Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2014

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of February 2014. This month there are two clinical guidelines and one public health guideline that impact upon primary care.

The Osteoarthritis clinical guideline updates original guidance issued in February 2008. This update planned to include a full review pharmacological management of osteoarthritis however further work in this area is pending. In the meantime the original recommendations from 2008 remain current advice with attention drawn to a recent review that identified that paracetamol may not be as effective as previously thought.

The Psychosis and schizophrenia in adults clinical guideline updates original guidance issued in March 2009. It offers evidence-based advice on the care of adults with psychosis and schizophrenia.

The Domestic violence and abuse public health guideline notes that domestic violence and abuse is a complex issue that needs sensitive handling by a range of health and social care professionals. The guideline makes recommendations regarding commissioning services, training and referral pathways. Training is recommended for clinicians and administrative staff in GP practices on how to make it easier for people to disclose domestic violence and abuse.

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

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Drug Safety Update - February 2014

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for February 2014 (PDF).

This issue contains drug safety advice informing clinicians of the results of a recent review of the association between combined oral contraceptives and the risk of venous thromboembolism. The review confirms that the risk of venous thromboembolism with all low-dose COCs (ethinylestradiol <50 micrograms) remains small and products with the lowest risk of VTE are those containing the progestogens levonorgestrel, norethisterone and norgestimate.

The review concludes that the benefits of treatment far outweigh the risk of serious side effects but recommends that prescribers and women using COCs should be aware of the major risk factors for thromboembolism and remain vigilant for the key signs and symptoms.

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

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SMC Update - February 2014

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

Colestilan (BindRen®) has been rejected for the treatment of hyperphosphataemia in adult patients with chronic kidney disease (CKD) stage 5 receiving haemodialysis or peritoneal dialysis. The clinical and economic analysis was not sufficiently robust to gain acceptance but a resubmission is expected.

Levonorgestrel (Upostelle®) has been accepted for use as emergency contraception within 72 hours of unprotected sexual intercourse or failure of a contraceptive method. The review notes that this product is a slightly cheaper alternative to an existing preparation.

Lomitapide (Lojuxta®) has been rejected for use as an adjunct to a low-fat diet and other lipid-lowering medicinal products, with or without low density lipoprotein (LDL) apheresis, in adult patients with homozygous familial hypercholesterolaemia (HoFH). The manufacturer failed to make a submission.

Timolol gel eye drops (Tiopex®) have been accepted for restricted for the reduction of the elevated intraocular pressure in patients with ocular hypertension or chronic open angle glaucoma. The restriction limits use to patients who have proven sensitivity to preservatives.

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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