Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - August 2014

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2014 (PDF).

This drug safety section in this issued advises clinicians of a recent European review of emergency contraceptives. The relationship between increasing body weight or BMI and efficacy of emergency contraceptives was considered. Concerns have been raised that emergency contraceptives may be less effective as body weight or BMI increases but this review found that the available data are inconclusive. The overall conclusion was that emergency contraceptives are suitable for all women regardless of body weight or body mass index. Readers are reminded that emergency contraceptives should be used as soon as possible after unprotected sex or contraceptive failure to prevent unintended pregnancy and should not be used to replace a regular contraceptive method.

This issue also advises that the learning module on anticoagulants has been launched. Responding to feedback on previous learning modules, this one is reported to be much more interactive.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

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Drug Safety Update - July 2014

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for July 2014 (PDF).

The stop press section warms of the risks of accidental exposure to strong opioids in patches as a consequence of incorrect disposal. There have been three reported cases of accidental exposure or inadvertent patch transfer. It is recommended that patients and caregivers follow the disposal instructions on the patch carton and in the accompanying leaflet.

This issue also advised that the learning module on opioids has been updated to include recent concerns about transdermal patches and the self-assessment questions have been revised.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

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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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MTRAC Reviews - July 2014

MTRAC issued a new Commissioning Support guidance in July 2014. The review covers DPP-4 inhibitors.

This Commissioning Guidance (PDF) reviews the evidence for all of the currently available 'gliptins'. It notes that no significant differences in blood glucose reducing efficacy have were identified in a systematic review or in a direct comparison between sitagliptin and saxagliptin. It is also noted that the current NICE Guidance recommends continued treatment with DDP-4 inhibitors only when there is a beneficial metabolic response (HbA1c reduction of 0.5% or 5-6mmol/mol). This guidance summary recommends that, "if a gliptin is to be used, it is advised that the gliptin is selected based on the appropriate licensed indications, with the lowest acquisition cost".

Action: Clinicians should be aware of these reviews and use the recommendations to guide appropriate use of these medicines in current practice.

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BNF for Children 2014-2015

The hard copy of the British National Formulary for Children 2014-2015 has been updated and published. Electronic versions are updated monthly.

Hard copies can be ordered from the publishers however many NHS clinicians should receive a free hard copy through usual channels and can also access the online version.

Significant changes in this revision include:

  • Revised dose and monitoring requirements for gentamicin in neonatal sepsis
  • Safety restrictions on the use of codeine, domperidone, and metoclopramide
  • Significant dose changes to amoxicillin, ampicillin, paracetamol, metronidazole, and naloxone
  • New advice on switching between different manufacturers’ products of an antiepileptic drug
  • Updated advice on the use of ototoxic ear drops in children with perforated tympanic membrane or patent grommet
  • Changes to recommendations on interchangeability of oral mesalazine preparations
  • Updated guidance on prevention of pertussis
  • Rotavirus vaccine included on immunisation schedule, and changes to schedule for meningococcal group C conjugate vaccine
  • New safety information on serious hypersensitivity reactions with intravenous iron

Action: BNFC is the primary source of prescribing information when prescribing to all children up to the age of 18 years.

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