Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

March CKS Update

Clinical Knowledge Summaries (CKS) has been updated in March for the following clinical areas:

Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.

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NICE Influenza guidance deactivated

On 11th January the Department of Health notified healthcare professionals that rising levels of influenza had activated the NICE guidance for the supply of oseltamivir for the treatment and prevention of influenza.

In a similar notice, the Department of Health have now confirmed that recent surveillance data indicate that the overall rate of influenza has now dropped below the required threshold. The NICE guidance has therefore been deactivated.

Action: Clinicians should avoid prescribing antiviral drugs for the prevention and treatment of influenza following isolated cases.

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Lung age improves quit rate

The British Medical Journal has published the results of a study that assess the impact on smoking cessation of quoting estimated lung age following spirometry.

The study included 561 patients over the age of 35. All patients were given a lung function assessment. The intervention group were informed of their estimated lung age while the control group were given the measured forced expiratory volume at one second (FEV1).

The primary outcome was confirmed smoking cessation at 12 months after recruitment. Secondary outcomes included were changing in consumption of cigarettes and new diagnosis of chronic obstructive pulmonary disease.

Quit rates were 7.2% higher in the intervention group. (p=0.005, 95% confidence interval 2.2% - 12.1%). The paper also estimates the cost of the intervention at £280 although this does not include prescription treatments.

Action: Clinicians should quote lung age to patients who are smokers and undergo spirometric assessment. The broader use of spirometry as a smoking cessation aid needs careful consideration before it becomes routine practice.

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No Smoking Day

Today is No Smoking Day. The theme of the campaign this year is a challenge to smokers to last a week.

It is hoped that reaching a manageable target of quitting for a week will help quitters develop the confidence to that they can go on to a smoke-free life.

In related news, the Summary of Product Characteristics for varenicline (Champix®) has been updated to include warnings about depression and suicidal ideation after recommendations were made in a Europe-wide review.

Action: Clinicians should be aware of No Smoking Day and be prepared to fully support smokers who are trying to stop.

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SMC March Update

The Scottish Medicines Consortium has issued its monthly advice on new medicines.

Zoledronic acid infusion (Aclasta®) has been accepted for restricted use in patients who are unsuitable for or unable to tolerate oral treatment options for osteoporosis.

Salmeterol / fluticasone 50/500 micrograms inhaler (Seretide 500 Accuhaler®) was rejected for the treatment of patients with chronic obstructive airways disease (COPD), with a forced expiration volume in 1 second (FEV1) 50 to <60% predicted normal. The manufacturer did not present a sufficiently robust economic case to gain acceptance.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected medicines should be avoided.

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