Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2015

The National Institute of Health and Care Excellence (NICE) has published new guidance for the month of May 2015. This month there are two guidelines that impact upon primary care.

The Challenging behaviour and learning disabilities guideline offers evidence-based advice on prevention and interventions for children, young people and adults with a learning disability and behaviour that challenges.

The Violence and aggression guideline offers evidence-based advice on the short-term management of violent and physically threatening behaviour in mental health, health and community settings. It is an update to guidance issued in February 2005 and now has recommendations for broader group of services.

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 - May 2015

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

Several treatments for hepatitis C infection, namely ledipasvir-sofosbuvir (Harvoni®), sofosbuvir (Sovaldi®) and daclatasvir (Daklinza®), have been found to interact with amiodarone and increase the risk of severe bradycardia and heart block. It is recommended that amiodarone only be used in conjunction with these treatments when other antiarrhythmics cannot be given and patients being started on amiodarone should be closely monitored for 48 hours.

Pomalidomide (Imnovid®), a treatment for adults with relapsed and refractory multiple myeloma, has been found to cause interstitial lung disease (ILD), cardiac failure and hepatotoxicity. It is recommended that patients receiving this treatment are monitored for the signs or symptoms of these conditions.

Finally this month there is a summary of letters sent to healthcare professionals in April 2015, including a reminder that ketoprofen gel is associated with photosensitivity reactions and of risk minimisation measures should be undertaken when skin is exposed to sunlight during treatment.

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

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SMC Update - May 2015

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

Budesonide (Budenofalk®) has been accepted for restricted use in the treatment of autoimmune hepatitis. The restriction limits use to non-cirrhotic patients who are intolerant of conventional oral corticosteroids (prednisolone) with severe corticosteroid-related side effects (actual or anticipated) such as psychosis, poorly controlled diabetes or osteoporosis.

Insulin degludec (Tresiba®) has been rejected for use in the treatment of diabetes mellitus in adults, adolescents and children from the age of 1 year. The manufacturer failed to make a submission and as a result this treatment cannot be recommended.

Linagliptin (Trajenta®) has been accepted for use in the treatment of type 2 diabetes mellitus to improve glycaemic control in adults in combination with insulin with or without metformin, when this regimen alone, with diet and exercise, does not provide adequate glycaemic control.

Liraglutide (Victoza®) has been accepted for use in the treatment of adults with type 2 diabetes mellitus to achieve glycaemic control in combination with basal insulin when this, together with diet and exercise, does not provide adequate glycaemic control.

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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