Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - December 2018

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

Brivaracetam (Briviact®) has been accepted for restricted use as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in children from 4 years to ≤15 years of age with epilepsy. The restrictions limits use to patients with refractory epilepsy and treatment should be initiated by physicians who have appropriate experience in the treatment of epilepsy.

Ciclosporin eye drops (Verkazia®) have been accepted for use in the treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents (until the age of 18)

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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CKS Updates - November 2018

During November 2018 Clinical Knowledge Summaries were published or updated in the following areas.

The following topics were all reviewed:

All of reviewed topics have undergone reviews and minor restructures.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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Bricanyl Turbohaler Supplies Low

The manufacturer of Bricanyl® Turbohaler has written to healthcare professionals, and also informed Asthma UK, advising that supplies of this inhaler are very low in the UK.

The reason behind this shortage is being investigated and it is currently expected that this issue will persist until the end of January 2019. Asthma UK is advising patients to check their inhalers and ensure they have adequate supply; it is also recommended to seek advice from a healthcare professional for a suitable alternative before their current inhaler runs out.

Switching to an alternative will require a change to salbutamol. Consideration should be given to the range of devices available including pressurised metered dose inhalers, breath actuated aerosols and dry powder inhalers. Provision of a spacer device may also be appropriate.

Action: Clinicians should be aware of this product supply shortage. It would be prudent to run clinical system searches to identify any patients who are currently prescribed this product to allow a review and arrangements made to identify a suitable alternative.

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NICE Guidance - November 2018

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2018. This month there are two guidelines that impact upon primary care.

The Heavy menstrual bleeding guideline has been updated. The update reinstates recommendations on ulipristal acetate (Esmya®) following a European Medicines Agency review. Information on shared decision making and monitoring for side effects has been added for this treatment option.

The Urinary tract infection (catheter-associated): antimicrobial prescribing guideline has also been published. It sets out an antimicrobial prescribing strategy for catheter-associated urinary tract infection in children, young people and adults. It aims to optimise antibiotic use and reduce antibiotic resistance.

Last month several similar guidelines were issued that were not included in last month's post, they are as follows:

As above, each aims to provide an antimicrobial prescribing strategy that aims to optimise antibiotic use and reduce antibiotic resistance.

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

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Cilest to be discontinued

The manufacturer of Cilest® (norgestimate and ethinyl estradiol) has written to healthcare professionals advising that this product will be discontinued with effect from July 2019.

The letter states that this was a commercial decision to exit the oral hormonal contraceptive market and it is stressed that the are no safety, efficacy or quality issues with the product. Current supplies are expected to last until mid-July 2019.

There are two alternative products that are currently available in the UK with the same active ingredients - Cilique® and Lizinna®.

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

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