Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE clarify ACS guidance

NICE have clarified their guidance in relation to the use of Clopidogrel (Plavix) in Acute Coronary Syndromes (ACS).

The original recommendation stated that the combination of aspirin and clopidogrel should be used for up to 12 months after the most recent event.

They have now clarified that the evidence of efficacy and cost-efficacy extends to 12 months, as determined by the clinical trials. Clinicians and funding bodies should not have discretion to change the period of treatment.

Action: Clinicians should be aware of this clarification. Clopidogrel should be prescribed for 12 months treatment following the most recent event. Amending directions on prescriptions to "One each day until November 2006" for example may make it easier to monitor prescribing in ACS patients.

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NICE recommend offering long acting contraceptives

NICE have published a Clinical Guideline that recommends all women seeking contraception should be offered information tailored to their needs including offering a choice of using long acting reversible contraceptives (LARCs).

LARCs include intrauterine devices, intrauterine systems, injectable contraceptives and implants. The advantage of these contraceptive options over other methods, such as condoms and combined oral contraceptives, is that users are not required to think about contraception every day or before intercourse.

Experts believe that wider use of LARCs will reduce the occurrence of unplanned pregnancy. It is currently estimated that up to 30% of pregnancies are unplanned.

Action: All clinicians who offer advice to women on contraception should make themselves aware of the NICE Guideline and of the LARC options available. These options should be made available to women with additional information so that the patient can reach an informed decision.

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Ethosuximide capsules discontinued

The antiepileptic Ethosuximide, in capsule form, is being discontinued with immediate effect. The product is available as Zarontin and Emeside. Zarontin Liquid will remain available.

There have been long running stock problems with Zarontin that have rapidly depleted stock of Emeside and it now appears that the manufacturers of both products have decided to abandon further attempts to meet market demand with a product that often fails to meet the expected quality standards.

Action: Patients who are prescribed Ethosuximide in capsule form should be identified and referred for specialist advice. The liquid preparation remains available but may not be suitable for some patients.

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NICE and BHS confirm BP Guideline Review

Both the National Institute of Health and Clinical Excellence (NICE) and the British Hypertension Society (BHS) have confirmed that they are to review their blood pressure guidelines following the publication of the ASCOT Study.

In a press release, available on both sites, the two organisations confirm that following a preliminary panel they will work together to provide doctors with clear guidance as soon as possible.

There is no indication at this stage what alterations might be made to the existing guidelines. Furthermore, there is no interim advice from either organisation.

Action: Clinicians are encouraged to await clearer guidance from NICE and BHS. Until this guidance is forthcoming continue to follow NICE (or BHS) recommendations.

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Patient Reporting of ADRs

The general public can now report Adverse Drug Reactions (ADRs) to the MHRA. In a press release the MHRA announced that, following a successful pilot of patient reporting since January, patient reporting of ADRs would be made available nationally.

The general public can now report suspected side effects online at www.yellowcard.gov.uk or by Freephone 0808 100 3352.

More details are available online for patients and for healthcare professionals.

Action: Prescribers should be aware that patients can now self report but should continue to report suspected reactions as before. Systems are in place to identify duplicate reports and patient reporting will therefore complement healthcare professional reporting, not replace it.

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