Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - January 2015

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of January 2015. This month there is one clinical guideline that impacts upon primary care.

The Gastro-oesophageal reflux disease: recognition, diagnosis and management in children and young people clinical guideline offers evidence-based advice on the recognition, diagnosis and management of gastro-oesophageal reflux disease in children and young people. This is also the first guideline issued in a new number system introduce this year.

This guidance notes that that reflux is very common in well infants and does not require treatment, but that clinicians should be alert to red flag symptoms which may suggest GORD or other disorders.

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

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Key therapeutic topics 2015

The Medicines and Prescribing Centre at NICE has published the 2015 update to Key therapeutic topics - Medicines management options for local implementation (PDF).

This publication summarises key therapeutic areas where there are potential opportunities for maintaining or improving quality and improving value.

This update has retained the previous 14 therapeutic topics. All the topics have been reviewed and updated in the light of new guidance and important new evidence. Changes include:

  • KTT2: Renin-angiotensin system drugs. The addition of a table summarising NICE recommendations on the use of renin-angiotensin system drugs in various indications
  • KTT3: Lipid-modifying drugs. Updated to reflect recommendations in the NICE guideline on lipid modification, published in July 2014
  • KTT4: Omega 3 fatty acid supplements. Updated to reflect recommendations in the NICE guideline on MI – secondary prevention, published in November 2013 and the NICE guideline on lipid modification, published in July 2014
  • KTT9: Antibiotic prescribing – especially broad spectrum antibiotics. Updated in line with Public Health England guidance on managing common infections, which was updated in November 2014
  • KTT10: Three-day courses of antibiotics for uncomplicated urinary tract infection. Updated in line with Public Health England guidance on managing common infections, which was updated in November 2014

Action: Clinicians and Commissioners should be aware of this document. The key topic areas can be reviewed and prioritised based upon local need and current performance.

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SMC Update - January 2015

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

Aztreonam lysine (Cayston®) has been accepted for restricted as suppressive therapy of chronic pulmonary infections due to Pseudomonas aeruginosa in patients with cystic fibrosis aged six years and older. Use is limited to cases where inhaled colistimethate sodium and inhaled tobramycin are not tolerated or providing an unsatisfactory therapeutic benefit. It is also contingent on the continued availability of a Patient Access Scheme (PAS) that improves the cost effectiveness.

Brimonidine (Mirvaso®) has been accepted for restricted use in the symptomatic treatment of facial erythema of rosacea in adult patients. The restriction limits use to patients with moderate to severe persistent facial erythema associated with rosacea.

Canagliflozin plus metformin (Vokanamet®) has been accepted for restricted use in type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycaemic control. The restriction limits use of this product to patients where combination of canagliflozin and metformin is an appropriate choice of therapy.

Olodaterol (Striverdi®) has been accepted for use as maintenance bronchodilator treatment in patients with chronic obstructive pulmonary disease.

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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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 December 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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