Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Antiviral Medicines Authorised for Influenza

The Department of Health has written to healthcare professionals via the Central Alerting System (PDF) to advise that antiviral medicines may now be prescribed at NHS expense due to rising levels in reporting of influenza-like illness.

Antiviral medicines can be prescribed for the prophylaxis and treatment of influenza, in accordance with National Institute for Health and Care Excellence (NICE) guidance and Schedule 2 to the National Health Service, commonly known as the Grey List or Selected List Scheme (SLS). Prescribing these medicines should be considered if patients are at risk of severe illness and/or complications from influenza if not treated, whether or not they are in a 'clinical at risk group'. The NICE guidance on the use of antiviral medicines covers treatment and prophylaxis.

Clinicians are reminded to endorse the prescription with 'SLS' to ensure that it can be dispensed in community pharmacies without undue delay. The letter also contains prescribing advice for children.

Action: Clinicians should be aware of this letter and familiarise themselves with the current NICE guidance.

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Thin Lancets Discontinued

The manufacturer of Thin Lancets has advised healthcare professionals that this product is being discontinued with effect from December 2015.

It is noted that Freestyle Lancets are a suitable equivalent product. This alternative is the same gauge (thickness) at 28g. Both lancets remain listed in the January 2016 Drug Tariff to allow existing stocks to be reimbursed on NHS prescriptions.

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

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Drug Safety Update - December 2015

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for December 2015 (PDF).

Clinicians are advised that mycophenolate mofetil and its active metabolite mycophenolic acid are associated with a high rate of serious birth defects and increased risk of spontaneous abortion. It is recommended that pregnancy is excluded before commencing treatment and that two effective forms of contraception are used during treatment and for a period after treatment (6 weeks for women and at least 90 days for men). Clinicians should ensure that women and men taking mycophenolate understand the risk of harm to a baby, the need for effective contraception, the need to plan for pregnancy and change treatment as necessary and the need to immediately consult a physician if there is a possibility of pregnancy. Finally it is noted that mycophenolate must not be used during pregnancy unless there is no suitable alternative treatment to prevent transplant rejection.

This month also notes that bisphosphonates have been linked with very rare reports (fewer than 1 in 10,000) of osteonecrosis of the external auditory canal. This diagnosis should be considered in patients receiving bisphosphonates who present with ear symptoms, including chronic ear infections, or in patients with suspected cholesteatoma. Associated risk factors include steroid use and chemotherapy, with or without local risk factors such as infection or trauma. Current data do not support a causal relation between denosumab and this condition but this situation is under close review, given that denosumab is known to be associated with osteonecrosis of the jaw.

Finally this month, warnings on fat redistribution and lactic acidosis are being removed from antiretroviral medicine product information (with the exception of zidovudine, stavudine and didanosine). These changed reflect current scientific understanding about lipodystrophy (including lipoatrophy) and lactic acidosis. Patients can be reassured that previous information about the risk of lipodystrophy and lactic acidosis for several medicines is no longer considered relevant.

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

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NICE Guidance - December 2015

The National Institute of Health and Care Excellence (NICE) have published new guidance for the month of December 2015. An updated version of the Diabetes guideline has already been published. In addition there is one clinical guideline and one technology appraisal that impact upon primary care.

The Care of dying adults in the last days of life guideline covers the clinical care of adults (18 years and over) who are dying during the last 2 to 3 days of life. It aims to improve end of life care for people in their last days of life by communicating respectfully and involving them, and the people important to them, in decisions and by maintaining their comfort and dignity. The guideline covers how to manage common symptoms without causing unacceptable side effects and maintain hydration in the last days of life.

The Ciclosporin for treating dry eye disease technology appraisal recommends ciclosporin eye drops (Ikervis) as a possible treatment for people with dry eye disease that has not improved despite treatment with artificial tears.

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

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SMC Update - December 2015

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

Atomoxetine (Strattera®) has been accepted for restricted use in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children of 6 years and older, in adolescents and in adults as part of a comprehensive treatment programme. Treatment must be initiated by a specialist in the treatment of ADHD, such as a paediatrician, child/adolescent psychiatrist, or psychiatrist. Diagnosis should be made according to current DSM criteria or the guidelines in ICD.

Co-careldopa (Duodopa®) has been rejected for the treatment of advanced levodopa-responsive Parkinson's disease with severe motor fluctuations and hyper-/dyskinesia when available combinations of Parkinson medicinal products have not given satisfactory results. The submitting company’s justification of the treatment’s cost in relation to its health benefits was not sufficient and in addition the company did not present a sufficiently robust economic analysis to gain acceptance

Efavirenz (Sustiva®) has been accepted for use in antiviral combination treatment of human immunodeficiency virus-1 (HIV-1) infected children aged 3 months to 3 years and weighing at least 3.5kg.

Ivermectin (Soolantra®) has been accepted for restricted use as a topical treatment of inflammatory lesions of rosacea (papulopustular) in adult patients. The restriction limits use to patients with moderate to severe inflammatory lesions of rosacea where a topical treatment is considered appropriate.

Naloxegol (Moventig®) has been accepted for the treatment of opioid-induced constipation in adult patients who have had an inadequate response to laxative(s).

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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