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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MeReC Extra 50

The National Prescribing Centre has published MeReC Extra 50 (PDF) which discusses the results of some observational studies of Yasmin® and important advice changes relating to drug interactions with hormonal contraception.

The first section discusses the results of two recent observational studies that identified an increased risk of venous thromboembolism (VTE) in women taking Yasmin®. The relative risk is increased two or three fold but is still lower than the risk of VTE associated with pregnancy. The Drug Safety Update in June also reviewed these findings.

The second section reviews some key changes in the advice from the Faculty of Sexual and Reproductive Healthcare. They advise that women taking combined oral contraceptives (COCs) no longer require additional contraceptive precautions during or after a course of antibacterials for three weeks or less (except rifabutin and rifampicin). These changes have been covered previously.

Action: Clinicians who prescribe contraceptive pills or who see women prescribed contraceptives will find this information useful and informative.

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NICE Guidance - August 2011

The National Institute of Health and Clinical Excellence (NICE) has published new guidance for the month of August 2011. This month there is one clinical guideline that impacts upon primary care.

The hypertension clinical guideline (QRG) replaces and updates the existing hypertension guideline that was issued in 2006. This updated guideline contains new recommendations on diagnosis, antihypertensive drug treatment and treatment monitoring.

The main differences are the recommendations to:

  • offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension (unless hypertension is severe)
  • use home blood pressure monitoring (HBPM) to confirm a diagnosis of hypertension when ABPM is not tolerated
  • treat patients with stage 1 hypertension (ABPM/HBPM ≥ 135/85 mmHg) and a 10-year cardiovascular risk equivalent to 20% or greater
  • use thiazides as a step 1 drug treatment only when calcium-channel blockers (CCBs) are contraindicated or not tolerated

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

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SMC Update - August 2011

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

Calcium carbonate and cholecalciferol (Kalcipos-D®) has been accepted for the prevention and treatment of calcium and vitamin D deficiency in the elderly and in addition to specific osteoporosis treatment of patients who are at risk of deficiency.

Darunavir (Prezista®) has been accepted for the treatment of HIV-1 infection in combination with low dose ritonavir.

Glucosamine sulphate (Dolenio®) has been rejected for symptomatic treatment of mild to moderate osteoarthritis of the knee. The manufacturer failed to make a submission.

Glucosamine sulphate (Glusartel®) has been rejected for relief of symptoms in mild to moderate osteoarthritis of the knee. The manufacturer failed to present a sufficiently robust economic case to gain acceptance.

Methotrexate 50mg/ml solution for injection (Metoject®) has been accepted for the treatment of polyarthritic forms of severe active juvenile idiopathic arthritis. It is an option for patients when the response to non-steroidal anti-inflammatory drugs has been inadequate, a disease modifying drug is indicated and parenteral administration of methotrexate is appropriate.

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 - August 2011

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

This issue contains drug safety information advising clinicians of the updated warnings and contraindications for pioglitazone after a review was conducted to review an increased risk of bladder cancer. Clinicians are also advised that the product licence for celecoxib (Onsenal®) has been voluntarily withdrawn after a trial that aimed to evaluate the drugs benefits in familial adenomatous polyposis failed to recruit sufficient patient numbers. Clinicians are reminded that celecoxib should not be used for this indication because the benefit has not been sufficiently demonstrated and is outweighed by side effects such as cardiovascular and gastrointestinal complications.

The stop press section warns clinicians that lacosamide (Vimpat®) 15mg/ml syrup is being recalled due to a quality issue that may cause the active ingredient to precipitate out. It is recommended that patients who are currently prescribed this product be switched to tablets where possible and that no new patients are initiated on the syrup.

This section also warns healthcare professionals regarding the potentially serious adverse effects of Lei Gong Teng (Tripterygium wilfordii), a traditional but unlicensed Chinese herbal medicine. Clinicians are asked to advise anyone known to be taking this product to discontinue use.

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

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Bear with me... again

A few years ago I asked you all to bear with me following the birth of my son.

Well, a few days ago my wife gave birth again to a beautiful baby girl. She weighed 8lbs and both mum and baby are doing fine.

As you might expect I'm going to be a little bit busy with family and the frequency of posts may dip over the next few weeks. I'll get back to a normal service once things settle down here.

In the meantime I'd like to introduce you all to Eve:

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