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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Fracture prevention quick reference guides

The National Institute for Health and Clinical Excellence has updated its website to include Quick References Guides (QRGs) for the recently published fracture prevention guidance.

The QRGs are now available for Primary Prevention and Secondary Prevention. These QRGs provide a summary of the advice for preventing fragility fractures in post-menopausal women. Alendronate is the initial recommendation in both guidelines with alternative agents being recommended in individuals who cannot take alendronate and who meet more stringent treatment criteria.

Action: Clinicians will fine these summary guidelines more accessible than the full clinical guidelines.

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NICE rimonabant advice withdrawn

The National Institute for Heath and Clinical Excellence has withdrawn its guidance on the use of rimonabant for the treatment of overweight and obese patients.

The withdrawal of this guidance is as a result of suspension of the marketing authorisation for rimonabant (Acomplia®) by the European Medicines Agency (EMEA) for safety reasons.

Action: Clinicians should already be aware of this license suspension. No new prescriptions should be issued and patients should be advised that it is safe to stop treatment at any time.

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Cardiovascular outcomes and diabetes medications

The Archives of Internal Medicine has published a systematic review of cardiovascular risk associated with oral medication for type 2 diabetes.

Forty studies were included in the review varying in duration from 3 months to 4 years. Eight of the studies actually contained cardiovascular endpoints as a primary or secondary endpoint with the remaining 32 studies contained this information by reporting serious adverse events.

The analysis found a statistically significant reduction in cardiovascular mortality when comparing treatment with metformin with other active treatments or placebo. There was also an increased risk of cardiovascular morbidity and mortality associated with rosiglitazone but this finding was not significant.

The authors conclude that, "Larger, long-term studies taken to hard end points and better reporting of cardiovascular events in short-term studies will be required to draw firm conclusions about major clinical benefits and risks related to oral diabetes agents".

Action: This analysis confirms current recommendations. Metformin is the first line hypoglycaemic and rosiglitazone should be avoided where alternatives exist.

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NICE issues fracture prevention guidance

The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the primary and secondary prevention of fractures due to osteoporosis in postmenopausal women. The full guidance documents are currently available with quick reference guides (QRGs) and patient information due for publication shortly.

The full guidance documents for primary (PDF) and secondary (PDF) prevention contain the recommendations with a full discussion of the evidence and interpretation. This guidance has taken several years to complete (the final scope was published in October 2004) and is perhaps the most complicated set if guidance to be issued by NICE.

Action: Clinicians who treat patients with osteoporosis with the aim of preventing primary or secondary fractures should assess the recommendations made in these two documents and implement necessary changes to practice (More details are provided below). It is hoped that the QRGs will be available soon and make the advice more accessible.

Continue reading NICE issues fracture prevention guidance...

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The Department of Health has launched a new campaign called Change4Life aimed at tackling childhood obesity.

The Chief Medical and Nursing Officers have written to healthcare professionals to introduce this campaign. Research has shown that:

  • Parents acknowledge childhood obesity is a problem they do not think it is their problem
  • Parents underestimate the amount they and their children eat and overestimate the amount of activity the family does
  • Parents do not make the connection between unhealthy weight status and long-term health problems

The ultimate aim of the campaign is to encourage people to eat well, move more and live longer with a view to reducing obesity and the long-term health problems it can cause.

Action: Healthcare professionals should aim to support this campaign by providing healthy life advice where possible.

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