Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

QIPP - Medicines Management Options

The National Prescribing Centre (NPC) has published a list (PDF) of potential work areas that offer opportunities for maintaining or improving quality and enhancing value for money.

Quality, Innovation, Productivity and Prevention or QIPP is a part of the Department of Health (DH) agenda for delivering better value for money in the NHS.

This document contains 15 areas where prescribing can be reviewed and, if considered appropriate, prioritised for local action to improve value for money.

It is also expected that the DH will launch a broad spectrum of QIPP initiatives in the late summer with there suggestions being made available now to aid future planning in PCTs and GP consortia.

Action: This document will be very useful to aid when planning future work that is intended to deliver better value for money.

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Contraceptive interaction guidance

The Faculty of Sexual and Reproductive Healthcare issued guidance (PDF) earlier this year about drug interactions with hormonal contraceptives.

The guidance discusses the impact of concurrent administration of contraceptives with several classes of drugs including antibiotics, enzyme-inducing drugs, progesterone receptor modulators, drugs that may affect absorption and drugs that affect stomach pH.

The recommendation that is the biggest change from current practice is that additional contraceptive precautions are no longer required to maintain contraceptive efficacy when using non-enzyme inducing antibiotics.

Action: This guidance should be considered essential information for clinicians who prescribe hormonal contraceptives or who prescribe medication to women already using hormonal contraceptives.

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Prescrire cleared by French court

As reported earlier, Prescrire had been sued by the manufacturer of tacrolimus ointment (Protopic®) on the grounds of "denigration" and claiming an "erroneous, or even deceitful, nature of certain critiques contained in the disputed article".

The Tribunal de Grande Instance de Paris rejected the case stating that Prescrire "did not exceed the legitimate objective that it had set for itself, nor the expectation on the part of its subscribers to have access to a documented critical analysis on a subject which falls into the domain of public interest and healthcare safety".

Prescrire note that this ruling supports the right to criticise provided that such criticism is supported by a rigorous and fully documented analysis.

Action: This ruling is welcome and supports the future of independent critical analysis of evidence to produce drug reviews.

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SMC Update - March 2011 [updated]

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

Adapalene and benzoyl peroxide gel (Epiduo®) has been rejected for use in the cutaneous treatment of acne vulgaris when comedones, papules and pustules are present. The clinical and economic case did not consider comparative efficacy versus alternative treatments.

[Updated] To clarify, Epiduo® has been rejected for use in combination with an oral antibacterial in severe acne in individuals who are contraindicated to or refuse treatment with oral isotretinoin.

Exenatide (Byetta®) has been accepted for restricted use in the treatment of type 2 diabetes mellitus in combination with thiazolidinediones with or without metformin in patients who have not achieved adequate glycaemic control. The restriction is to use in combination with metformin and a thiazolidinedione as a third-line pre-insulin treatment option.

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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BNF 61

The 61st Edition of the British National Formulary has been published and it is expected that it will soon be distributed within the NHS.

New or revised content in this version includes updated advice regarding:

  • Management of stroke
  • Antiepileptic medication in pregnancy
  • Rosiglitazone withdrawal
  • Drug interactions with combined hormonal contraceptives
  • Cautionary and advisory labels
  • Reorganisation of the Substance misuse section
  • New look for table summarising antibacterial therapy
  • Combined oral contraceptives tabulated

The web version has already been updated and printed version is available for purchase.

Action: All clinicians should start using BNF 61 as soon as the print version arrives. The web version can be used to access the latest information if necessary.

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