Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

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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Rupatadine discontinued

The product license holder of rupatadine (Rupafin®) has written to healthcare professionals advising that with effect from the 31st March 2015 this medicine will be effectively discontinued in the UK.

An agreement between the license holder and a UK based distributor has come to an end and a new distributor is not being sought. It is estimated that supplies would be exhausted by the end of March 2015. As such alternative treatment options will need to be considered.

Action: Clinicians should be aware of the product being discontinued. It may be prudent to run clinical system searches to identify any patients who are currently prescribed this product to allow an alternative to be arranged.

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Drug Safety Update - March 2015

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2015 (PDF). This month there are two updates pertinent to primary care.

A new e-learning module for corticosteroids has been created that aims to help clinicians understand how to identify, manage and avoid the
important side effects of these valuable and widely prescribed medicines - vital knowledge for optimising the use of corticosteroids.

Readers are also encouraged to report misleading medicines advertisements. Reports can be made to the MHRA at advertising@mhra.gsi.gov.uk or Prescription Medicines Code of Practice Authority (PMCPA) at complaints@pmcpa.org.uk.

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

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NICE Guidance - March 2015

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

The Medicines optimisation guideline offers best practice advice on the care of all people who are using medicines and also those who are receiving suboptimal benefit from medicines. The recommendations include topic areas such as medication review, medicines reconciliation and patient decision aids.

The Excess winter deaths and morbidity guideline makes recommendations on how to reduce the risk of death and ill health associated with living in a cold home. Clinicians may find this guideline useful when consulting vulnerable people.

The Maintaining a healthy weight guideline makes recommendations on behaviours that may help people maintain a healthy weight or prevent excess weight gain. The recommendations aim to:

  • encourage people to make changes in line with existing advice
  • encourage people to develop physical activity and dietary habits that will help them maintain a healthy weight and prevent excess weight gain
  • encourage people to monitor their own weight and associated behaviours
  • promote the clear communication of benefits of maintaining a healthy weight and making gradual changes to physical activity and diet
  • ensure messages are tailored to specific groups
  • ensure activities are integrated with the local strategic approach to obesity

The Depression in children and young people guideline has been updated in sections 1.5 and 1.6 where new recommendations on psychological therapies and antidepressants have been added.

The Empagliflozin technology appraisal recommends this treatment for type 2 diabetes, in combination with metformin, only if the person cannot take a sulfonylurea or is at significant risk of hypoglycaemia or its consequences. It can also be used in triple therapy in addition to metformin and a sulphonylurea or a glitazone, and finally use in combination with insulin, with or without other antidiabetic drugs is also allowed.

The Rivaroxaban technology appraisal recommends this treatment as an option within its marketing authorisation, in combination with aspirin plus clopidogrel or aspirin alone, for preventing atherothrombotic events in people who have had an acute coronary syndrome with elevated cardiac biomarkers. The risk of bleeding needs to be assessed before treatment is started and a decision on continuation of treatment should be taken no later than 12 months after starting treatment.

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

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