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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - January 2017

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

The Cerebral palsy in under 25s guideline covers diagnosing, assessing and managing cerebral palsy in children and young people from birth up to their 25th birthday. It aims to make sure they get the care and treatment they need for the developmental and clinical co-morbidities associated with cerebral palsy, so that they can be as active and independent as possible.

The Antimicrobial stewardship guideline covers making people aware of how to correctly use antimicrobial medicines (including antibiotics) and the dangers associated with their overuse and misuse. It also includes measures to prevent and control infection that can stop people needing antimicrobials or spreading infection to others. It aims to change people’s behaviour to reduce antimicrobial resistance and the spread of resistant microbes.

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 - January 2017

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

Healthcare professionals are advised that INR should be monitored closely during treatment of chronic hepatitis C with direct-acting antivirals in patients also receiving vitamin K antagonists (e.g. warfarin), because of possible changes in liver function during treatment.

It is also noted that a review of the evidence from clinical trials and postmarketing cases has suggested a causal association between apremilast (Otezla®) and suicidal thoughts and suicidal behaviour. Any patient presenting with new or worsening depression and suicidal thoughts should have treatment stopped.

There is also a summary of letters sent to healthcare professionals in December including notification of the potential for medication errors associated with overdose with liquid levetiracetam, usually in children. To minimise the risk it is recommended that the dosing directions should specify the dose in milligrams and millilitres and patients should be advised to only use the medicines syringe supplied with the medicine.

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

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SMC Update - January 2017

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

Buprenorphine transdermal patch (Butec®) has been accepted for restricted use in adults, for the treatment of chronic non-malignant pain of moderate intensity when an opioid is necessary for obtaining adequate analgesia. The restriction limits use to elderly patients (over 65 years).

Conjugated oestrogens and bazedoxifene acetate (Duavive®) has been rejected in the treatment of oestrogen deficiency symptoms in postmenopausal women with a uterus (with at least 12 months since the last menses) for whom treatment with progestin-containing therapy is not appropriate. The manufacturer failed to make a submission.

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 - December 2016

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

The following topics were all reviewed:

The shingles topic updated changed recommendations with respect to the choice of drugs for neuropathic pain and also added sections on prevalence, risk factors, and differential diagnosis. There were also minor changes to the prescribing information section on antiviral drugs. The remaining changes for the other topics were minor structural changes.

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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