Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - June 2019

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

Fluticasone/formoterol (Flutiform®) has been accepted for use in the regular treatment of asthma in children aged 5 to 12 years where the use of a combination product (an inhaled corticosteroid and a long-acting β2 agonist) is appropriate:

  • for patients not adequately controlled with inhaled corticosteroids and 'as required' inhaled short-acting β2 agonist
  • or for patients already adequately controlled on both an inhaled corticosteroid and a long-acting β2 agonist

This product has already been accepted for use in adults and adolescents aged 12 years and above on the same basis.

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 2019

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

The majority of topics have undergone reviews and minor restructures. The Hypercholesterolaemia - familial topic has been updated in line with current NICE guidance. The Ulcerative colitis topic has been significantly restructured with recommendations on the diagnosis and management amended in line with current evidence and the sections on specialist investigations and management have been updated and expanded.

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 2019

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

The Suspected neurological conditions: recognition and referral guideline has been published. It covers the initial assessment of symptoms and signs that might indicate a neurological condition. It helps non-specialist healthcare professionals to identify people who should be offered referral for specialist investigation.

The Stroke and transient ischaemic attack in over 16s: diagnosis and initial management guideline has been published and it replaces previous guidance from July 2008. It covers interventions in the acute stage of a stroke or transient ischaemic attack (TIA). It offers the best clinical advice on the diagnosis and acute management of stroke and TIA in the 48 hours after onset of symptoms.

The Crohn’s disease: management guideline has been published and it replaces previous guidance from October 2012. It covers the management of Crohn’s disease in children, young people and adults. It aims to reduce people’s symptoms and maintain or improve their quality of life.

The Ulcerative colitis: management guideline has been published and it replaced previous guidance from June 2013. It covers the management of ulcerative colitis in children, young people and adults. It aims to help professionals to provide consistent high-quality care and it highlights the importance of advice and support for people with ulcerative colitis.

The Prostate cancer: diagnosis and management guideline has been published and it replaces previous guidance from January 2014 and June 2015. It covers the diagnosis and management of prostate cancer in secondary care, including information on the best way to diagnose and identify different stages of the disease, and how to manage adverse effects of treatment. It also includes recommendations on follow-up in primary care for people diagnosed with prostate cancer.

The Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care diagnostics guidance has been published. It recommends that there is not enough evidence to recommend the routine adoption of lead-I electrocardiogram (ECG) devices to detect atrial fibrillation in primary care. Further research is recommended and centres already using these devices are encouraged to take part in research and data collection.

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 - May 2019

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

This issue only contains one item relevant to primary care and that is a request to help to reverse the decline in reporting of suspected adverse drug reactions (ADRs). 2018 saw a fall in the number of reported suspected (ADRs) to the Yellow Card Scheme and this was consistent across several reporter groups including GP, hospital pharmacists, community pharmacists, hospital doctors and nurses. Readers are reminded of the ways Yellow Cards can be submitted and are reminded that duplicate reports can be detected. So, to avoid under-reporting, send a Yellow Card, even if you think someone else has done it.

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

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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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