Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Creon 40,000 temporarily unavailable

The manufacturer of Creon has written to healthcare professionals advising that Creon 40,000 capsules are temporarily unavailable due to manufacturing yield problems.

A letter from the manufacturer notes that Creon is a biological product and lower than expected yields of high-potency enzymes from porcine glands has impacted on the current availability of the 40,000 strength product. This issue does not impact upon the lower dose products and therefore Creon 25,000 and 10,000 remain available.

It is therefore recommended that an equivalent dose of a lower dose be used with a preference to use the 25,000 strength product to reduce the number of capsules taken by individual patients.

Action: Clinicians should be aware of this supply issue. 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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SMC Update - March 2015

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

Aapixaban (Eliquis®) has been accepted for use in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and prevention of recurrent DVT and PE in adults.

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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Pregabalin Prescribing Guidance

NHS England has written to CCGs, pharmacies and GP practices regarding prescribing of generic pregabalin.

Pregabalin as the brand Lyrica® is licensed for epilepsy, generalised anxiety disorder and neuropathic pain. The patent for the neuropathic pain indication extends until July 2017. Generic versions of pregabalin are likely to be imminently available but are only licensed for epilepsy and generalised anxiety disorder due to this patent.

The manufacturer of Lyrica® is currently in a dispute with a number of generic pharmaceutical suppliers. The Court has required that NHS England issue guidance in relation to the prescribing and dispensing of pregabalin. This guidance states:

"Pregabalin should only be prescribed for the treatment of neuropathic pain under the brand name Lyrica®® (unless there are clinical contra-indications or other special clinical needs e.g. patient allergic to an excipient, branded product unavailable etc which apply to Lyrica®®, when you should not prescribe Lyrica®® or pregabalin)".

Action: Clinicians should be aware of this guidance. Consideration should be given to what measures need to be taken to protect against allegations of patent infringement.

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Drug Safety Update - February 2015

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

The TIOSPIR clinical trial has been published and found no significant difference in mortality when tiotropium is delivered via Respimat or Handihaler device. This is reassuring however patients with certain cardiac conditions were excluded from the trial. As such it is still recommended to take into consideration the risk of cardiovascular side effects in patients with certain cardiovascular conditions including:

  • recent myocardial infarction < 6 months
  • any unstable or life threatening cardiac arrhythmia
  • cardiac arrhythmia requiring intervention or a change in drug therapy in the past year
  • hospitalisation of heart failure (NYHA Class III or IV) within the past year

Clinicians are also reminded that the new drugs and driving offence will be enforced from 2 March 2015 in England and Wales. It is recommended that clinicians talk to patients who are on medicines with potential to impair driving and discuss the patient leaflet advice.

Finally this month there is a summary of letters sent to healthcare professionals since November 2014, including the discontinuation of carbocisteine 125mg/5ml oral solution.

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

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SMC Update - February 2015

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

Colestilan (BindRen®) has been rejected for the treatment of hyperphosphataemia in adult patients with chronic kidney disease (CKD) stage 5 receiving haemodialysis or peritoneal dialysis. Comparative date with others similar agents did not demonstrate non-inferiority conclusively. The manufacturer did not present a sufficiently robust clinical and economic analysis to gain acceptance.

Umeclidinium / Vilanterol (Anoro®) has been accepted for use as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease. Two randomised controlled studies demonstrated improved lung function compared with an inhaled long-acting muscarinic antagonist and indirect comparisons demonstrated comparable efficacy with similar drug combinations.

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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