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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Calcipotriol cream discontinued

The manufacturer of calcipotriol cream (Dovonex®) has advised that this product has been discontinued for economic reasons.

The Psoriasis Association note that there are no safety or quality concerns. Current supplies of the cream can continue to be dispensed and used.

Calcipotriol ointment remains available, both as a generic product and as Dovonex. This may be a suitable alternative after consideration of patient acceptability of a greasier product.

Action: Clinicians should be aware of this product discontinuation and make arrangements to switch patients to suitable alternatives.

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HPV vaccine to change from September 2012

The Department of Health has written (PDF) to NHS colleagues to advise that the vaccine used to provide the national human papilloma virus (HPV) immunisation programme will change from September 2012.

The current vaccine Cervarix® will continue to be used for the current academic year but with effect from September 2012 the vaccine used will change to Gardasil®. This change follows a competitive tendering exercise which included an updated cost effectiveness analysis of HPV vaccines carried out by the Health Protection Agency.

Action: Clinicians should be aware of this announcement and the expected change in vaccine.

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MeReC Extra 51

The National Prescribing Centre has published MeReC Extra 51 (PDF) which discusses the recently updated guidance on the management of hypertension published by NICE.

This MeReC notes that important changes since the previous guidance include:

  • Using ambulatory or home blood pressure monitoring to confirm the diagnosis of hypertension
  • Offering treatment with a calcium-channel blockers as first choice step 1 antihypertensive for people aged over 55 years and black people of African or Caribbean family origin of any age
  • Offering an ACE inhibitor or a low-cost angiotensin-II receptor antagonist (A2RA) as step 1 antihypertensive drug for non-black people younger than 55 years
  • Offering an ACE inhibitor or low-cost A2RA in combination with a calcium-channel blocker for people of any age if this is necessary to achieve suitable blood pressure reduction (step 2 drug treatment)
  • Offering chlortalidone or indapamide in preference to bendroflumethiazide or hydrochlorothiazide if diuretic therapy is to be changed or initiated
  • Offering spironolactone 25 mg once daily as first choice additional treatment (if the person’s blood potassium level is 4.5 mmol/L or less) at step 4

Action: Clinicians who diagnose and treat hypertension will find this to be a useful and informative summary of the key changes to hypertension guideline.

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NICE Guidance - November 2011

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

The self-harm (longer term management) clinical guideline (PDF) covers the longer-term psychological treatment and management of both single and recurrent episodes of self-harm.

The following key priority areas for implementation are recommended:

  • aim to develop a trusting, supportive and engaging relationship with people who self-harm
  • be aware of the stigma and discrimination sometimes associated with self-harm, both in the wider society and the health service, and adopt a non-judgemental approach
  • ensure that people are fully involved in decision-making about their treatment and care
  • aim to foster people's autonomy and independence wherever possible
  • maintain continuity of therapeutic relationships wherever possible
  • ensure that information about episodes of self-harm is communicated sensitively to other team members

Care plans are also recommended with the aim of reducing escalation or harm arising from self-harm, reducing or stopping self-harm and other risk-related behaviours and improving quality of life. It is suggested that these plans are reviewed at least annually and shared with GPs.

Action: Clinicians should be aware of this guideline and ensure that key priority areas are implemented.

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Drug Safety Update - November 2011

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

This issue contains drug safety information advising clinicians that clinical trials investigating use of lenalidomide in patients with newly diagnosed multiple myeloma have shown a four-fold increased risk of second primary malignancy. The risk appears to be lower in patients treated for relapsed or refractory myeloma. Use of lenalidomide in newly diagnosed multiple myeloma is currently unlicensed and therefore not recommended except as part of a clinical trial. It is advised that clinicians should consider the possibility of possibility of second malignancy in patients treated with lenalidomide.

The yellow card scheme section highlights the value of spontaneous post-marketing surveillance by describing how yellow card reports received in the first year following the launch of rosuvastatin helped to identify a higher than expected rate of rhabdomyolysis with the 40mg dose. A review of the reports led to updating prescribing advice that protected public health.

The stop press section contains a reminder that dosing recommendations for paracetamol in children have been updated. Products are now entering the market with the revised dosing instructions.

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

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