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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2024. This month there is one guideline thats impacts upon primary care.

The Tuberculosis guideline has been updated. It covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. This update has removed family history of TB in the past 5 years from the list of criteria for BCG vaccination in neonates in low-incidence areas in line with national recommendations. It is also noted that antibiotic recommendations are being reviewed following the MHRA drug safety update regarding fluoroquinolone antibiotics.

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

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Drug Safety Update - February 2024

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for February 2024 (PDF).

This issue notifies clinicians that codeine linctus has now been reclassified as a prescription-only medicine (POM), following a public consultation. A recent review identified greater levels of recreational use than the intended use as a cough suppressant. As a risk minimisation measure to protect the health of patients this product will no longer be supplied without a prescription.

This issue also advises clinicians that pseudoephedrine has been very rarely associated with posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS). These conditions present with a sudden severe headache or thunderclap headache, sudden onset of nausea and vomiting, confusion, seizures and/or visual disturbances. Urgent medical attention should be sought if these symptoms occur and patients presenting with these symptoms should be asked about their medication history.

Lastly in this issue is a summary of letters to healthcare professionals in January. These generally related to supply issues and recalls but also include letters sent to appropriate healthcare professionals about revised educational materials for valproate-containing medicines, the dose-dependent increased risk of atrial fibrillation in patients using omega-3-acid ethyl ester medicines as reported in the drug safety update last month and a change to the pump priming advice prior to first use of Tostran® (Testosterone, 2% gel) following a manufacturing change.

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

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CKS Updates - January 2024

During January 2024 Clinical Knowledge Summaries were published or updated in the following areas.

The Spondyloarthritis and psoriatic arthropathy topic is new. The remaining topics have all been reviewed and updated with minor structural and layout changes. The Neck pain - whiplash injury topic has a new section section providing information on prevalence, causes and complications. The Sinusitis topic has updated the classification of chronic sinusitis in line with the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020). The Urinary tract infection (lower) - women topic has been updated in line with the UK Health Security Agency (UKHSA) quick reference tool for primary care for diagnosis and urinalysis and the management recommendations of UTI with haematuria have been updated in line with the NICE guideline on suspected cancer.

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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NICE Guidance - January 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of January 2024. This month there are three guidelines that impact upon primary care.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. It covers managing COVID-19 in babies, children, young people and adults in community and hospital settings. The update contains editorial changes and transferred the guideline from the MAGICapp platform to the NICE website.

The COVID-19 rapid guideline: managing the long-term effects of COVID-19 guideline has been updated. It covers covers identifying, assessing and managing the long-term effects of COVID-19, often described as 'long COVID'. The update contains presentation changes and transferred the guideline from the MAGICapp platform to the NICE website.

The Suspected sepsis: recognition, diagnosis and early management guideline has been updated. It covers the recognition, diagnosis and early management of suspected sepsis. The update makes new recommendations on risk evaluation and management of suspected sepsis for people aged 16 or over who are not and have not recently been pregnant, in mental health, ambulance and acute hospital settings.

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

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Drug Safety Update - January 2024

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for January 2024 (PDF).

This issue notifies clinicians of the new safety and educational materials to support regulatory measures to reduce the harms from valproate in men and women under 55 years of age. This includes a patient information leaflet, a patient guide and an information page that collects all resources in one place.

This issue also advises clinicians that systemic fluoroquinolone antibiotics must now only be prescribed when other commonly recommended antibiotics are inappropriate. The MHRA has recently reviewed the existing measures in place to encourage safe prescribing and has now taken additional regulatory actions to update prescribing information for all systemic fluoroquinolones.

Also this month, clinicians are notified that systematic reviews and meta-analyses of randomised controlled trials have highlighted a dose-dependent increased risk of atrial fibrillation in patients using omega-3-acid ethyl ester medicines. These studies recruited patients with established cardiovascular diseases or cardiovascular risk factors but in this population the incidence of atrial fibrillation was 3.9% when active treatment was compared to placebo. It is recommended that patients are advised to seek medical attention if they develop symptoms of atrial fibrillation and if atrial fibrillation is confirmed the medicine should be discontinued permanently.

Lastly in this issue is a summary of letters to healthcare professionals in December. These generally related to supply issues and recalls.

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

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