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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - April 2015

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for April 2015 (PDF).

The maximum dose of hydroxyzine in an adult is restricted to 100mg due to an increased risk of QT interval prolongation and Torsade de Pointes. It is also recommended that hydroxyzine is not prescribed to people with a prolonged QT interval or who have risk factors for QT interval prolongation, for example those on other medicines that prolong QT interval, those with cardiovascular disease, family history of sudden cardiac death, significant electrolyte imbalance (low potassium or magnesium levels) or significant bradycardia. It is also advised to use the lowest effective dose for the shortest time possible.

Codeine is not recommended for use in children aged under 12 years old due to the risk of respiratory side effects. It is not recommended in those aged 12 to 18 years who have problems with breathing. The MHRA have received 26 Yellow Card reports of respiratory side-effects associated with the use of codeine in children up to 5 August 2014.

The European Medicines Agency is consulting on guidance to minimise the risk of medication error with high strength insulins. Until recently all insulins came in a standard strength of 100 units/mL. Several new insulin products have come to market recently; three high strength insulins which have concentrations greater than 100 units/mL (Tresiba®, Humalog®, Toujeo®), a fixed combination of insulin degludec and liraglutide (Xultophy®) and a biosimilar of insulin glargine (Abasaglar®). Extreme care should be taken when prescribing and dispensing these products to ensure that the patient is given the correct strength.

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

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Why A&E Campaign

It is 10 years since the first video was uploaded to YouTube. So it's nice to see that the Think! Why A&E campaign has uploaded a video encouraging patients to access the right NHS service for their symptoms.

Action: This may be a useful resource for general practices to link on their websites and perhaps use on practice television systems with due regard for the copyright. Practices wishing to use this resource should contact Colette Cassin at Blackpool CCG.

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SMC Update - April 2015

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

Aclidinium / Formoterol Inhaler (Duaklir Genuair®) has been accepted for use as maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease.

Levonorgestrel IUD (Jaydess®) has been accepted for use as contraception for up to 3 years.

Tacrolimus prolonged release tablets (Envarsus®) have been accepted for the prophylaxis of transplant rejection in adult kidney or liver allograft recipients and treatment of allograft rejection resistant to treatment with other immunosuppressive medicinal products in adult patients. It is noted that this product has demonstrated non-inferiority to a tacrolimus immediate-release capsule and has a similar cost per equivalent dose.

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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BNF 69

The 69th Edition of the British National Formulary has been published. As previously noted, the BNF will now only be distributed annually in the NHS.

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

  • Updated general guidance on drugs and driving in response to new regulations in force from March 2015
  • Updated guidance on risk assessment and treatment in the management of arrhythmias
  • Updated recommendations on minimising risk of osteonecrosis of the jaw and hypocalcaemia associated with denosumab following new MHRA advice
  • New guidance on dose adjustment in renal impairment for atorvastatin
  • New recommendations on concomitant use of drugs affecting the renin-angiotensin system
  • New guidance on dose adjustment in hepatic and renal impairment for zolpiclone
  • Updated guidance on assessing cardiovascular risk and modification of blood lipids in the primary and secondary prevention of cardiovascular disease
  • Updates to recommended regimens for prophylaxis against malaria for specific countries

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 69 via electronic methods were possible. The web version can be used to access the latest information if necessary.

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Rupatadine discontinued

The product license holder of rupatadine (Rupafin®) has written to healthcare professionals advising that with effect from the 31st March 2015 this medicine will be effectively discontinued in the UK.

An agreement between the license holder and a UK based distributor has come to an end and a new distributor is not being sought. It is estimated that supplies would be exhausted by the end of March 2015. As such alternative treatment options will need to be considered.

Action: Clinicians should be aware of the product being discontinued. It may be prudent to run clinical system searches to identify any patients who are currently prescribed this product to allow an alternative to be arranged.

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