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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - September 2012

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

This update contains drug safety information informing clinicians that dipeptidylpeptidase-4 (DPP-4) inhibitors or gliptins have been associated with an increased risk of pancreatitis. It is advised that patients are informed of the characteristic symptoms of acute pancreatitis and seek healthcare advice should these symptoms develop. If acute pancreatitis is suspected the gliptin should be stopped and a YellowCard completed.

This section also advises that the strength of oseltamivir oral suspension (Tamiflu®) will change this autumn to 6mg/ml. A new dosing dispenser will also become available but clinicians should be aware of this change and should warn patients the product is now different if it has been used it previously.

The stop press section contains updated advice on the place in therapy for levofloxacin in the treatment of acute bacterial sinusitis, acute exacerbation of chronic bronchitis, community acquired pneumonia or complicated skin and soft tissue infections. The safety profile of levofloxacin restricts it to use when other medicines cannot be prescribed or have been ineffective.

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

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BNF and BNFC Apps

NICE has previously released a BNF App for mobile devices and has now also released a BNFC App.

The applications work on the Android and iOS platforms and can be downloaded as follows:

An NHS Athens account is necessary to use the applications but eligible individuals can sign up for an account or log in with their existing details from within the app itself.

Once installed the apps provide offline access to the most recent editions of the BNF and BNFC.

Action: Clinicians who prefer to use mobile devices to access the BNF and BNFC may find apps useful.

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NICE Guidance - September 2012

The National Institute of Health and Clinical Excellence (NICE) has published new guidance for the month of September 2012. This month there is one clinical guideline that impacts upon primary care.

The Headaches clinical guideline discusses the diagnosis and management of headaches in young people (aged 12 years and older) and adults. In particular the guideline covers tension-type headache, migraine (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache. Diagnostic criteria are specified for each headache type and treatments are suggested, where appropriate, for acute episodes and prophylaxis.

The publication of this guideline has been reported in the media (BBC) with the main focus of the articles being medication overuse headaches.

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

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MUR service changes

The Department of Health has implemented some changes to the regulations governing the advanced and enhanced pharmaceutical services. According to Primary Care Commissioning, the most significant change applies to the MUR service.

The new regulations came into force on the 1st September 2012 and the changes mean that pharmacists are now only required to inform GPs that an MUR has occurred if issues have been identified where the pharmacist believes the GP should be informed.

Action: Clinicians should be aware of this change. The volume of MUR paperwork should reduce and any MUR paperwork received should now be more relevant and beneficial.

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SMC Update - September 2012

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

Colecalciferol (Fultium-D3®) has been accepted for the prevention and treatment of vitamin D deficiency and as an adjunct to specific therapy for osteoporosis in patients with vitamin D deficiency or at risk of vitamin D insufficiency.

Fingolimod (Gilenya®) has been accepted for restricted use following a resubmission. Fingolimod can be used as a single disease modifying therapy in highly active relapsing remitting multiple sclerosis (RRMS) in adults. Use is restricted to individuals with a high disease activity despite treatment with a beta-interferon and an unchanged or increased relapse rate or ongoing severe relapses, as compared to the previous year. Continued access is also contingent upon the availability of the patient access scheme that improves cost-effectiveness.

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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