Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Bimatoprost 0.03% discontinued

The manufacturer of bimatoprost (Lumigan®) has discontinued the 0.3mg/ml or 0.03% strength of this product in dropped bottles, the 0.01% product and the unit dose version are not affected and remain available.

According to an Assessment Report at the European Medicines agency the lower strength product is a direct equivalent. The report states, "Compared with the current authorised strength which contains 0.3 mg/ml bimatoprost and 50 ppm benzalkonium chloride, the new strength contains a third of the concentration of bimatoprost (0.1 mg/ml) and 200 ppm benzalkonium chloride. The higher concentration of benzalkonium chloride increases the ocular absorption of bimatoprost thus allowing for a lower concentration of bimatoprost to be administered (0.1 mg/ml). This new formulation, with a reduced concentration of bimatoprost, achieves comparable IOP-lowering efficacy to the current authorised strength and an improved overall safety profile.

There is a cost difference between the two strengths with the 0.03% strength currently priced at £10.30 for 3ml and the 0.01% strength currently more expensive at £11.71 for 3ml.

Action: Clinicians should be aware of this product being discontinued. It may be prudent to run clinical system searches to identify any patients who are currently prescribed this product to allow a review and an alternative to be arranged.

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NICE Guidance - August 2015

The National Institute of Health and Care Excellence (NICE) have published new guidance for the month of August 2015. This month there are four clinical guidelines that impact upon primary care.

The Type 1 diabetes in adults guideline covers the care and treatment of adults (aged 18 and over) with type 1 diabetes. This guideline updates and replaces the sections for adults in NICE guideline CG15.

The Diabetes (type 1 and type 2) in children and young people guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. The guideline recommends strict targets for blood glucose control to reduce the long-term risks associated with diabetes.

The Diabetic foot problems guideline covers prevention and management of foot problems in children, young people and adults with diabetes. The guideline aims to reduce variation in practice.

The Antimicrobial stewardship guideline covers the effective use of antimicrobials (including antibiotics) in children, young people and adults. It aims to change prescribing practice to help slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment for infection.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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Drug Safety Update - August 2015

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2015 (PDF).

Clinicians are advised that amiodarone use has been associated with severe bradycardia and heart block when used with simeprevir (Olysio®) and sofosbuvir (Sovaldi®) combination therapy for chronic hepatitis C. Amiodarone is only recommended in this combination when all other antiarrhythmics cannot be given. When there is no alternative very careful monitoring is recommended. Patients should be advised to report symptoms of bradycardia including shortness of breath, light-headedness, palpitations and fainting.

Finally this month there is a summary of letters sent to healthcare professionals in July 2015, including one regarding the risk of diabetic ketoacidosis observed with SGLT2 inhibitors and one regarding the new contraindication for denosumab in patients with unhealed lesions from dental or oral surgery and the introduction of patient safety cards about osteonecrosis of the jaw. Both of these items have been covered in previous Drug Safety Updates.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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SMC Update - August 2015

The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.

Darunavir / Cobicistat (Rezolsta®) has been accepted for use in combination with other antiretroviral medicinal products for the treatment of human immunodeficiency virus-1 (HIV-1) infection in adults aged 18 years or older. Genotypic testing should guide its use.

Tedizolid (Sivextro®) has been accepted for restricted use in the treatment of acute bacterial skin and skin structure infections (ABSSSI) in adults. The restriction limits use to patients with ABSSSI caused by Gram-positive Staphylococcus aureus (specifically methicillin-resistant Staphylococcus aureus [MRSA] isolates as an alternative oxazolidinone antibacterial on the specific advice of local microbiologists or specialists in infectious disease.

Tiotropium solution for inhalation (Spiriva® Respimat®) is accepted for use as an add-on maintenance bronchodilator treatment in adult patients with asthma who are currently treated with the maintenance combination of inhaled corticosteroids (≥800 micrograms budesonide/day or equivalent) and long-acting beta2 agonists and who experienced one or more severe exacerbations in the previous year.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

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NICE Guidance - July 2015

The National Institute of Health and Care Excellence (NICE) have published new guidance for the month of July 2015. This month there is one technology appraisal that impacts upon primary care.

The naloxegol technology appraisal recommends this treatment as an option people with opioid induced constipation that has had an inadequate response to laxatives.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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