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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - August 2022

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

Beclometasone, formoterol, glycopyrronium inhaler (Trimbow®) has been accepted for use as a maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a long-acting beta2-agonist and high dose of inhaled corticosteroid, and who experienced one or more asthma exacerbations in the previous year.

Somatrogon (Ngenla®) has been accepted for use in the treatment of children and adolescents from 3 years of age with growth disturbance due to insufficient secretion of growth hormone. It is noted that this is an additional treatment choice in the therapeutic class of recombinant human growth hormones.

Potassium citrate and potassium hydrogen carbonate granules (Sibnayal®) has been accepted for use in the treatment of distal renal tubular acidosis (dRTA) in adults, adolescents and children aged one year and older. It is noted that this advice applies only in the context of an approved NHSScotland Patient Access Scheme (PAS) and the evidence used for this decision is based on three days of treatment. As such it would be expected that this item would be prescribed in secondary care.

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 - July 2022

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

The Coronavirus - COVID-19 topic is new. All of the other topics have been reviewed and updated with minor structural and layout changes. A red flag section has been added to the Dyspepsia - pregnancy-associated topic and prescribing recommendations for acid-suppressing drugs have been updated in line with recent NICE guidelines. The Fibroids topic has been updated with an additional information section added to the Management section, which outlines specialist assessment and management options.

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 - July 2022

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of July 2022. This month there are four guidelines and one technology appraisal that impact upon primary care.

The Pneumonia in adults: diagnosis and management guideline has been reinstated. It was temporarily withdrawn in May 2020 because of the COVID-19 pandemic. It covers diagnosing and managing pneumonia in adults who do not have COVID-19. It aims to improve accurate assessment and diagnosis of pneumonia to help guide antibiotic prescribing and ensure that people receive the right treatment.

The Social, emotional and mental wellbeing in primary and secondary education guideline has been published. It covers ways to support social, emotional and mental wellbeing in children and young people in primary and secondary education (key stages 1 to 5), and people 25 years and under with special educational needs or disability in further education colleges. It aims to promote good social, emotional and psychological health to protect children and young people against behavioural and health problems.

The Melanoma: assessment and management guideline has been updated. It covers the assessment and management of melanoma (a type of skin cancer) in children, young people and adults. The update includes recommendations on genetic testing, staging, surgery.

The Urinary tract infection in under 16s: diagnosis and management guideline has been published. It covers diagnosing and managing first or recurrent upper or lower urinary tract infection (UTI) in babies, children and young people under 16. It aims to achieve more consistent clinical practice, based on accurate diagnosis and effective management.

The Icosapent ethyl with statin therapy for reducing the risk of cardiovascular events in people with raised triglycerides technology appraisal has been published. This treatment is recommended as an option for reducing the risk of cardiovascular events in adults. It is recommended if they have a high risk of cardiovascular events and raised fasting triglycerides (1.7 mmol/litre or above) and are taking statins, but only if they have:

  • established cardiovascular disease (secondary prevention), defined as a history of any of the following:
    • acute coronary syndrome (such as myocardial infarction or unstable angina needing hospitalisation)
    • coronary or other arterial revascularisation procedures
    • coronary heart disease
    • ischaemic stroke
    • peripheral arterial disease, and
  • low-density lipoprotein cholesterol (LDL‑C) levels above 1.04 mmol/litre and below or equal to 2.60 mmol/litre

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 - July 2022

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

This issue advises clinicians that a new safety review of topiramate has been initiated. This is in response to the results of an observational study reporting an increased risk of neurodevelopmental disabilities in children whose mothers took topiramate during pregnancy. Topiramate is already associated with an increased risk of congenital malformations and effects on fetal growth if used during pregnancy. Clinicians are advised to counsel patients who can become pregnant on the known and emerging risks of topiramate for an unborn baby and on the need to use effective contraception throughout use. It would be prudent to provide this counselling prior to commencing this medication and also at routine reviews.

This issue contains the latest COVID-19 vaccine and medicine information including product information updates for Vaxzevria®.

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

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

Solriamfetol (Sunosi®) has been accepted for restricted use to improve wakefulness and reduce excessive daytime sleepiness in adult patients with narcolepsy (with or without cataplexy). The restriction limits use to patients who have failed to respond to modafinil or have a contraindication or intolerance to modafinil.

Delafloxacin (Quofenix®) has been accepted for restricted use for the treatment of acute bacterial skin and skin structure infections (ABSSSI) in adults when it is considered inappropriate to use other antibacterial agents that are commonly recommended for the initial treatment of this infection. The restrictions limits use to patients with suspected or confirmed polymicrobial infection following treatment failure or when standard antibacterial therapies are not suitable. It is also noted that delafloxacin should be used on the advice of local microbiologists or specialists in infectious disease.

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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