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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2024. This month there are two guidelines that impact upon primary care.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. It covers managing COVID-19 in babies, children, young people and adults in community and hospital settings. The update includes revised guidance and new recommendations on the use of anti-vial treatments for COVID-19.

The Atogepant for preventing migraine guideline has been published. It recommends this treatment as an option for preventing migraine in adults who have at least 4 migraine days per month, only if at least 3 preventive medicines have failed. It is further advised that treatment is stopped after 12 weeks if the frequency of migraine does not reduce by 50% in the case of episodic migraine or 30% in the case of chronic migraine. This treatment is reviewed in comparison to monoclonal antibody treatments and botulinum toxin type A and as such recommendation and treatment initiation would be supervised by a specialist.

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

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CKS Updates - April 2024

During April 2024 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and updated with minor structural and layout changes. The Axial spondyloarthritis topic has been renamed from "Ankylosing spondylitis" in line with current terminology, recommendations have been updated in line with current evidence and a new Assessment section has been added. The Hypercholesterolaemia - familial topic has a new section describing important risk factors and the prescribing information now includes bempedoic acid and inclisiran. The Insomnia topic now incorporates NICE recommendations on the use of Sleepio and daridorexant in the management of insomnia.

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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Prescription Charge Changes for 2024

The Department of Health and Social Care has announced changes to the NHS Prescription Charges that take effect from the 1st May 2024.

The prescription charge has increased by 25 pence from £9.65 to £9.90 for each item dispensed. In line with this increase, the price of the 3 month, 12 month and HRT Pre-Payment certificates has also increased, to £32.05, £114.50 and £19.80 respectively.

Action: Clinicians should be aware of the current prescription charge and also the value for money represented by pre-payment certificates, including the new HRT pre-payment certificate.

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Drug Safety Update - April 2024

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for April 2024 (PDF).

This issue reminds clinicians of the risk of psychiatric and sexual side effects seen in association with finasteride and notes that these effects can persist after discontinuation of treatment. It is recommended that patients are asked if they have a history of depression or suicidal ideation before commencing treatment and are advised to seek medical advice should symptoms develop during treatment. A patient card will be introduced in all finasteride packs, which will highlight the risk of sexual side effects and psychiatric side effects reported with finasteride to increase awareness among patients and prescribers.

This issue also reminds clinicians to be alert to the risk of neuropsychiatric reactions in all patients, including children and adolescents, who are prescribed montelukast. Warnings in the Patient Information Leaflet have been strengthened and highlighted for greater emphasis. It is recommended that patients and their caregivers are directed to read the list of neuropsychiatric reactions in the Patient Information Leaflet and to seek medical advice immediately should they occur. Treatment should be discontinued with the occurrence of new or worsening neuropsychiatric symptoms.

This issue also contains a summary of letters to healthcare professionals in March. 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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NICE Guidance - April 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of April 2024. This month there are two guidelines that impact upon primary care.

The Twin and triplet pregnancy guideline has been updated. It covers care for pregnant women and pregnant people with a twin or triplet pregnancy in addition to routine care during pregnancy and labour. The update makes new recommendations including the use of progesterone 200 mg vaginal capsules to prevent preterm birth.

The Endometriosis: diagnosis and management guideline has been updated. It covers diagnosing and managing endometriosis. It aims to raise awareness of the symptoms of endometriosis, and to provide clear advice on what action to take when women and people with signs and symptoms first present in healthcare settings. This update provides new and updated recommendations on treatment of endometriosis when fertility is a priority.

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

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