Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2016

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

The Ezetimibe technology appraisal recommends this treatment as monotherapy as an option for people with primary (heterozygous‑familial or non‑familial) hypercholesterolaemia who have a contraindication to or cannot tolerate a statin. It is also recommended for co-administration with a statin when cholesterol targets are not being met despite maximal statin therapy or when a change from initial statin therapy to an alternative statin is being considered.

The Motor neurone disease clinical guideline covers the assessment and management of motor neurone disease (MND). It aims to improve care from the time of diagnosis, and covers information and support, organisation of care, managing symptoms and preparing for end of life care and includes recommendation on recognition and referral.

The Sunlight exposure clinical guideline covers how to communicate the risks and benefits of natural sunlight exposure (specifically, the ultraviolet rays UVA and UVB) to help people understand why they may need to modify their behaviour to reduce their risk of skin cancer and vitamin D deficiency. This guideline was also used to update the Skin cancer prevention public health guidance.

The Tuberculosis clinical guideline received a correction regarding identification of babies eligible for vaccination prior to birth, ideally through antenatal services.

The Bipolar disorder clinical guideline received an update to include a link to the Medicines and Healthcare Products Regulatory Agency’s (MHRA) toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy.

The Epilepsies clinical guideline received an update to include a link to the Medicines and Healthcare Products Regulatory Agency’s (MHRA) toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy.

The Attention deficit hyperactivity disorder clinical guideline received an update to the recommendations on dietary advice.

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 - February 2016

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

This issue launches communication materials to further improve awareness of the risks of developmental disorders and congenital malformations associated with valproate use in pregnancy. These materials are aimed at supporting discussion of these risks with women of childbearing potential and girls who take valproate. Hard copies are being sent to relevant healthcare professionals from this week.

This issue also highlights the risk of potentially fatal hyperkalaemia during concurrent use of spironolactone and renin-angiotensin system drugs in heart failure. It is recommended that the combination is avoided where possible and especially in patents with renal impairment. Where treatment is necessary the lowest effective doses should be used and regular monitoring of blood electrolytes is essential in such patients.

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

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Health Protection Guidance - Zika virus

Public Health England have issued guidance on Zika virus. The guidance contains information on epidemiology, symptoms, transmission, diagnosis and travel advice.

There are also links to travel advice portals, an algorithm for assessing pregnant women following travel and specific guidance for clinicians working in primary care.

The main advice points for primary care are:

  • All travellers to areas with active Zika virus transmission should practise mosquito bite avoidance measures
  • Pregnant women planning to travel should consider avoiding travel to areas with active Zika transmission
  • All pregnant women who have recently travelled to a country where active Zika transmission is reported should notify their primary care clinician, obstetrician or midwife
  • An application of insect repellent containing 50% DEET (N,N-diethyl-m-toluamide) will repel mosquitoes for approximately 12 hours; such repellents containing 50% DEET can be used by pregnant women
  • To reduce the risk of sexual transmission to woman of child bearing age, including those already pregnant, male partners should use a condom for 28 days after arriving from an affected area or 6 months following recovery if a clinical illness compatible with Zika virus infection or laboratory-confirmed Zika virus infection was reported

Action: Clinicians should be aware of this guidance and ensure they implement the recommendations.

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SMC Update - February 2016

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

Fulvestrant (Faslodex®) has been accepted for use in he treatment of postmenopausal women with oestrogen receptor positive, locally advanced or metastatic breast cancer for disease relapse on or after adjuvant anti-oestrogen therapy, or disease progression on therapy with an anti-oestrogen. This is a re-submission assessed under the end of life process and takes account of the benefits of a Patient Access Scheme (PAS) that improves the cost-effectiveness of fulvestrant. This advice is contingent upon the continuing availability of the PAS in NHS Scotland or a list price that is equivalent or lower.

Guanfacine (Intuniv®) has been accepted for use in the treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents 6 to 17 years old for whom stimulants are not suitable, not tolerated or have been shown to be ineffective. Treatment must be used as part of a comprehensive ADHD treatment programme, typically including psychological, educational and social measures.

Ulipristal (Esmya®) has been accepted for the intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age.

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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