Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - April 2017

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

Emtricitabine / Tenofovir (Truvada®) has been accepted for use in combination with safer sex practices for pre-exposure prophylaxis to reduce the risk of sexually acquired HIV-1 infection in adults at high risk. It should denoted that NHS Boards in Scotland will make it available within the next three months when systems are in place.

Insulin aspart (Fiasp®) has been accepted for the treatment of diabetes mellitus in adults. It is noted that this is a new formulation with a faster onset of action than another formulation of insulin aspart and is available at an equivalent cost.

Ticagrelor (Brilique®) has been rejected for use when co-administered with acetylsalicylic acid for the prevention of atherothrombotic events in adult patients with a history of myocardial infarction and a high risk of developing an atherothrombotic event. The manufacturer did not present a sufficiently robust clinical and economic analysis to gain acceptance.

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 - March 2017

During March 2017 Clinical Knowledge Summaries were updated for the following topics:

The following topics were all reviewed:

The topics have undergone minor restructures. The most significant change is that all people presenting with suspected TIA within the last week should be referred urgently (to be seen within 24 hours) to a stroke physician without risk stratification.

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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Dabigatran capsule colour change

The manufacturer of dabigatran (Pradaxa®) has written to healthcare professionals to advise that the colour of the capsule is being changed in a move that is likely to improve patient safety.

Dabigatran is available in three strengths, 75mg, 110mg and 150mg. Previously the capsule shell was the same colour for all three strengths with the size and imprint text being different. The new colour will see the 75mg capsule coloured white, the 110mg will be light blue and the 150mg will be two-tone white and light blue. The size and text imprint will remain the same. The changes have also removed sunset yellow as a colouring agent.

Patient support materials are available from company representatives or direct from the company by emailing of calling 01344 742 579.

Action: Clinicians should be aware of this change. Patients who are concerned that their medication has changed in appearance can be reassured and advised to continue to take dabigatran as prescribed.

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Drug Safety Update - March 2017

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2017 (PDF).

This issue contains updated advice on the increased risk of lower-limb amputation (mainly toes) associated with use of the SGLT2 inhibitor canagliflozin. The updated advice notes that the current evidence does not show an increased risk for dapagliflozin and empagliflozin, but warns the risk may be a class effect. As previously suggested, patients receiving canagliflozin should be monitored for risk factors for amputation such as poor diabetes control and vascular disease. Treatment should be stopped if foot complications such as infection, skin ulcers, osteomyelitis or gangrene develop. It is also noted that preventive foot care is important for all patients with diabetes and especially in those being treated with an SGLT2 inhibitor.

The issue also announces a year long pilot of a reporting scheme for healthcare professionals to report suspected adverse reactions to illicit drugs, particularly new psychoactive substances (or 'legal highs'). A new site is available containing the Report Illegal Drug Reaction form that also collects information about licensed medicine that may help identify common issues arising from combinations of specific licensed medicines and psychoactive substances.

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

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NICE Guidance - March 2017

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of March 2017. This month there are two guidelines that impact upon primary care.

The Stroke and transient ischaemic attack in over 16s clinical guideline has been updated to give a definition of aspirin intolerance, rather than a link to a definition. The guideline 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, although some interventions of up to 2 weeks are covered as well.

The Familial breast cancer clinical guideline has been updated after a review of the evidence for chemoprevention for women with no personal history of breast cancer. The guideline covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer. It aims to improve the long-term health of these families by describing strategies to reduce the risk of and promote early detection of breast cancer (including genetic testing and mammography). It also includes advice on treatments (tamoxifen, raloxifene) and surgery (mastectomy).

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

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