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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - November 2014

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

The Obesity clinical guideline updates and replaces section 1.2 of NICE clinical guideline 43. It offers evidence-based advice on the care and treatment of obesity and includes new recommendations about low-calorie and very-low-calorie diets, bariatric surgery and follow-up care.

New recommendations have been added about low-calorie and very-low-calorie diets, bariatric surgery and follow-up care.

The Nalmefene for reducing alcohol consumption technology appraisal recommends this drug a possible treatment for people with alcohol dependence who:

  • are still drinking more than 7.5 units per day (for men) and more than 5 units per day (for women) 2 weeks after an initial assessment and
  • do not have physical withdrawal symptoms and
  • do not need to either stop drinking straight away or stop drinking completely

The guidance also recommends that nalmefene should only be taken if the person is also having ongoing support to change their behaviour and to continue to take their treatment, to help them reduce their alcohol intake.

The Vitamin D: increasing supplement use among at-risk groups public health guideline aims to increase supplement use to prevent vitamin D deficiency among at-risk groups including:

  • infants and children aged under 5
  • pregnant and breastfeeding women, particularly teenagers and young women
  • people over 65
  • people who have low or no exposure to the sun, for example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
  • people with darker skin, for example, people of African, African-Caribbean or South Asian family origin

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

Updated: 27/11/2014 to include "Obesity: identification, assessment and management of overweight and obesity in children, young people and adults" Clinical Guideline

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Drug Safety Update - November 2014

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

The drug safety section in this issue reminds clinicians that agomelatine (Valdoxan®) may cause liver toxicity in some people and that liver function should be tested before and during treatment. It is recommended that treatment is stopped if serum transaminases exceed three times the upper limit of normal and that patients are advised to stop taking agomelatine and to get medical help immediately if they have any signs or symptoms of liver injury. This section also reports that there have been reports of Colobreathe® (colistimethate sodium) capsules shattering when pierced by their inhaler device. The instructions for inhaler use have been revised and it is recommended that the new inhaler is demonstrated to patients and carers and that the first dose is supervised.

The stop press section reminds readers of the risk of ingestion of desiccants in blister packs. There have been two reports recently of people swallowing the desiccant that came with their nicorandil tablets instead of the tablet itself. It is noted that the foil blister and patient information leaflet clearly advise people not to swallow the desiccant. It is recommended that people receiving blister packs containing a desiccant are reminded the desiccant should not be swallowed.

The other information section advises that the arrangements for email alerts about Drug Safety Update are changing. Current subscribers can check their settings at https://service.govdelivery.com/accounts/UKMHRA/subscriber/new.

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

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SMC Update - November 2014

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

Brinzolamide and brimonidine eye drops (Simbrinza®) have been accepted for use to decrease of elevated intraocular pressure (IOP) in adult patients with open-angle glaucoma or ocular hypertension for whom monotherapy provides insufficient IOP reduction. It is noted that this combination is not significantly more expensive and allows patients to administer fewer drops.

Denosumab (Prolia®) has been rejected for the treatment of osteoporosis in men at increased risk of fractures. The manufacturer failed to make a submission and as a result this treatment cannot be recommended.

Saxagliptin (Onglyza®) has been accepted for use in adult patients aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control as combination therapy with insulin (with or without metformin), when this regimen alone, with diet and exercise, does not provide adequate glycaemic control.

Voriconazole (Vfend®) has been rejected for the prophylaxis of invasive fungal infections in high risk allogeneic hematopoietic stem cell transplant (HSCT) recipients. The manufacturer failed to make a submission and as a result this treatment cannot be recommended.

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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