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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2011

The National Institute of Health and Clinical Excellence has published new guidance for the month of May 2011. This month there is one clinical guideline, one technology appraisal and one public health guidance that impact upon primary care.

The Common mental health disorders clinical guideline (QRG) offers advice on the care and treatment of adults who have common mental health disorders, with a particular focus on primary care. It covers depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and social anxiety disorder.

The Peripheral arterial disease technology appraisal (QRG) reviews the role of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate in the treatment of intermittent claudication in patients with peripheral arterial disease. Naftidrofuryl is recommended as an option while the other three options are not recommended.

The Preventing type 2 diabetes public health guidance (QRG) aims to help prevent type 2 diabetes among populations and communities of adults who are at high risk. Several risk factors for developing type 2 diabetes are explored and strategies to promote a healthy diet and greater physical activity are recommended.

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

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MeReC Extra 49

The National Prescribing Centre has published MeReC Extra 49 (PDF) which discusses recent important changes to a piece of guidance from the National Institute for Health and Clinical Excellence (NICE) and the results of an observational study of angiotensin receptor blockers (ARBs) in heart failure.

The first topic reviews the changes in the recommendations regarding the use of antithrombotics in for the prevention of occlusive vascular events. It provides a useful summary of the new recommendations reviewing the advice for patients after an ischaemic stroke, transient ischaemic attack, myocardial infarction or those with peripheral arterial disease or mulitvascular disease.

The second topic reviews the results of a recent observational study in patients with heart failure that indicated there may be improved survival in those treated with candesartan compared with losartan. The study did have some limitations such as being an observational study and having no control arm. The article reminds clinicians that ARBs are still only recommended as second line alternatives to angiotensin converting enzyme inhibitors (ACEI) in patients who develop an intolerable cough.

Action: Clinicians who see patients with vascular disease or heart failure will find this information useful and informative.

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Green Book advises against routine fever prevention

The Green Book has been updated (PDF) and now advises that routine prevention of fever following vaccination is not recommended as it may result in lower antibody responses to some vaccines.

This advice is based upon a previously reported study that found successive doses of paracetamol appeared to reduce the level of antibody production. This new advice recommends that ibuprofen is also avoided.

Action: Clinicians should be aware of these new recommendations. Parents should be advised on the use and appropriate dose of paracetamol or ibuprofen liquid to treat a fever but should be cautioned against using these drugs to prevent a fever.

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Drug Safety Update - May 2011

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

This issue contains drug safety information advising clinicians of rare reports of serious hypersensitivity reactions noted with prasugrel (Efient®). These reactions have included cases of angioedema; some of which occurred in patients with a history of hypersensitivity to clopidogrel. Patients are advised to immediately report symptoms suggesting hypersensitivity (e.g. swelling of the face, neck, tongue, lips, or throat; rash; itching or shortness of breath) and clinicians are asked to report such reactions through the yellow card scheme.

This issue also reports that the smoking cessation product Nicobrevin® has been withdrawn from the market. A review of the benefits and risks noted a lack of evidence for efficacy and the association of quinine and camphor with adverse reactions. The product license has been cancelled and distribution has ceased.

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

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SMC Update - May 2011

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

Quetiapine prolonged release and immediate release (Seroquel XL® and Seroquel IR®) have been rejected for use in the treatment of major depressive episodes in bipolar disorder. The manufacturer did not present a sufficiently robust economic analysis to gain acceptance.

Tadalafil (Adcirca®) has been rejected for the treatment of pulmonary arterial hypertension. The manufacturer failed to make a submission.

Ticagrelor (Brilique®) has been accepted for use, when co-administered with aspirin, in the prevention of atherothrombotic events in adult patients with acute coronary syndromes. When administered with aspirin, ticagrelor demonstrated a significant reduction in ischaemic events compared with another antiplatelet drug without significantly increasing the incidence of study-defined major bleeding. However, the SMC notes that alternative treatments are available at a lower drug acquisition cost.

Tocofersolan oral solution (Vedrop®) has been rejected for the treatment of vitamin E deficiency due to digestive malabsorption in paediatric patients suffering from congenital chronic cholestasis or hereditary chronic cholestasis. The manufacturer did not supply any economic analysis therefore the cost-effectiveness could not be assessed.

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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