Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2013 [updated]

The National Institute of Health and Clinical Excellence (NICE) has published new guidance for the month of February 2013. This month there is one clinical guideline and one technology appraisal that impact upon primary care.

The Fertility guideline offers evidence-based advice on the care and treatment of people with fertility problems and is an update to original guidance from 2004. This update recommends IVF treatment for eligible women who have been unable to conceive after two years of regular vaginal intercourse. The previous guideline recommended three years. This update also extends to women aged 40-42 provided IVF has not been used before, there is no evidence of low ovarian reserve and there has bee discussion of the additional implications of IVF and pregnancy at this age.

Other changes include no longer routinely offering intrauterine insemination for couples with unexplained infertility, mild endometriosis or 'mild male factor infertility' and not offering oral ovarian stimulation agents (such as clomifene) to women with unexplained infertility.

The Stroke and systemic embolism - apixaban technology appraisal recommends that Apixaban is an option for preventing stroke and systemic embolism within its marketing authorisation, that is, in people with nonvalvular atrial fibrillation with 1 or more risk factors such as:

  • prior stroke or transient ischaemic attack
  • age 75 years or older
  • hypertension
  • diabetes mellitus
  • symptomatic heart failure

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

Details of the apixaban guideline were added 5th March 2013

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