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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - March 2014

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

Alogliptin (Vipidia®) has been rejected for use in adults with type 2 diabetes mellitus to improve glycaemic control in combination with other glucose lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control. The manufacturer did not present sufficiently robust clinical and economic analysis to gain acceptance.

Dapagliflozin (Forxiga®) has been accepted for restricted use in adults with type 2 diabetes mellitus to improve glycaemic control in combination with other glucose-lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control. The restriction limits use to combination with insulin, when insulin with diet and exercise, does not provide adequate glycaemic control.

Insulin degludec (Tresiba®) has been rejected for the treatment of diabetes mellitus in adults. The manufacturer did not present a sufficiently robust economic analysis to gain acceptance

Saxagliptin (Onglyza®) has been rejected for use as monotherapy in adult patients with type 2 diabetes mellitus to improve glycaemic control inadequately controlled by diet and exercise alone and for whom metformin is inappropriate due to contraindications or intolerance. The manufacturer failed to make a submission.

Solifenacin and tamsulosin (Vesomni®) has been accepted for the treatment of moderate to severe storage symptoms (urgency, increased micturition frequency) and voiding symptoms associated with benign prostatic hyperplasia in men who are not adequately responding to treatment with monotherapy.

Zonisamide (Zonegran®) has been accepted for restricted use as adjunctive therapy in the treatment of partial seizures, with or without secondary generalisation, in adolescents and children aged 6 years and above. The restriction limits use only when advised by specialists (paediatric neurologists or paediatricians with an expertise in epilepsy).

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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New advice on strontium ranelate

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a press release noting that updated advice will be distributed to healthcare professionals regarding strontium ranelate (Protelos®) which is used to treat severe osteoporosis in post-menopausal women and men with a high risk of fracture.

A review was conducted by the European Medicines Agency recently because of study data which suggested an increased risk of heart problems. The review concluded there is no increased risk in individuals who have no history of heart or circulatory problems. However, in individuals who do have a history of heart or circulatory problems strontium is now only recommended if they are unable to take alternative medicines.

This advice will be disseminated to healthcare professionals via letter and will also be included in the March edition of the Drug Safety Update.

Action: Clinicians should be aware of this new advice. This change in advice would make a good topic for an audit.

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eFPIP being decommissioned

The NHSBSA has announced that the electronic financial and prescribing information for practices system (or eFPIP) is to be decommissioned in April 2014 and will be replaced by the Information Services Portal (ISP).

According to a fact sheet distributed to practices in February anyone who wishes to continue to access prescribing needs to send an email to NHSBSA.GPdata@nhs.net with your name, email address, telephone number and practice code.

Once registered the ISP service is available at https://apps.nhsbsa.nhs.uk/infosystems/welcome. The system can also be accessed in a limited way as a guest user.

Action: Clinicians who use eFPIP and who wish to continue to access their prescribing information need to register for the ISP service.

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