Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - November 2017

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

Midazolam (Epistatus®) has been accepted for use in the treatment of prolonged, acute, convulsive seizures in children and adolescents aged 10 to less than 18 years. This product provides a licensed alternative to unlicensed preparations.

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 - October 2017

During October 2017 Clinical Knowledge Summaries were updated in the following areas.

The following topics were all reviewed:

The majority of topics have undergone reviews and minor restructures.

The most significant changes are in the Crohn's disease topic where recommendations on the diagnosis and management of confirmed Crohn's disease have been amended in line with current evidence, the sections on specialist investigations and management has been updated and expanded and the Prescribing information section has been deleted and links made to other relevant CKS topics. The Knee pain - assessment topic has been updated with new sections on risk factors and prognosis and the assessment and management recommendations have been amended in line with current evidence. Lastly, the Prostate cancer topic has been updated with recommendations on prostate-specific antigen (PSA) testing and treatments for prostate cancer amended in line with the latest guidance.

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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Drug Safety Update - October 2017

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for October 2017 (PDF).

This issue warns clinicians that Solu-Medrone 40mg contains lactose derived from cows' milk and as such it may contain trace amounts of milk proteins. As such, this product must not be used in patients with known or suspected allergy to cows' milk. Serious allergic reactions have been reported.

It is also noted that gabapentin has been associated with a rare risk of severe respiratory depression even without concomitant opioid medicines. Patients at higher risk of experiencing severe respiratory depression include those with compromised respiratory function, respiratory or neurological disease, renal impairment, concomitant use of CNS depressants and elderly people. Dose adjustments might be necessary in these patients. Gabapentin is usually started at low dose and increased based on efficacy and tolerance; directly asking patients about respiratory symptoms during dose increases may be prudent.

Isotretinoin has been associated with rare reports of erectile dysfunction and decreased libido. Further reporting of any suspected adverse events is recommended.

Clinicians are also reminded of the potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus with Clozapine. It is therefore vital that constipation is recognised and actively treated and particular care should be exercised in patients receiving other drugs known to cause constipation, those with history of colonic disease or lower abdominal surgery, and in patients aged 60 years and older.

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

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NICE Guidance - October2017

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of October 2017. This month there are two guidelines that impact upon primary care.

The Cystic fibrosis guideline covers diagnosing and managing cystic fibrosis. It specifies how to monitor the condition and manage the symptoms to improve quality of life. There are also detailed recommendations on treating the most common infections in people with cystic fibrosis.

The Child maltreatment clinical guideline covers the signs of possible child maltreatment in children and young people aged under 18 years. It aims to raise awareness and help health professionals who are not child protection specialists to identify the features of physical, sexual and emotional abuse, neglect and fabricated or induced illness.

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

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SMC Update - October 2017

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

Beclometasone / formoterol / glycopyrronium inhaler (Trimbow®) has been accepted for restricted use as a maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta2-agonist. The restriction limits use to patients with a forced expiratory volume in one second less than 50% predicted normal.

Opicapone (Ongentys®) has been rejected for use as an adjunctive therapy to preparations of levodopa / DOPA decarboxylase inhibitors in adult patients with Parkinson's disease and end-of-dose motor fluctuations who cannot be stabilised on those combinations. The manufacturer did not make a submission to the SMC and therefore the product cannot be recommended.

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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