma attacks and increased mortality associated with overuse of SABA, with or without anti-inflammatory maintenance therapy in patients with asthma.
Healthcare professionals are advised not to prescribe SABA to people of any age with asthma without a concomitant prescription of an inhaled corticosteroid, ensure all patients with asthma receive optimal anti-inflammatory maintenance therapy even when their asthma is well controlled and to review patients using a SABA more than twice weekly or where there is an increase in SABA use or a failure to collect prescribed anti-inflammatory maintenance treatment.
It is also recommended that patients are advised to seek urgent medical assistance for worsening asthma symptoms, to use the asthma anti-inflammatory maintenance medication as prescribed by a healthcare professional even when asthma is well-controlled and the blue inhaler is rarely or never needed and track the doses used of SABA inhalers, either with a device counter or manually, seeking a review if they use a SABA more than twice weekly.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published a Drug Safety Update for April 2025.
This update warns clinicians about the risk of liver injury with fezolinetant▼ (Veoza®). This is a relatively new treatment for moderate to severe vasomotor symptoms (VMS) associated with menopause. Cases of serious liver injury with deranged liver function tests and signs and symptoms of hepatic dysfunction have been reported. These findings were generally reversible on discontinuation of therapy.
Clinicians are advised to avoid fezolinetant in patients with known liver disease or patients at higher risk for liver disease. Baseline liver checks are also advised with tests repeated monthly for the first three months of treatment and periodically thereafter.
Treatment must be discontinued in patients who develop symptoms of liver injury or when transaminases are above three times the upper limit of normal (3xULN) or bilirubin is above 2xULN. Liver monitoring is recommended should any signs or symptoms suggestive of liver injury occur and patients should be advised to seek immediate medical attention if they develop such signs. This would include fatigue, pruritus, jaundice, dark urine, pale faeces, nausea, vomiting, decreased appetite and/or abdominal pain. Any suspected adverse drug reactions associated with fezolinetant should be reported via the Yellow Card scheme.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.
Dapagliflozin (Forxiga®) has been accepted for restricted use in adults for the treatment of chronic kidney disease (CKD). The restriction limits use to patients having individually optimised standard care (including angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, unless these are contraindicated or not tolerated), and either, at the start of treatment:
- an estimated glomerular filtration rate (eGFR) of 20 mL/min/1.73m2 up to 45
mL/min/1.73m2, or
- an eGFR of 45 mL/min/1.73m2 up to 90 mL/min/1.73m2 and either:
- A urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more, or
- Type 2 Diabetes Mellitus (T2DM)
It is noted that dapagliflozin offers an additional treatment choice in the therapeutic class of sodium-glucose co-transporter 2 (SGLT2) inhibitor.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
During March 2025 Clinical Knowledge Summaries were published or updated in the following areas.
The Abdominal pain - acute topic and the Sensory neuropathy topic are new. All of the other topics have been reviewed and updated with minor structural and layout changes. The Depression in children topic has had the definitions of mild, moderate and severe depression updated in line with the World Health Organization (WHO) International Classification of Diseases 11th revision (ICD-11). The Epilepsy topic has been updated in line with current literature including the NICE guideline. The term 'antiepileptic drug' has been changed to 'antiseizure medication' and the definition section has been expanded. Recommendations about reproductive health advice have been expanded to include men on antiseizure medication who are sexually active.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
