Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - January 2018

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

Eluxadoline (Truberzi®) has been rejected for use in adults for the treatment of irritable bowel syndrome with diarrhoea (IBS-D). The submitting company did not present a sufficiently robust economic analysis to gain acceptance

Metformin hydrochloride (Glucophage SR®) has been rejected for use to reduce the risk or delay of the onset of type 2 diabetes mellitus in adult, overweight patients with impaired glucose tolerance and/or impaired fasting glucose and/or increased HbA1C who are:

  • at high risk for developing overt type 2 diabetes mellitus and
  • still progressing towards type 2 diabetes mellitus despite implementation of intensive lifestyle change for 3 to 6 months

The manufacturer failed to make a submission.

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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Drug Safety Update - January 2018

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for January 2018 (PDF).

This issue advised clinicians that Daclizumab (Zinbryta®) has new restrictions on use and strengthened liver monitoring recommendations due to the risk of severe liver injury. Awareness is also raised on the very rare risk of severe cutaneous adverse reactions associated with recombinant human erythropoietins; patients on these medicines should stop treatment and seek immediate medical attention if they develop widespread rash and blistering.

Clinicians are also reminded to take extra care when prescribing or dispensing drugs when there are other names that look or sound similar. For example: risperidone and ropinirole. Following recent cases, six new examples have been added.

This issue also advised that co-dydramol has recently been licensed in two new strengths. Previously it was available as 10mg/500mg of dihydrocodeine and paracetamol. It is now available as 20mg/500mg and 30/mg/500mg, although these have existed previously as paracetamol and dihydrocodeine (Remedeine®). It is therefore now recommended that when prescribing co-dydramol that the tablet strength and dose are clearly indicated.

Finally this month, readers are encouraged to report suspected adverse reactions to the Yellow Card Scheme for any patients taking herbal medicines. When an adverse reaction is suspected, clinicians are encouraged to ask patients whether they are taking any herbal medicines and report the reaction accordingly.

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

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Notice of Testim Discontinuation

The manufacturer of Testim® has advised that it intends to cease production and supply of this product in 2018.

The product is currently out of stock but supplies are expected to be delivered in early 2018, currently estimated as February. However, once this delivery of stock has been made it seems the product will be discontinued with no further supplies being made. The manufacturer stresses that the decisions to discontinue this product is not due to issues regarding safety, quality or efficacy of the product.

Testim® contains 50 mg of testosterone in a 5g unit dose container. Testogel® would appear to be a reasonable replacement; it contains the same strength of testosterone in the same unit dose presentation.

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 suitable alternatives to be arranged.

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NICE Guidance - December 2017

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2017. This month there is one guideline, one diagnostic guideline and one technology appraisal that impact upon primary care.

The Autism spectrum disorder in under 19s clinical guideline has been updated to include ADHD as a factor associated with an increased prevalence of autism and changed references from DCM-4 to DCM-5. The guideline covers recognising and diagnosing autism spectrum disorder in children and young people from birth up to 19 years and it also covers referral.

The Atrial fibrillation and heart valve disease: self-monitoring diagnostic guideline has been updated removing the recommendations for the InRatio2 PT/INR monitor as this device is no longer available.

The Naltrexone–bupropion for managing overweight and obesity technology appraisal has been published. Naltrexone–bupropion (Mysimba®) is not recommended within its marketing authorisation for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity.

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

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Antiviral Medicines Authorised for Influenza Season 2017/18

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.

Surveillance data indicates an increase in influenza cases in the community, GPs and other prescribers working in primary care may now prescribe antiviral medicines for the prophylaxis and treatment of influenza. Doses and treatment schedules are contains in existing Public Health England guidance.

Clinicians are reminded to endorse the prescription with 'SLS' to ensure that it can be dispensed in community pharmacies without undue delay.

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

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