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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog


.. starts tomorrow, as I'm sure you've noticed. I hope that you have all had a pleasant break from work and are ready for the challenges that will come in the year ahead.

I have taken the opportunity presented by this quiet time of year to check some areas of this site and have found some glitches that I've hopefully now fixed. My apologies to those of you who have subscribed but have not been getting your email notifications.

[Update] It would seem the glitch was a little harder to fix than I first thought but I'll keep working on it!

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Smoking Quit Kit

The Department of Health has announced the availability of the NHS Stop Smoking Quit Kit. Designed by smoking cessation experts and smokers the kit contains tools that are scientifically proven to help reduce cravings or have been developed in response to smokers’ needs.

When asked what would help them to quit:

  • More than half (54%) of smokers wanted help to manage cravings
  • One third of smokers wanted tools and advice to strengthen willpower
  • Nearly a third (32%) simply want something to do with their hands
  • Nicotine gum and patches were the most popular aids to quitting, with 42% of smokers planning on using a Nicotine Replacement Therapy (NRT) such as gum or patches this new year

The Quit Kit can be order online or by calling 0800 0 665 826 and includes the following:

  • A "train to win" willpower assessor helping quitters to identify smoking triggers and providing tips on how to avoid them
  • Two MP3 downloads that are scientifically proven to reduce cravings
  • A "tangle" – a new stress relieving distraction tool for the hands, to help manage cravings
  • A toothbrush – to remind quitters of the benefits of fresher breath and so they can see the difference when they brush (smokers get a yellow residue on their toothbrush)
  • A health/wealth wheel to work out how much money quitters can save and the immediate health benefits of quitting smoking
  • An A3 “Quit plan” wall chart so that quitters can mark their progress over 28 days and stay focused
  • Details of smokers’ local NHS Stop Smoking Services, where they can access NRT and stop smoking medicines, and tailored support – either through one to one or group sessions

Action: Clinicians should be aware of this kit especially when the New Year is traditionally a time that motivates individuals to make changes.

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Medicine mixing laws changed

The Medicines and Healthcare products Regulatory Agency (MHRA) completed a public consultation in July 2009 into the legal position of practitioners mixing and administering medicines in palliative care.

The review concluded that changes were necessary:

  • To allow doctors and dentists (who can already mix medicines themselves) to direct others to mix (other than a pharmacist under existing legislative provisions, or by a person holding a manufacturer’s licence)
  • To allow non-medical prescribers to mix medicines themselves and direct others to mix (other than a pharmacist under existing legislative provisions, or by a person holding a manufacturer’s licence)
  • To allow nurse and Pharmacist Independent Prescribers to prescribe unlicensed medicines for their patients on the same basis as doctors and supplementary prescribers

A statutory instrument (PDF) has now come into force that creates new exemptions from the restrictions imposed by sections 7 and 8 of the Medicines Act 1968.

It should be noted that the changes made do not currently extend to controlled drugs. However, the MHRA has already stated that it would not consider taking enforcement action for breaches of medicines legislation in the long standing accepted practice of prescribing and administering (and providing directions to others to administer) a mixture of licensed medication via a single injection or a syringe driver unless it would be in the public interest to do so.

Action: Clinicians can be reassured by this amendment to the law. It is hoped that the position with respect to controlled drugs will also be clarified.

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Sibutramine cardiovascular concerns

The European Medicines Agency (EMEA) has announced (PDF) that they will be conducting a safety review for sibutramine (Reductil®) after cardiovascular safety concerns were raised.

The Sibutramine Cardiovascular OUTcomes (SCOUT) trial involved approximately 10,000 patients who were overweight or obese and had risk factors for cardiovascular disease for example diabetes or dyslipidaemia. The study aimed to assess the efficacy of drug assisted weight loss using sibutramine on cardiovascular outcomes in this higher risk population.

The EMEA are reviewing data that indicate an increased risk of serious cardiovascular events, such as stroke or heart attack. In the meantime clinicians and patients are reminded to use sibutramine-containing medicines with caution, and only in accordance with the currently approved product information. It is noted that the patients recruited to the SCOUT study would have been contraindicated in the majority of cases.

Clinicians should refer to the Summary of Product Characteristics and be aware of the following:

  • Sibutramine is contraindicated in patients with a history of coronary artery disease, congestive heart failure, tachycardia, peripheral arterial occlusive disease, arrhythmia or cerebrovascular disease (stroke or TIA)
  • All patients taking sibutramine should be regularly monitored for increases in blood pressure and heart rate
  • Patients who do not lose at least 5% of their body weight within 3 months should stop treatment
  • The maximum treatment duration should not exceed one year

Action: Clinicians should be aware of this review and use sibutramine cautiously until it is completed. Preferential use of orlistat, for the time being at least, would seem sensible.

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December CKS Update

Clinical Knowledge Summaries (CKS) has been updated in December 2009 for the following clinical areas:

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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