Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - September 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of September 2016. This month there are three guidelines and one clinical guideline that impact upon primary care.

The Multimorbidity: clinical assessment and management guideline covers optimising care for adults with multimorbidity (multiple long-term conditions) by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care. It aims to improve quality of life by promoting shared decisions based on what is important to each person in terms of treatments, health priorities, lifestyle and goals. The guideline sets out which people are most likely to benefit from an approach to care that takes account of multimorbidity, how they can be identified and what the care involves.

The Harmful sexual behaviour among children and young people guideline covers children and young people who display harmful sexual behaviour, including those on remand or serving community or custodial sentences. It aims to ensure these problems don’t escalate and possibly lead to them being charged with a sexual offence. It also aims to ensure no-one is unnecessarily referred to specialist services.

The Dementia clinical guideline was updated and covers preventing, diagnosing, assessing and managing dementia in health and social care, and includes recommendations on Alzheimer’s disease. It aims to improve care for people with dementia by promoting accurate diagnosis and the most effective interventions, and improving the organisation of services. The update replaces a recommendation with links to the Mental health problems in people with learning disabilities guideline.

The Mental health problems in people with learning disabilities guideline covers preventing, assessing and managing mental health problems in people with learning disabilities in all settings (including health, social care, education, and forensic and criminal justice). It aims to improve assessment and support for mental health conditions, and help people with learning disabilities and their families and carers to be involved in their care.

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 - September 2016

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for September 2016 (PDF).

This issue contains updated advice on emergency hormonal contraception in patients taking hepatic enzyme inducers. It is now advised that women taking hepatic enzyme inducers, or who have taken them in the previous 4 weeks, are recommended to preferably use a non-hormonal emergency contraceptive - i.e. a copper intrauterine device. Where this is not possible a double dose of levonorgestrel must be used. It is also advised that a pregnancy test is performed to exclude pregnancy after use of levonorgestrel-containing emergency contraception and advice sought if they do become pregnant.

Hepatic enzyme inducers include medicines used to treat:

  • epilepsy (e.g. barbiturates, primidone, phenytoin, carbamazepine)
  • tuberculosis (e.g. rifampicin, rifabutin)
  • HIV (e.g. ritonavir, efavirenz)
  • fungal infections (e.g. griseofulvin)
  • and Herbal remedies that contain St John’s wort (Hypericum perforatum)

This issue also contains additional information that posaconazole suspension and tablets are not dose equivalent as noted in the summary of letters to healthcare professionals in last month's update.

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

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SMC Update - September 2016

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

Calcipotriol and Betamethasone cutaneous foam (Enstilar®) has been accepted as a topical treatment of psoriasis vulgaris in adults. It is noted that this product may be associated with a small budget impact.

Fosfomycin granules (Monuril®) have been accepted for:

  • Treatment of acute lower uncomplicated urinary tract infections, caused by pathogens sensitive to fosfomycin in adult and adolescent females
  • Prophylaxis in diagnostic and surgical transurethral procedures

It is noted that consideration should be given to national guidance on the appropriate use of antibacterial agents.

Liraglutide (Victoza®) has been rejected for use as monotherapy for the treatment of adults with type 2 diabetes mellitus to achieve glycaemic control when diet and exercise alone do not provide adequate glycaemic control in patients for whom use of metformin is considered inappropriate due to intolerance or contraindications. The manufacturer has not made 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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Retigabine to be discontinued

The manufacturer of retigabine (Trobalt®) has written to healthcare professionals advising that this medicine is to be discontinued.

Retigabine is licensed as an adjunctive treatment of drug-resistant partial onset seizures with or without secondary generalisation in patients aged 18 years or older with epilepsy where other combinations have been inadequate or not tolerated.

The decision to discontinue this product is a commercial one based on limited use and a decline in new patients being started on this treatment. There are no safety concerns.

It is recommended that treatment is gradually withdrawn over a period of at least three weeks and safety monitoring should continue during treatment. No new patients should be started on this treatment. The manufacturer is working with regulatory authorities and suppliers to ensure that this medication remains available for the next year to allow time for alternative treatment to be identified and initiated.

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 a review and arrangements made to identify a suitable alternative.

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CKS Updates - August 2016

During August 2016 Clinical Knowledge Summaries were updated for the following topics:

There were no major changes but sections were added on the prognosis and diagnosis of bunions and there were some minor changes to the recommendations on management of greater trochanteric pain syndrome.

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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