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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Innovation Scorecards

NICE has announced that hospital and primary care trusts will be rated on a publicly available innovation scorecard measuring which trusts are adopting the latest NICE-approved treatments and drugs most quickly.

It is hoped that making such information available will ensure a more consistent response to national guidance, reduce geographical variations and bring an end to 'postcode prescribing'.

Health Minister Paul Burstow has stated that trusts will be expected to explain why NICE-approved treatments are not available in their area where that appears to be the case.

Action: Clinicians should be aware of this proposed scorecard system. Patients may raise questions with individual clinicians based on the reported scorecard performance in their area.

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Drug Safety Update - August 2012

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2012 (PDF).

This update contains drug safety information informing clinicians that all intra-nasal formulations of calcitonin (Miacalcic®) are being withdrawn because of an increased risk of cancer associated with the long-term use. These products are licensed for use in osteoporosis; the injectable products will remain available for short term use in conditions such as Paget’s disease and hypercalcaemia in malignancy.

The stop press section contains updated advice on drug interactions associated with simvastatin. Analysis of data from clinical trials and post-marketing surveillance has been used to update the recommended contra-indications and cautions.

  • Simvastatin is now contraindicated with ciclosporin, danazol and gemfibrozil
  • The maximum recommended dose for simvastatin in conjunction with amlodipine or diltiazem is now 20 mg per day

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

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NICE Guidance - August 2012

The National Institute of Health and Clinical Excellence (NICE) has published new guidance for the month of August 2012. This month there are three clinical guidelines that impact upon primary care.

The Lower limb peripheral arterial disease clinical guideline discusses the diagnosis and management of peripheral arterial disease. It is suggested that mild symptoms can be managed in primary care including advice about exercise, management of cardiovascular risk factors and vasoactive drug treatment.

The Osteoporosis fragility fracture clinical guideline aims to provide guidance on the selection and use of risk assessment tools in the care of people who may be at risk of fragility fractures. The FRAX and QFracture risk prediction tools are both recommended. Risk assessments are recommended in all women over 65 years old and men over 75 years old. Assessments are also recommended in individuals younger than this with risk factors such as previous fragility fractures, use or oral steroids, history of falls, family history of hip fracture, low body mass index (BMI), smoking and alcohol intake above recommended limits.

The Urinary incontinence in neurological disease clinical guideline discusses the assessment and management of lower urinary tract dysfunction that can be the result of neurological disease. Behavioural, drug and interventional treatments are reviewed as well as strategies to recognise and manage potential complications such as frequent urinary tract infections, renal impairment, bladder stones and bladder cancer.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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SMC Update - August 2012

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

Rifaximin (Xifaxanta®) has been rejected for the treatment of travellers' diarrhoea that is not associated with fever, bloody diarrhoea, 8 or more unformed stools in the previous 24 hours or occult blood or leucocytes in the stool. The manufacturer failed to make a submission.

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 for Children 2012-2013

The British National Formulary for Children 2012-2013 has been updated, published and made available online.

Hard copies can be ordered from the publishers however many NHS staff will receive a free hard copy through usual channels and can also access the online version.

Significant changes in this revision include:

  • Proton pump inhibitors - rebound acid hypersecretion
  • Oral anticoagulants - prescribing notes updated
  • Antipsychotic drugs - section updated and reorganised
  • Paracetamol - MHRA advice on oral doses for children
  • Cellulitis - treatment update
  • Aminoglycosides - section updated and reorganised
  • Prophylaxis against malaria - recommendations for Argentina, Armenia, Bolivia, Dominican Republic, China, Iraq, Laos, Myanmar, Peru, and Venezuela
  • Antithyroid drugs - use in pregnancy
  • Bisphosphonates: atypical femoral fractures and osteonecrosis of the jaw
  • Combined oral contraceptives - starting and switching contraceptive routines updated
  • Several vaccine section updates

Action: BNFC is the primary source of prescribing information when prescribing to all children up to the age of 18 years.

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