Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - August 2017

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2017. This month there are three guidelines and three technology appraisals that impact upon primary care.

The Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women technology appraisal has been updated. The guidance on the use of etidronate for the primary prevention of osteoporotic fragility fractures in postmenopausal women has been withdrawn because etidronate is no longer marketed in the UK.

The Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women technology appraisal has also been updated. The guidance on the use of etidronate for the primary prevention of osteoporotic fragility fractures in postmenopausal women has been withdrawn because etidronate is no longer marketed in the UK.

The Bisphosphonates for treating osteoporosis technology appraisal has been published and partially updates both of the technology appraisals above.

The Developmental follow-up of children and young people born preterm guideline has been published and covers the developmental follow-up of babies, children and young people under 18 years who were born preterm (before 37+0 weeks of pregnancy). It explains the risk of different developmental problems and disorders, and specifies what extra assessments and support children born preterm might need during their growth and development.

The Fever in under 5s clinical guideline has been updated to include a cross-reference to the NICE guideline on sepsis.

The Nutrition support for adults clinical guideline has been updated to include links to resources in several of the recommendations.

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 - August 2017

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2017 (PDF).

This issue contains information on reports of ventricular tachyarrhythmia and an increased risk of hepatitis B reactivation and opportunistic infections in patients treated with ibrutinib (Imbruvica®). Treatment should be suspended in patients who develop ventricular tachyarrhythmia and consultant advice sought.

This issue also notes the rare risk of central serous chorioretinopathy is now associated with topical steroid use, as well as systemic use. Patients on steroid treatment should be encouraged to report any blurred vision or other visual disturbances and referred to an ophthalmologist for evaluation should they report problems with vision.

This issue also advised that, following a European review, it is recommended that two adrenaline auto-injectors are prescribed, which patients should carry at all times, for use in treating anaphylaxis. This recommendation is based upon uncertainties about the site of drug delivery and the speed of adrenaline action within the body. The manufacturers have been asked to carry out studies in humans to more fully understand when and how much adrenaline reaches the blood stream, and how quickly and effectively it acts on body tissues when given through an auto-injector.

In the summary of letters sent to healthcare professionals in July it is noted that further information has been sent to doctors and pharmacists about the use of valproate medicines in girls, women of childbearing potential and women who are pregnant or planning pregnancy. This information supports the advice issued in the Drug Safety Update in April 2017.

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

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SMC Update - August 2017

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

Desmopressin (Noqdirna®) has been accepted for restricted in the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults. The restriction limits use to adults aged 65 years and over.

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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Hepatitis B added to Routine Immunisation Schedule

Public Health England has announced that a hexavalent vaccine will be used for routine immunisation of babies born on or after 1st August 2017. This announcement has been covered by mainstream media outlets (BBC).

The introduced vaccine provides protection against diphtheria, tetanus, pertussis, Haemophilus influenzae type b, polio and now hepatitis B. Interestingly, the vaccine has been available since October 2000 with approximately 150 million doses given worldwide.

Routine vaccine schedules are also available. Children who were started on the schedule using the pentavalent vaccine should continue primary course with pentavalent vaccine unless this is not available, in which case the hexavalent vaccine can be used. The programme guidance provides lots of routine information about the vaccine including contraindications and precautions, storage and administration, vaccine composition and discussion of potential errors in administration.

Action: Clinicians who will be involved in the delivery of the routine infant immunisation programme should be aware of this announcement and may wish to familiarise themselves with details provided.

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CKS Updates - July 2017

During July 2017 Clinical Knowledge Summaries were updated in the following areas.

The following topics were all reviewed:

The majority of topics have undergone reviews and minor restructures.

The most significant changes are the expansion of assessment recommendations for Infantile Colic and the recommendations on primary care management and referral in the Dyspepsia topics.

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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