Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Bimatoprost 0.03% discontinued

The manufacturer of bimatoprost (Lumigan®) has discontinued the 0.3mg/ml or 0.03% strength of this product in dropped bottles, the 0.01% product and the unit dose version are not affected and remain available.

According to an Assessment Report at the European Medicines agency the lower strength product is a direct equivalent. The report states, "Compared with the current authorised strength which contains 0.3 mg/ml bimatoprost and 50 ppm benzalkonium chloride, the new strength contains a third of the concentration of bimatoprost (0.1 mg/ml) and 200 ppm benzalkonium chloride. The higher concentration of benzalkonium chloride increases the ocular absorption of bimatoprost thus allowing for a lower concentration of bimatoprost to be administered (0.1 mg/ml). This new formulation, with a reduced concentration of bimatoprost, achieves comparable IOP-lowering efficacy to the current authorised strength and an improved overall safety profile.

There is a cost difference between the two strengths with the 0.03% strength currently priced at £10.30 for 3ml and the 0.01% strength currently more expensive at £11.71 for 3ml.

Action: Clinicians should be aware of this product being discontinued. 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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NICE Guidance - August 2015

The National Institute of Health and Care Excellence (NICE) have published new guidance for the month of August 2015. This month there are four clinical guidelines that impact upon primary care.

The Type 1 diabetes in adults guideline covers the care and treatment of adults (aged 18 and over) with type 1 diabetes. This guideline updates and replaces the sections for adults in NICE guideline CG15.

The Diabetes (type 1 and type 2) in children and young people guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. The guideline recommends strict targets for blood glucose control to reduce the long-term risks associated with diabetes.

The Diabetic foot problems guideline covers prevention and management of foot problems in children, young people and adults with diabetes. The guideline aims to reduce variation in practice.

The Antimicrobial stewardship guideline covers the effective use of antimicrobials (including antibiotics) in children, young people and adults. It aims to change prescribing practice to help slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment for infection.

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

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NICE Guidance - July 2015

The National Institute of Health and Care Excellence (NICE) have published new guidance for the month of July 2015. This month there is one technology appraisal that impacts upon primary care.

The naloxegol technology appraisal recommends this treatment as an option people with opioid induced constipation that has had an inadequate response to laxatives.

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

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Meningococcal B Vaccination Information

Public Health England has published information for healthcare professionals about the introduction of immunisation against meningococcal B disease for infants aged from 2 months with effect from September 2015.

The aim of the vaccination (Bexsero®) is to reduce the burden and severity of invasive meningococcal disease caused by Neisseria meningitidis capsular B in the UK by protecting those at increased risk of disease. Starting on the 1st September 2015 all infants born on or after the 1 July 2015 will be eligible for the meningococcal B vaccine which will be administered together with the other primary immunisations at 2 months, 4 months and 12 months. There will also be a catch-up programme for infants born from 1st May 2015 to the 30th June 2015.

Action: Clinicians should be aware of these changes to the national vaccination programme. Anyone involved with the delivery of the vaccination programme should ensure they familiar with the new vaccine and the proposed catch-up programme.

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NICE Guidance - June 2015

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of June 2015. This month there are four guidelines and one technology appraisal that impact upon primary care.

The Suspected cancer: recognition and referral guideline offers evidence-based advice on the recognition of and referral for suspected cancer in children, young people and adults. This guideline is an update to CG27 published in June 2005.

The Lower urinary tract symptoms in men: assessment and management guideline offers evidence-based advice on the effective management of lower urinary tract symptoms (LUTS) in men. A new recommendation on phosphodiesterase-5 inhibitors has been added to section on drug treatment advising that these agents are not used solely for the purpose of treating lower urinary tract symptoms in men, except as part of a randomised controlled trial.

The Anaemia management in people with chronic kidney disease guideline offers evidence-based advice on diagnosing and managing anaemia of chronic kidney disease. This guideline is an update to CG114 published in February 2011.

The Workplace Health guideline makes recommendations on improving the health and wellbeing of employees, with a particular focus on organisational culture and context, and the role of line managers.

The Apixaban technology appraisal recommends this treatment, within its marketing authorisation, as an option for treating and preventing recurrent 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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