Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MeReC Bulletin - Management of Constipation

The National Prescribing Centre (NPC) has published a MeReC Bulletin (PDF) that reviews the management of constipation.

The review uses a case-based approach to provide an overview of the management of constipation in adults but also touches on the management of children, pregnant and breastfeeding women.

The review also provides a list of medications that may cause constipation, red flag symptoms that may indicate a more serious underlying problem and some treatment goals proposed in the Clinical Knowledge Summary (CKS).

Action: Clinicians who see patients with constipation will find this bulletin a useful summary of the management of this condition.

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SMC Update - January 2011

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

Degarelix (Firmagon®) has been accepted for the treatment of adult male patients with advanced hormone-dependent prostate cancer. The SMC note the benefits of a patient access scheme (PAS) that improves the cost-effectiveness of degarelix and this recommendation is based upon continued access to this scheme.

Valsartan (Diovan®) has been accepted for restricted use in the treatment of hypertension in children and adolescents 6 to 18 years of age provided that treatment is recommended by a paediatric specialist consultant.

Fentanyl nasal spray (PecFent®) has been accepted for restricted use in the management of breakthrough pain in adults who are already receiving maintenance opioid therapy for chronic cancer pain in patients unsuitable for short-acting oral opioids.

Levetiracetam oral solution (Keppra®) has been restricted use as an adjunctive therapy in the treatment of partial onset seizures with or without secondary generalisation in children and infants from 1 month of age to 4 years with epilepsy provided that initiation and management is under the supervision of a paediatric neurologist.

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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Drug Safety Update - January 2011

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for January 2011 (PDF).

This issue contains drug safety advice warning clinicians of the increased incidence of cardiac failure when pioglitazone is used in combination with insulin, especially in patients with predisposing factors. The prescribing information for pioglitazone already contains these warnings and they are now being added to the prescribing information for all insulin products. Clinicians are advised to monitor patients on the combination for signs and symptoms of heart failure, weight gain, and oedema and to discontinue the pioglitazone if cardiac status deteriorates.

Clinicians are also informed of the worldwide withdrawal of sitaxentan (Thelin®), a drug for pulmonary arterial hypertension, due to unpredictable hepatotoxicity.

The hot topic section contains a summary of a recent American study that found that dextropropoxyphene can have serious effects on the heart even at normal therapeutic doses. Dextropropoxyphene is in co-proxamol which has been an unlicensed product in the UK since the product licence was withdrawn in 2007. This new data may prompt clinicians who still prescribe co-proxamol to reassess the balance of risks and benefits.

The stop press section provides reassurance that the seasonal influenza vaccines do not appear to increase the risk of febrile convulsions in children. At least 46,000 doses have been administered to children aged 6 months to 5 years this winter. There have been 2 reported cases of suspected febrile convulsions and in both cases the child recovered.

The stop press section also guides readers to the information for women and healthcare professionals made available in light of recent media coverage regarding the contraceptive implant Implanon®.

Action: Clinicians will find this publication to be a useful review of current issues in drug safety.

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Avaxim stock shortage

The manufacturer of Avaxim®, a hepatitis A vaccine, has written to healthcare professionals advising of a global shortage of this product.

The supply issues are as a result of a manufacturing problem and the manufacturer is currently unable to meet any orders.

Action: Clinicians should be aware of this shortage and seek an alternative supplier if affected.

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