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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - December 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2016. This month there are two guidelines and one technology appraisal that impact upon primary care.

The HIV testing guideline covers how to increase the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, promote awareness of HIV testing and increase opportunities to offer testing to people who may have undiagnosed HIV.

The End of life care for infants, children and young people with life-limiting conditions guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

The Ticagrelor for preventing atherothrombotic events after myocardial infarction technology appraisal recommends this treatment as an option for preventing atherothrombotic events in adults who had a myocardial infarction and who are at high risk of a further event. Treatment should be stopped when clinically indicated or at a maximum of 3 years.

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 - December 2016

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for December 2016 (PDF).

Healthcare professionals are advised of a rare but potentially serious reaction that may occur in the co-administration of a corticosteroid with an HIV-treatment-boosting agent that increases the risk of adrenal suppression due to a pharmacokinetic interaction. There have been several cases reported worldwide of interactions between cobicistat and ritonavir and steroids including triamcinolone and fluticasone. The interaction is still possible when the corticosteroid is administered via the epidural, inhaled, intranasal, intra-articular or ocular routes. It is recommended that co-administration is avoided unless the potential benefit to the patient outweighs the risk and where possible beclomethasone should be considered as the interaction risk may be lower.

Advice issued in February 2016 regarding the concomitant use of spironolactone with an angiotensin converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) has also been re-issued to clarify that the combination must be used with caution. Feedback from the initial advice indicated that some readers interpreted that advice to mean that the combination must not be used.

There is also a summary of letters sent to healthcare professionals in November.

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

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SMC Update - December 2016

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

Ferric maltol (Feraccru®) has been rejected for the treatment of iron deficiency anaemia (IDA) in adult patients with inflammatory bowel disease (IBD). The submitting company did not present sufficiently robust clinical and economic analyses to gain acceptance.

Hydrocortisone (Plenadren®) has been rejected for use in the treatment of adrenal insufficiency in adults. The submitting company did not present a sufficiently robust clinical and economic analysis to gain acceptance.

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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CKS Updates - November 2016

During November 2016 Clinical Knowledge Summaries were updated for the following topics:

Two new topics were added:

The following topics were all reviewed:

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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BNF 72

The 72nd Edition of the British National Formulary has recently been published. As previously noted, hard copies of the BNF will now only be distributed annually in the NHS.

Some of the significant content updates in this edition include:

  • New safety information about the risk of abnormal pregnancy outcomes with sodium valproate and valproic acid
  • Updated guidance for conditions including asthma, obesity, coeliac disease, irritable bowel syndrome and prostate cancer
  • New drug monographs including edoxaban, albiglutide, dulaglutide, dasabuvir, and vortioxetine
  • Updated pregnancy-prevention advice for patients taking mycophenolate mofetil
  • Updated guidance on the risk of hepatitis B reactivation with BCR-ABL tyrosine kinase inhibitors, and pomalidomide
  • Advice about the risk of ulceration with nicorandil treatment
  • NICE guidelines including the use of vedolizumab for treating moderately to severely active Crohn’s disease
  • New guidance on suspected or confirmed drug allergy
  • Evidence grading of BNF recommendations

The web version is updated monthly and can be accessed via NHS computers or via NICE Evidence Services. The printed version is also available for purchase.

Action: All clinicians should start using BNF 72 via electronic methods were possible. The web version can be used to access the latest information if necessary.

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