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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - September 2013

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of September 2013. This month there in one clinical guideline that impacts upon primary care.

The Urinary incontinence in women guideline offers evidence-based advice on the care and treatment of women with urinary incontinence. It updates the existing guideline published in 2006 and it includes new methods of managing urinary incontinence have become available on the NHS including pharmacological agents, Botulinum toxin A and sacral nerve stimulation.

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

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BNF 66

The 66th Edition of the British National Formulary has been published and it is currently being distributed in the NHS.

New or revised content in this version includes updated advice in the following areas:

  • New restrictions on the use of cilostazol
  • Updated paediatric dose information for rifampicin and ethambutol for the treatment of tuberculosis
  • Updated driving guidance for patients with diabetes mellitus
  • New advice on the risk of atypical femoral fractures with denosumab
  • Updated advice on the risk of serious cardiovascular disease with strontium ranelate
  • Updated immunisation schedule for meningococcal group C conjugate and rotavirus vaccines

The web version has already been updated but requires registration or an Athens account for continued access. The printed version is available for purchase.

Action: All clinicians should start using BNF 66 as soon as the print version arrives. The web version can be used to access the latest information if necessary.

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Antimicrobial Resistance Strategy

The Department of Health has published a five year strategy that aims to tackle antimicrobial resistance (AMR).

This document is jointly owned by the Department of Health (DH) and the Department for Environment, Food and Rural Affairs (DEFRA) and has included collaboration from a wide range of government departments such as public health agencies, the Food Standards Agency (FSA), the Medicines and Healthcare products Regulatory Agency (MHRA), the Ministry of Defence and of course the NHS.

It acknowledges that antibiotic resistance cannot be eradicated but it can be managed to limit the threat to, and minimise the impact on, human and animal health. Seven key areas are identified for future action:

  • Improving infection prevention and control practices
  • Optimising prescribing practice
  • Improving professional education, training and public engagement
  • Developing new drugs, treatments and diagnostics
  • Better access to and use of surveillance data
  • Better identification and prioritisation of AMR research needs
  • Strengthened international collaboration

Action: Clinicians should be aware of this new strategy. National and local schemes are likely to be implemented in the future in order to deliver the aims laid out in this document.

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Drug Safety Update - September 2013

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for September 2013 (PDF).

This issue contains drug safety advice informing clinicians that filgrastim and pegfilgrastim have been associated with an increased risk of potentially life-threatening capillary leak syndrome (CLS). This drug will usually be prescribed in specialist settings whoever some patients may be self-administering this injection and report emerging side effects to their GP. This update notes that CLS symptoms commonly have rapid onset and include generalised body swelling, puffiness (which may be associated with less-frequent urination), difficulty breathing, abdominal swelling and tiredness. Patients who are self-administering this injection and present with such symptoms should be referred for treatment.

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

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SMC Update - September 2013

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

Aripiprazole (Abilify®) has been accepted for restricted use in the treatment of moderate to severe manic episodes in Bipolar I Disorder in adolescents aged 13 years and older for up to 12 weeks. The restriction recommends that treatment is initiated and supervised by a child/adolescent psychiatrist.

Lixisenatide (Lyxumia®) has been accepted for restricted use in the treatment of adults with type 2 diabetes mellitus in combination with oral glucose-lowering medicinal products and/or basal insulin when these, together with diet and exercise, do not provide adequate glycaemic control. The restriction limits use to patients for whom a glucagon-like protein-1 (GLP-1) agonist is appropriate, as an alternative to existing GLP-1 agonists.

Medroxyprogesterone acetate (Sayana Press®) has been accepted for long-term female contraception. This review notes that return to fertility (ovulation) may be delayed for up to one year. It is also noted that treatment in individuals who are 12-18 years old should be limited to when other contraceptive methods are considered unsuitable or unacceptable due to unknown long-term effects of bone loss.

Rifaximin (Targaxan®) has been accepted to reduce the recurrence of episodes of overt hepatic encephalopathy (HE) in patients 18 years of age and older.

In addition, there are five reviews of medicines for the treatment of HIV-1 infection where use is restricted to a specialist:

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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