Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

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

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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NICE Guidance - September 2014

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

The Long-acting reversible contraception guideline has been re-issued with an addendum which updates the recommendations on progestogen-only subdermal implants. The new advice relates to information provided to women about these implants.

The Drug allergy guideline offers evidence-based advice on the diagnosis and management of drug allergy in adults, children and young people.

The Dyspepsia and gastro‑oesophageal reflux disease guideline offers evidence-based advice on the care and treatment of adults (aged 18 and over) with symptoms of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease (GORD), or both. It replaces CG17 that was published in August 2004 and contains new recommendations about investigation and referral, Helicobacter pylori eradication therapy, specialist management, and surveillance of Barrett’s oesophagus in people with dyspepsia.

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

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Domperidone Now Prescription Only

The Medicines and Healthcare products Regulatory Agency (MHRA) has announced that domperidone will no longer be available to purchase from pharmacies with effect from the 4th September 2014.

The Drug Safety Update from May 2014 warned of the risk of cardiac side effects especially in those with existing cardiac conduction conditions, impaired liver function or taking medication that may interact with domperidone.

It was noted that while community pharmacists are able to manage the majority of risks identified with this medicine, they would not routinely have access to a patient’s full medical history and would not quickly and accurately be able to assess which patients were at risk of cardiac side effects.

Action: Clinicians should be aware of this over the counter (OTC) drug withdrawal. Patients may present to GPs to enable continued access to this medication on prescription.

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NICE Guidance - July 2014

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

The Lipid Modification guideline offers evidence-based advice on the care and treatment of people at risk of cardiovascular disease and people who have had previous cardiovascular disease. It includes new and updated recommendations on risk assessment, lifestyle modifications and the use of lipid-lowering drugs. In particular the following changes are noted:

  • The QRISK2 risk assessment tool is recommended to assess CVD risk
  • Lipid-lowering drugs are now recommended in people with a QRISK of 10% when the management of all other modifiable CVD risk factors has been optimised
  • Atorvstatin 20mg daily is the recommended treatment for primary prevention and 80mg daily is recommended for secondary prevention

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

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