Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - May 2019

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

Cariprazine (Reagila®) has been accepted for restricted use in the treatment of schizophrenia in adult patients. The restriction limits use to second-line therapy in patients where predominantly negative symptoms have been identified as an important feature.

Latanoprost and timolol (Fixapost®) has been accepted for restricted use for the reduction of intraocular pressure (IOP) in patients with open angle glaucoma and ocular hypertension who are insufficiently responsive to topical beta-blockers or prostaglandin analogues. The restriction limits use to patients who have proven sensitivity to preservatives.

Doxylamine succinate and pyridoxine hydrochloride (Xonvea®) has been rejected for the treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management. The submitting company did not present a sufficiently robust clinical or economic analysis to gain acceptance by SMC.

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 - April 2019

During April 2019 Clinical Knowledge Summaries were published or updated in the following areas.

The majority of topics have undergone reviews and minor restructures. The CVD risk assessment and management topic now recommends using the QRISK3 risk prediction tool. The Chronic kidney disease topic has had an Assessment section added, more information on the management of people with diabetes mellitus and chronic kidney disease is provided and the prescribing information section has been updated.

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 - April 2019

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of April 2019. This month there are three guidelines that impact upon primary care.

The Urinary incontinence and pelvic organ prolapse in women guideline has been published. It covers assessing and managing urinary incontinence and pelvic organ prolapse in women aged 18 and over. It also covers complications associated with mesh surgery for these conditions. It updates and replaces four previous guidance documents.

The Surgical site infections: prevention and treatment guideline has been published. It covers preventing and treating surgical site infections in adults, young people and children who are having a surgical procedure involving a cut through the skin. It focuses on methods used before, during and after surgery to minimise the risk of infection.

The Ectopic pregnancy and miscarriage: diagnosis and initial management guideline has been published. It covers diagnosing and managing ectopic pregnancy and miscarriage in women with complications, such as pain and bleeding, in early pregnancy (that is, up to 13 completed weeks of pregnancy). It aims to improve how early pregnancy loss is diagnosed, and the support women are given, to limit the psychological impact of their loss.

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 - April 2019

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for April 2019 (PDF).

This issue warns that yellow fever vaccine (Stamaril®) must not be given to anyone who is immunosuppressed and extreme caution needs to be used people aged 60 years and older due an increased risk of life-threatening reactions. This follows two recent reports of fatal adverse reactions with suspected yellow fever vaccine-associated viscerotropic disease (YEL-AVD) shortly after administration of the vaccine.

This issue also advises that the Annual Risk Acknowledgement Form, which should be used during annual specialist review of all women and girls of childbearing potential on valproate medicines, has been updated. The updated form dated March 2019 should be used in future reviews.

Readers are reminded that pregabalin (Lyrica®) and gabapentin (Neurontin®) were rescheduled as controlled drugs with effect from the start of this month. It is recommended that healthcare professionals evaluate patients carefully for a history of drug abuse before prescribing pregabalin and gabapentin and observe patients for development of signs of abuse and dependence.

Finally this month, the summary of letters to healthcare professionals includes a letter advising of the new restrictions and precautions for use of fluoroquinolone antibiotics as covered in Drug Safety Update last month.

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

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SMC Update - April 2019

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

Testosterone (Testavan®) has been accepted for restricted use as testosterone replacement therapy for adult male hypogonadism, when testosterone deficiency has been confirmed by clinical features and biochemical tests. The restriction limits use to patients requiring a transdermal delivery system and it is noted that this product is bioequivalent to another testosterone transdermal preparation and costs less.

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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