Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - November 2016

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

The Hypertension in adults guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over. It has been updated to include two MHRA drug safety alerts regarding ACE inhibitor use during pregnancy and breastfeeding.

The Diabetes in children and young people guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. It has been updated to add information on when eye screening should begin and referral for eye screening should happen.

The Dapagliflozin in triple therapy for treating type 2 diabetes technology appraisal replaces existing advice (see below). Triple therapy regimen is recommended as an option for treating type 2 diabetes in adults only in combination with metformin and a sulfonylurea.

The Dapagliflozin in combination therapy for treating type 2 diabetes technology guideline has been updated to including sign-posting to the new guidance above covering triple therapy.

The Apremilast for treating moderate to severe plaque psoriasis technology appraisal is recommended as an option for treating chronic plaque psoriasis in adults whose disease has not responded to other systemic therapies, including ciclosporin, methotrexate and PUVA (psoralen and ultraviolet‑A light). Treatment should be initiated by specialists.

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

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British Asthma Guideline Update

The British Asthma Guideline jointly published by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network has been updated.

Available in a Quick Reference format or as a Full Guideline the guideline covers diagnosis and management of asthma in adults and children. This update contains minor corrections and changes apart from change advised to now immediately treat children under 2 years old in hospital settings with acute asthma symptoms.

Action: This guideline is a cornerstone of asthma management. Clinicians who diagnose and treat asthma should be aware of this update and have access to this guideline.

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SMC Update - November 2016

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

Dequalinium (Fluomizin®) has been accepted for restricted use in the treatment of bacterial vaginosis where the initial treatment is ineffective or not well tolerated.

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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Drug Safety Update - November 2016

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

Brimonidine gel (Mirvaso®) has been associated with exacerbations or rebound symptoms of rosacea. This has occurred in up to 16% of patients treated with brimonidine gel in clinical studies and in most cases erythema and flushing resolve after stopping treatment. It is recommended that a small amount of gel is used for the first week and the dose should be increased gradually. Patients should also be advised not to exceed the maximum dose and should stop treatment and consult a doctor if their symptoms worsen during treatment.

This issue also advised of a social media campaign to promote the reporting of suspected adverse drug reactions to the Yellow Card Scheme.

There is also a summary of letters sent to healthcare professionals in October including the reintroduction to market of levothyroxine and introduction of new tablet strengths by Teva.

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

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CKS Updates - October 2016

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

In the Immunizations - Seasonal influenza topic the recommendations on the clinical risk groups eligible for annual influenza immunisation have been updated to include people with morbid obesity and the information on the extension of the national childhood influenza immunisation programme has been updated to include children of appropriate age for school years 1, 2, and 3. Information on the available vaccines and the management of children and adults with egg allergy has been updated in line with the chapter on Influenza in the Public Health England (PHE) document Immunisation against infectious disease (The Green Book).

In the Morton's neuroma topic non-steroidal anti-inflammatory drugs are now included as a management option and there have been minor changes to the recommendations on referral.

Additionally this month there is a new topic area covering Non-alcoholic fatty liver disease (NAFLD).

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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