Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MeReC Bulletin - COPD

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that discusses recent safety issues with inhaled treatments for chronic obstructive pulmonary disease (COPD).

The bulletin reviews the benefits of long acting bronchodilators and inhaled corticosteroids (ICS) in patients with COPD and then details the safety issues for long-acting beta2 agonists (LABAs), anticholinergics and ICS individually.

The article concludes with a review of the factors to consider when making treatment choices. This includes a reminder that treatment options should be trialled in patients with COPD and discontinued if there is no benefit.

Action: Clinicians involved in the management of patients with COPD will find this bulletin useful and informative.

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Swine 'flu

Health service providers are likely to face increasing enquiries as more information regarding the spread of swine 'flu becomes available (BBC).

Cases have been confirmed in Mexico, America, Canada and more recently Spain. The Health Protection Agency (HPA) has issued advice for patients and healthcare professionals. The HPA has also produced an algorithm for screening and assessment of individuals who present with symptoms suggestive of swine 'flu.

Action: Clinicians should be aware of the latest health advice and ensure that appropriate action is taken to treat and contain suspected infections.

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New salicylate gel advice for under 16s

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new advice regarding the use of salicylate containing dental and teething gels in children and young people under 16 years old. This new advice has been reported in the general media (BBC).

Several topical products that are indicated for dental and teething problems contain salicylate salts. These ingredients are similar to aspirin and there is a theoretical risk that a child developing may Reye's syndrome. The MHRA are not aware of any confirmed cases and this advice is a precautionary measure however there are currently three reports of serious adverse drug reaction resulting in hospital admission after exposure to choline salicylate.

The following products are based on topical anaesthetics and are unaffected by this announcement:

  • Bonjela® Teething Gel
  • Calgel®
  • Anbesol® Teething Gel
  • Anbesol® Liquid
  • Dentinox®

Action: Clinicians should be aware of this safety advice and ensure that suitable alternatives are recommended.

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April NICE Guidance

The National Institute of Health and Clinical Excellence has published new guidance for the month of April.

There are two guidelines that may impact on primary care, a clinical guideline on diarrhoea and vomiting in children under 5 and another clinical guideline on glaucoma.

The former guidelines covers the diagnosis, assessment of dehydration, fluid management, nutritional management and the role of antibiotics and other therapies in treating diarrhoea and vomiting in children under 5. The guideline also dispels the commonly held view that sugary drinks such as flat cola and lemonade aids in recovery; in fact this strategy may worsen symptoms. This aspect of the guidance has been widely reported in the media (BBC).

The latter guideline details the diagnosis, treatment and care of:

  • adults with a diagnosis of the condition known as chronic open angle glaucoma
  • adults with a diagnosis of ocular hypertension
  • adults who are at a high risk of developing glaucoma

Action: Clinicians who see and treat children under 5 or adults with eye problems will find this information useful.

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OTC orlistat

Orlistat will shortly be available to purchase from community pharmacies following a successful application to regulatory authorities. This product launch has gained significant media attention (BBC).

Each Alli® capsule will contain 60mg of orlistat and is recommended for people who are overweight (BMI > 28), want to lose weight, and will commit to healthier eating. The product is expected to retail for approximately £50 for a months supply.

This over-the-counter (OTC) product is half the strength of the prescription only version (Xenical®) but concerns have been raised about the potential for side effects if lifestyle changes are not implemented.

Action: Clinicians should be aware of the wider availability of this product.

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