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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - June 2022

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for June 2022 (PDF).

This issue advises clinicians that vitamin B12 deficiency is now considered to be a common side effect in patients on metformin treatment. The risk increases with higher dose or longer treatment duration and in those with existing risk factors. Checking vitamin B12 serum levels is recommended in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency, this may include megaloblastic anaemia or new-onset neuropathy. It is also advised that periodic monitoring for patients with risk factors for vitamin B12 deficiency should be considered.

Clinicians are also notified that a National Patient Safety Alert has been issued following serious reports of harm associated with insulin leakage during use of the Accu-Chek Insight Insulin pump with NovoRapid PumpCart prefilled insulin cartridges. It is recommended that patients should be moved onto alternative insulin pumps where possible.

This issue contains the latest COVID-19 vaccine and medicine information including an updated shelf life for Comirnaty® to 12 months and a warning on the risk of flare-ups of capillary leak syndrome in patients who already have this syndrome following Spikevax® use.

Lastly in this issue is a summary of letters to healthcare professionals in May. 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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SMC Update - June 2022

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

Relugolix / estradiol / norethisterone tablets (Ryeqo®) have been accepted for restricted use in the treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The restriction limits use to patients who have not responded to or are unsuitable for conventional therapies (first line treatments), such as tranexamic acid, hormonal contraceptives and intrauterine delivery systems.

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 - May 2022

During May 2022 Clinical Knowledge Summaries were published or updated in the following areas.

All of these topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Eczema - atopic topic now includes a prescribing information section for topical calcineurin inhibitors and the supporting evidence now incorporates the latest literature. The Headache - cluster topic now includes expanded prescribing information for the use of sumatriptan and zolmitriptan preparations for acute treatment of cluster headache. And the Irritable bowel syndrome topic recommendations on the diagnosis and management of irritable bowel syndrome have been updated in line with guidance from the National Institute for Health and Care Excellence and the British Society of Gastroenterology.

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 - May 2022

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2022. This month there is one guideline and one medical technologies guidance that impact upon primary care.

The Vaccine uptake in the general population guideline has been published. It aims to increase the uptake of all vaccines provided on the NHS routine UK immunisation schedule by everyone who is eligible.

The Sleepio to treat insomnia and insomnia symptoms medical technologies guidance has been published. Sleepio is is a self-help sleep improvement programme based on cognitive behavioural therapy for insomnia. It is recommended as a cost saving option for treating insomnia and insomnia symptoms in primary care for people who would otherwise be offered sleep hygiene or sleeping pills. A medical assessment is recommended before referral for people who may be at higher risk of other sleep disorder conditions.

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

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Plendil brand discontinued

According to the Electronic Medicines Compendium, Plendil is discontinued. This has been confirmed with the manufacturing company via the medical information department.

A letter was reportedly sent in September 2021 advising that this medication would be discontinued with effect from the end of December 2021. Continued availability of this medicine from other manufacturers would indicate that there are no safety concerns. The brand has most likely been discontinued for commercial reasons.

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 ensure a suitable alternative is arranged.

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