Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - December 2010

The National Institute of Health and Clinical Excellence has published new guidance for the month of December 2010. This month there are two technology appraisals that impact upon primary care.

The clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events technology appraisal is a review (PDF). There has been a change in the advice as follows:

  • Treatment with modified-release dipyridamole in combination with aspirin for people who have had an ischaemic stroke is now recommended only if clopidogrel is contraindicated or not tolerated
  • Treatment with modified-release dipyridamole in combination with aspirin for people who have had an ischaemic stroke or a transient ischaemic attack is no longer limited to 2 years’ duration from the most recent event
  • Clopidogrel is no longer recommended only for people who are intolerant of aspirin and have had an occlusive vascular event or have peripheral arterial disease

There is also a new appraisal for prucalopride (Resolor®) for the treatment of chronic constipation in women (PDF). Treatment is recommended provided at least two different types of laxatives at the highest possible recommended doses, for at least 6 months, which has provided inadequate relief and invasive treatment for constipation is being considered. In this instance a 4 week trial can be offered with a subsequent review of benefit. It is also recommended that prescribing is undertaken by a clinician with experience of treating chronic constipation.

Action: Clinicians should be aware of these recommendations and implement any necessary changes to practice.

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2 Comments to “NICE Guidance - December 2010”

  1. @Susan,

    That is certainly how I read it. If someone is on aspirin already and has an ischaemic stroke then the aspirin is replaced with clopidogrel.

    The evidence in this entire area is both sparse and not particularly strong for any of the choices which is probably why this guidance is so difficult to interpret and implement.

    Comment by Matthew Robinson — March 9, 2011 #
    Reply

  2. Does this mean that if on aspirin and has a stroke we add in clopidogrel or change to it?

    Comment by Susan Moore — March 8, 2011 #
    Reply

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