Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC October Update

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

Metformin modified release (Glucophage SR®) has been restricted to use in patients who are intolerant of immediate release metformin where prolonged release tablet allows the use of a dose of metformin or in patients for whom a once-daily preparation offers a clinically significant benefit. It is noted that evidence of improved gastrointestinal tolerability is not convincing and that the prolonged-release formulation is more expensive.

Vildagliptin (Glavus®) has been accepted for use in combination with a sulphonylurea for the treatment of type 2 diabetes. This appraisal only reviews combination use with a sulphonylurea; previous advice has been issued for combination use with metformin, combination use with glitazones cannot currently be recommended pending a submission.

Olmesartan/amlodipine (Sevikar®) has been accepted for treatment of essential hypertension in patients whose blood pressure is not adequately controlled on olmesartan or amlodipine monotherapy. The review notes that angiotensin receptor blockers are an alternative to ACE inhibitors where these are not tolerated. It is also noted that this fixed dose combination product offers a cost advantage over the individual drugs at certain doses but that other treatment options may be available which are less expensive.

Estradiol/dienogest (Qlaira®) has been rejected for use as a contraceptive in the absence of a submission from the manufacturer.

Etonogestrel (Nuvaring®) has been accepted for use as a contraceptive. Cost efficacy was demonstrated against women who chose to discontinue oral contraceptives and it is therefore noted that other non-oral contraceptives are available at lower cost.

Quetiapine (Seroquel®) has been rejected for the treatment of major depressive episodes associated with bipolar disorder. Efficacy relative to current practice was not demonstrated.

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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