Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

PHE Advice on Gabapentin and Pregabalin

Public Health England (PHE) has recently issued advice (PDF) for prescribers on the risk of misuse of pregabalin and gabapentin.

The advice was produced by an expert group and contains suggestions for a balanced and rational use of these medicines. It is noted the majority of patients will use these medicines appropriately but that in some cases they can lead to dependence and may be misused or diverted.

It is suggested that less harmful, alternative drugs can often be first-line treatments for the indicated conditions for which pregabalin and gabapentin are now used, and may be tried preferentially in higher risk settings or in patients who may be more likely to be harmed by the drugs.

Action: Clinicians should be aware of the potential for misuse and diversion of these medicines and the recommendations made to reduce these risks.

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NICE Guidance - December 2014

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of November 2014. This month there are four clinical guidelines and one technology appraisal that impact upon primary care.

The Antenatal and postnatal mental health clinical guideline offers evidence-based advice on the recognition, assessment, care and treatment of mental health problems in women during pregnancy and the postnatal period (up to 1 year after childbirth), and in women who are planning a pregnancy.

The Colorectal Cancer clinical guideline offers evidence-based advice on the diagnosis and management of colorectal cancer.

The Pneumonia clinical guideline offers evidence-based advice on the care and management of adults with community- and hospital-acquired pneumonia.

The Dabigatran: deep vein thrombosis and/or pulmonary embolism technology appraisal recommends this treatment as a possible treatment for adults with deep vein thrombosis or pulmonary embolism.

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

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NICE Guidance - November 2014

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of November 2014. This month there is one clinical guideline, one technology appraisal and one public health guideline that impacts upon primary care.

The Obesity clinical guideline updates and replaces section 1.2 of NICE clinical guideline 43. It offers evidence-based advice on the care and treatment of obesity and includes new recommendations about low-calorie and very-low-calorie diets, bariatric surgery and follow-up care.

New recommendations have been added about low-calorie and very-low-calorie diets, bariatric surgery and follow-up care.

The Nalmefene for reducing alcohol consumption technology appraisal recommends this drug a possible treatment for people with alcohol dependence who:

  • are still drinking more than 7.5 units per day (for men) and more than 5 units per day (for women) 2 weeks after an initial assessment and
  • do not have physical withdrawal symptoms and
  • do not need to either stop drinking straight away or stop drinking completely

The guidance also recommends that nalmefene should only be taken if the person is also having ongoing support to change their behaviour and to continue to take their treatment, to help them reduce their alcohol intake.

The Vitamin D: increasing supplement use among at-risk groups public health guideline aims to increase supplement use to prevent vitamin D deficiency among at-risk groups including:

  • infants and children aged under 5
  • pregnant and breastfeeding women, particularly teenagers and young women
  • people over 65
  • people who have low or no exposure to the sun, for example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
  • people with darker skin, for example, people of African, African-Caribbean or South Asian family origin

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

Updated: 27/11/2014 to include "Obesity: identification, assessment and management of overweight and obesity in children, young people and adults" Clinical Guideline

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NICE Guidance - October 2014

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of October 2014. This month there are three clinical guidelines that impact upon primary care.

The Multiple sclerosis guideline offers evidence-based advice on the diagnosis, care and treatment of adults with multiple sclerosis.

The Acute heart failure clinical guideline offers evidence-based advice on the care and management of adults with acute heart failure or possible acute heart failure.

The Gallstone disease clinical guideline offers evidence-based advice on the diagnosis and management of gallstone disease in adults.

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

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BNF 68

The 68th Edition of the British National Formulary has been published and it is currently being distributed in the NHS. 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 guidance on the incidence of venous thromboembolism associated with combined hormonal contraceptives
  • Updated oral doses of amoxicillin and ampicillin for children
  • New MHRA restrictions on the use of domperidone following a review of the risks and benefits of its use
  • Changes made to the recommendations on interchangeability of oral mesalazine preparations
  • New MHRA advice on self-administration of adrenaline for anaphylaxis
  • The dose of naloxone for acute opioid overdosage in adults and children has been revised
  • Updates to recommendations on doses and indications of paracetamol in children
  • Updates to guidance on the treatment of epilepsy

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 68 as soon as the print version arrives. The web version can be used to access the latest information if necessary.

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