Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - April 2015

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

Aclidinium / Formoterol Inhaler (Duaklir Genuair®) has been accepted for use as maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease.

Levonorgestrel IUD (Jaydess®) has been accepted for use as contraception for up to 3 years.

Tacrolimus prolonged release tablets (Envarsus®) have been accepted for the prophylaxis of transplant rejection in adult kidney or liver allograft recipients and treatment of allograft rejection resistant to treatment with other immunosuppressive medicinal products in adult patients. It is noted that this product has demonstrated non-inferiority to a tacrolimus immediate-release capsule and has a similar cost per equivalent dose.

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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BNF 69

The 69th Edition of the British National Formulary has been published. As previously noted, the BNF will now only be distributed annually in the NHS.

New or revised content in this version includes updated advice in the following areas:

  • Updated general guidance on drugs and driving in response to new regulations in force from March 2015
  • Updated guidance on risk assessment and treatment in the management of arrhythmias
  • Updated recommendations on minimising risk of osteonecrosis of the jaw and hypocalcaemia associated with denosumab following new MHRA advice
  • New guidance on dose adjustment in renal impairment for atorvastatin
  • New recommendations on concomitant use of drugs affecting the renin-angiotensin system
  • New guidance on dose adjustment in hepatic and renal impairment for zolpiclone
  • Updated guidance on assessing cardiovascular risk and modification of blood lipids in the primary and secondary prevention of cardiovascular disease
  • Updates to recommended regimens for prophylaxis against malaria for specific countries

The web version has already been updated but requires registration or an Athens account for continued access. The printed version is available for purchase.

Action: All clinicians should start using BNF 69 via electronic methods were possible. The web version can be used to access the latest information if necessary.

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Rupatadine discontinued

The product license holder of rupatadine (Rupafin®) has written to healthcare professionals advising that with effect from the 31st March 2015 this medicine will be effectively discontinued in the UK.

An agreement between the license holder and a UK based distributor has come to an end and a new distributor is not being sought. It is estimated that supplies would be exhausted by the end of March 2015. As such alternative treatment options will need to be considered.

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

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Drug Safety Update - March 2015

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2015 (PDF). This month there are two updates pertinent to primary care.

A new e-learning module for corticosteroids has been created that aims to help clinicians understand how to identify, manage and avoid the
important side effects of these valuable and widely prescribed medicines - vital knowledge for optimising the use of corticosteroids.

Readers are also encouraged to report misleading medicines advertisements. Reports can be made to the MHRA at or Prescription Medicines Code of Practice Authority (PMCPA) at

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

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