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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - March 2014

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of March 2014. This month there is one public health guideline that impacts upon primary care.

The Contraceptive services with a focus on young people public health guideline recommends that young men and women should be given advice and information on all types of contraception to help them choose the best method for their needs and lifestyle. This makes it more likely that contraception will be used effectively. The recommendations apply to commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, contraceptive services.

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

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MTRAC Additional Review - March 2014

MTRAC issued an additional Commissioning Support review in March 2014. This review covers fluticasoe/vilanterol dry powder inhaler.

The fluticasoe/vilanterol (Relvar®) summary advises that this inhaler cannot be recommended for prescribing for the treatment of chronic obstructive pulmonary disease (COPD). It is noted that the evidence for efficacy was considered relatively weak although strong enough to gain regulatory approval. The main reason for this recommendation is a potential safety concern regarding the similarity of this inhaler to reliever inhalers in terms of colour that could result in accidental overuse of the inhaled steroid. The SPC describes the inhaler as having a "light grey body, a pale blue mouthpiece cover and a dose counter". Until now, blue coloured inhalers have generally contained short-acting beta-adrenoceptor agonists (SABA), not inhaled corticosteroids and long-acting beta-adrenoceptor agonists.

Action: Clinicians should be aware of these reviews and use the recommendations to guide appropriate use of these medicines in current practice.

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Drug Safety Update - March 2014

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

This issue contains drug safety advice informing clinicians of a theoretical interaction between orlistat and antiretroviral HIV medicines. Orlistat may reduce the absorption of these medicines and as such reduce efficacy. It is recommended that orlistat is only used in patients taking antiretroviral HIV medicines after careful consideration. It is also recommended that individuals interested in purchasing orlistat (Alli®) over the counter should consult their doctor before starting treatment.

This section also reminds clinicians that St John’s wort interacts with hormonal contraceptives. Two Yellow Card reports have been submitted recently regarding women using the etonogestrel implant (Implanon® or Nexplanon®) who used St John’s wort and subsequently had an unplanned pregnancy. Clinicians are advised to tell women taking hormonal contraceptives for pregnancy prevention not to take herbal products containing St John’s wort.

The stop press section contains additional information about the recently announced restricted indications and new monitoring requirements for strontium ranelate in light of increased cardiovascular risks and also the new restricted use and monitoring requirements for methysergide in light of serious fibrotic reactions. Methysergide is currently only available in the UK via unlicensed imports. The stop press section also advises that the updated packaging design for dorzolamide/timolol (Cosopt®) preservative-free eye drops, which aims to prevent inadvertent eye injuries, is now available.

Finally, in other information, advice disseminated via the NHS Central Alerting System in January regarding combined hormonal contraception is clarified. Annexes sent with this alert recommend that women at higher risk of VTE use "a non-hormonal form of contraception" when it ought to have stated "that a different form of contraception should be used". This change indicates that progestogen-only contraceptives as well as non-hormonal methods are suitable options.

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

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MTRAC Reviews - March 2014

MTRAC issued two new Commissioning Support reviews in March 2014. The reviews cover denosumab and rifaximin.

The denosumab (Prolia®) summary advises that this drug is suitable for restricted prescribing in primary care, following secondary care initiation and stabilisation of treatment. The review notes that this medicine has relatively strong evidence but a lower place in therapy as recommended by NICE guidance.

The rifaximin (Targaxan®) summary advises that this drug is suitable for restricted prescribing in primary care, following secondary care initiation and stabilisation and with the guidance of a shared care agreement. The review notes that this medicine has relatively strong evidence but a lower place in therapy after existing treatment options were inadequate or inappropriate.

Action: Clinicians should be aware of these reviews and use the recommendations to guide appropriate use of these medicines in current practice.

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Prescription Charges for 2014

The Department of Health has announced that the price for an NHS prescription in England will increase by 20p to £8.05 with effect from April 2014. It is also intended that an additional 20p increase will be added in April 2015 bring the price per item to £8.25.

The prices for 3 and 12 month pre-payment certificates has remained the same at £29.10 and £104 respectively. For anyone requiring more than 4 items in 3 months or more than 13 in a year these certificates can provide significant savings.

Other NHS charges such as for dental work, wigs and fabric supports are also being increased.

Action: Clinicians should be aware of the current prescription charge and also the value for money represented by pre-payment certificates.

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