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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - July 2010

The National Institute of Health and Clinical Excellence has published new guidance for the month of July 2010.

This month there is a clinical guideline and public health guidance that have an impact on primary care. The clinical guideline details the care of adults with, or at risk of, delirium in hospital and in long-term residential care or a nursing home. The public health guidance reviews dietary interventions and physical activity interventions for weight management before, during and after pregnancy.

Action: Clinicians should be aware of these guidelines. They will be a useful resource for clinicians who care for patients in residential care or women of child-bearing age.

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Lipitor tablets getting smaller

The manufacturer of atorvastatin (Lipitor®) has written to doctors informing them that smaller round tablets will replace the existing oval shaped tablets across the range of strengths for atorvastatin.

A change in the manufacturing process has allowed the tablets to be made smaller. There will also be some changes to the tablet markings and the product packaging.

Action: Clinicians should be aware of the change and patients can be reassured that the active ingredient is unchanged.

Source: Personal communication

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MeReC Bulletin - Advanced Wound Dressings

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that reviews the evidence for the evidence based prescribing for advanced wound dressings (A2RA).

This bulletin reviews the evidence based for advanced wound dressings noting that lack of high-quality studies using clinically relevant endpoints. It is also noted that there is no robust clinical evidence that dressings containing antimicrobials (e.g. silver, iodine or honey) are more effective than unmedicated dressings for the prevention or treatment of wound infection.

The bulletin recommends that:

  • Unless the use of a specific dressing can be adequately justified on clinical grounds, it would seem appropriate for NHS health professionals to routinely choose the least costly dressing of the type that meets the required characteristics and is appropriate for the type of wound and its stage of healing
  • Indiscriminate use of topical antimicrobial dressings should also be discouraged because of concerns over bacterial resistance and toxicity

Action: Clinicians who prescribe or recommend dressings will find this bulletin a useful summary of the evidence.

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BNF for Children 2010-2011

The British National Formulary for Children 2010-2011 has been updated, published and made available online.

Hard copies can be ordered from the publishers however many NHS staff will receive a free hard copy through usual channels and can also access the online version at http://www.bnfc.nhs.uk.

Update prescribing information in this revision include:

  • Equivalent doses of morphine sulphate and diamorphine hydrochloride table: the table has been updated to improve clarity
  • Constipation: advice now takes into account the recommendations of the National Institute for Health and Clinical Excellence (NICE)
  • Melatonin: shared-care protocol that specify the manufacturer for the melatonin to be dispensed in the community are recommended
  • Paracetamol: dosage advice is now simpler, clearer and more consistent
  • Vaccinations in preterm babies: routine immunisation is recommended based on actual date of birth. The increased risk of apnoea in preterm babies is also highlighted with advice on how this should be managed

Action: BNFC is the primary source of prescribing information when prescribing to all children up to the age of 18 years.

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FDA to review ARB cancer link

The Food and Drugs Administration (FDA) has announced that it is conducting a safety review of angiotensin receptor blockers (ARBs) after a recently published study suggested they may be associated with an increased risk of cancer.

This announcement clarifies that:

  • FDA's review is ongoing and the Agency has not concluded that ARBs increase the risk of cancer
  • At this time, FDA believes that the benefits of these medicines continue to outweigh their potential risks
  • FDA recommends that these drugs continue to be used as recommended in their approved labels

The announcement also provides a useful summary of the data reported in the initial meta-analysis including details of several limitations in the analysis.

Action: Clinicians should be aware of this review. Concerned patients can be reassured or changed to angiotensin converting enzyme inhibitors (ACEI) where these drugs have not been tried previously.

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