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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog


The Clinical Knowledge Summaries (CKS) web site as recently updated with a new layout. This update also introduced My CKS.

Registering for a My CKS account allows users to receive email notifications when content is added or update. Registered users can also customise the layout of the site.

Perhaps the most useful developments are the introduction of Shortcuts and Read-later Lists. These two areas allow users to bookmark areas of the site that they refer to regularly or to tag an article to read at a later date before deciding to bookmark it.

Action: All clinicians will find the CKS content extremely helpful during daily practice. Regular users will benefit from registration.

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NPC guide to Medication Review

The National Prescribing Centre has published a guide to Medication Review.

The guide is aimed at providers and commissioners of medication reviews with the aim of providing a framework for conducting reviews to ensure a consistent and effective approach. The document also provides a list of good practice points and highlights several case studies that provide good examples of medication review in different service settings.

Action: Any clinician who prescribes, reviews and amends medicines will find this document to be a useful resource when planning and delivering medication reviews.

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Second FAD for osteoporosis guidance

The National Institute for Health and Clinical Excellence has issued Final Appraisal Determinations (FAD) for Primary Prevention and Secondary Prevention of fractures in postmenopausal women with osteoporosis.

These are the second set of FAD documents to have been published. The originals were published almost a year ago but have been the subject of several appeals.

The current guidance is still considered to be in draft form until it is published as a completed appraisal. If the advice is not subjected to further appeals then alendronate will be the first line therapy choice with alternatives reserved for cases of intolerance but only in patients who have more severe osteoporosis as measured by T score.

Action: As previously recommended, clinicians should await the finalised NICE guidance before making changes to current practice or existing treatments.

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SMC July Update

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

Vildagliptin in combination with metformin (Eucreas®) has been accepted for restricted use (PDF). The combination should be used in patients for whom monotherapy with metformin provides insufficient glycaemic control and where the addition of a sulphonylurea is not appropriate. In this instance the addition of vildagliptin is an alternative to using glitazones.

Fesoterodine fumarate (Toviaz®) has also been accepted for restricted use (PDF). The advice notes that this drug is equivalent to existing therapies in terms of efficacy and also has a typical adverse event profile. The higher acquisition cost restricts this new drug to second-line use.

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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