Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - June 2015

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of May 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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Hypnotics and cancer risk concerns

New research published in the journal Sleep Medicine has raised concerns of an association between the use of hypnotics and an increased risk of cancer, in particular lung cancer. This study has been published in the wider media (Daily Mail and Daily Express).

This study connected data from the Finnish Public Sector study with the Finnish Cancer Register and the Drug Prescription Register of Finland. 5,053 cases of cancer were matched with 24,388 controls. Sex, age, socio-economic status, employer, and geographical area were used for matching. Purchases of prescribed sleep medications were used as an indicator of use of these medications.

Compared to non-use of sleep medications the odds ratio was 1.18 (95% CI 1.01-1.39) for those who used more than 100 defined daily doses per year and 1.16 (95% CI 1.01-1.34) for those who had such medication for more than three years. In cancers of the respiratory system the odds ratio for >100 defined daily doses per year versus no use was further raised at 3.47 (95% CI 1.97-6.11).

There are several limitations to this study; the data are observational, purchase of a prescription is presumed to be equivalent to use and there appears to have been no corrections made for smoking status.

The authors conclude that, "sleep medications use was associated with increased cancer incidence of the respiratory system". However they also state that, "further studies are needed to examine potential carcinogenic mechanisms".

Action: Clinicians should be aware of this study. There are already good reasons to limit use of these medicines to severe cases and for short durations of treatment. This study may be an opportunity to reduce use in patients who are on long term treatment and who are concerned about their cancer risk.

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NICE Guidance - May 2015

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

The Challenging behaviour and learning disabilities guideline offers evidence-based advice on prevention and interventions for children, young people and adults with a learning disability and behaviour that challenges.

The Violence and aggression guideline offers evidence-based advice on the short-term management of violent and physically threatening behaviour in mental health, health and community settings. It is an update to guidance issued in February 2005 and now has recommendations for broader group of services.

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

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Why A&E Campaign

It is 10 years since the first video was uploaded to YouTube. So it's nice to see that the Think! Why A&E campaign has uploaded a video encouraging patients to access the right NHS service for their symptoms.

Action: This may be a useful resource for general practices to link on their websites and perhaps use on practice television systems with due regard for the copyright. Practices wishing to use this resource should contact Colette Cassin at Blackpool CCG.

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BNF 69

The 69th Edition of the British National Formulary has been published. 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 general guidance on drugs and driving in response to new regulations in force from March 2015
  • Updated guidance on risk assessment and treatment in the management of arrhythmias
  • Updated recommendations on minimising risk of osteonecrosis of the jaw and hypocalcaemia associated with denosumab following new MHRA advice
  • New guidance on dose adjustment in renal impairment for atorvastatin
  • New recommendations on concomitant use of drugs affecting the renin-angiotensin system
  • New guidance on dose adjustment in hepatic and renal impairment for zolpiclone
  • Updated guidance on assessing cardiovascular risk and modification of blood lipids in the primary and secondary prevention of cardiovascular disease
  • Updates to recommended regimens for prophylaxis against malaria for specific countries

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 69 via electronic methods were possible. The web version can be used to access the latest information if necessary.

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