Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - December 2017

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2017. This month there is one guideline, one diagnostic guideline and one technology appraisal that impact upon primary care.

The Autism spectrum disorder in under 19s clinical guideline has been updated to include ADHD as a factor associated with an increased prevalence of autism and changed references from DCM-4 to DCM-5. The guideline covers recognising and diagnosing autism spectrum disorder in children and young people from birth up to 19 years and it also covers referral.

The Atrial fibrillation and heart valve disease: self-monitoring diagnostic guideline has been updated removing the recommendations for the InRatio2 PT/INR monitor as this device is no longer available.

The Naltrexone–bupropion for managing overweight and obesity technology appraisal has been published. Naltrexone–bupropion (Mysimba®) is not recommended within its marketing authorisation for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity.

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

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Antiviral Medicines Authorised for Influenza Season 2017/18

The Department of Health has written to healthcare professionals via the Central Alerting System (PDF) to advise that antiviral medicines may now be prescribed at NHS expense due to rising levels in reporting of influenza-like illness.

Surveillance data indicates an increase in influenza cases in the community, GPs and other prescribers working in primary care may now prescribe antiviral medicines for the prophylaxis and treatment of influenza. Doses and treatment schedules are contains in existing Public Health England guidance.

Clinicians are reminded to endorse the prescription with 'SLS' to ensure that it can be dispensed in community pharmacies without undue delay.

Action: Clinicians should be aware of this letter and familiarise themselves with the current prescribing guidance.

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Drug Safety Update - December 2017

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

This issue advised that fingolimod (Gilenya®) can increase the risk of skin cancers and lymphoma and serious opportunistic infections. It is now recommended that patients on this treatment avoid UV light exposure and seek urgent medical advice if they notice any skin lesions. It is also recommended to seek urgent medical advice on the development of any symptoms or signs consistent with an infection, including up to 2 months after the end of fingolimod therapy. This treatment has also been associated with persistent bradycardia, which can increase the risk of serious cardiac arrhythmias. New contraindications have been introduced but patients currently on treatment should be reviewed should cardiac symptoms develop.

Lastly, the summary of letters sent to healthcare professionals in November includes a warning regarding a potential defect on midazolam (Buccolam®) oral syringes. An apparent fault with the syringe cap can prevent administration. If this occurs in use the e translucent tip cap needs to be manually removed to allow administration.

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 2017

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

Aviptadil / Phentolamine (Invicorp®) has been accepted for restricted use in the symptomatic treatment of erectile dysfunction in adult males due to neurogenic, vasculogenic, psychogenic, or mixed aetiology. The restriction limits use to those patients who have failed on oral therapies (oral phosphodiesterase type-5 inhibitors) and other non-injectable formulations of erectile dysfunction medications. It is also likely that the existing SLS criteria will apply to this product.

Fulvestrant (Faslodex®) has been rejected for use in the treatment of oestrogen receptor positive, locally advanced or metastatic breast cancer in postmenopausal women not previously treated with endocrine therapy. The manufacturer failed to make a submission.

Tiotropium (Spiriva Respimat®) has been accepted for use as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD). This product was previously restricted use in patients who have poor manual dexterity but a price reduction has resulted in this restriction has been removed.

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 2017

During November 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 Irritable bowel syndrome and Psoriasis topics. The Irritable bowel syndrome topic has been updated where the recommendations on the diagnosis and management of irritable bowel syndrome have been amended in line with current evidence, including the addition of linaclotide as a drug treatment option. The Psoriasis topic has been updated where recommendations on the diagnosis and management of psoriasis have been amended in line with current evidence, an additional node has been added to the Management section on Specialist investigations and treatment and the section on Topical corticosteroids has been replaced with a link to the CKS topic on Corticosteroids - topical (skin), nose, and eyes.

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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