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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - January 2012

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

Exenatide once weekly (Bydureon®) has been accepted for restricted use in the treatment of type 2 diabetes mellitus in combination specified oral hypoglycaemic agents when adequate glycaemic control is not achieved despite being on maximally tolerated doses of these oral therapies. The restriction places this treatment as third line treatment option.

Fentanyl single dose nasal spray (Instanyl) has been accepted for restricted use for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. The restriction allows use in patients who are unsuitable for other short-acting oral opioids (e.g. oral morphine) as an alternative to other buccal and sublingual fentanyl preparations.

Linagliptin (Trajenta®) has been accepted for restricted use in the treatment of adults with type 2 diabetes mellitus to improve glycaemic control. The restriction allows use in combination therapy with metformin when diet and exercise plus metformin alone does not provide adequate glycaemic control in patients for whom the addition of a sulphonylurea is inappropriate.

Ranolazine (Ranexa®) has been rejected for use as an add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled or intolerant to first-line anti-anginal therapies. The clinical and economic case was insufficiently robust to gain acceptance.

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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