Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2017

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

The Drug misuse prevention guideline covers targeted interventions to prevent misuse of drugs, including illegal drugs, 'legal highs' and prescription-only medicines. It aims to prevent or delay harmful use of drugs in children, young people and adults who are most likely to start using drugs or who are already experimenting or using drugs occasionally.

The Osteoporosis: assessing the risk of fragility fracture clinical guideline has been updated and covers assessing the risk of fragility fracture in people aged 18 and over with osteoporosis. It aims to provide guidance on the selection and use of risk assessment tools in the care of adults at risk of fragility fractures in all NHS settings. The update corrects the reference to the WHO in relation to the FRAX tool.

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 2017

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

Healthcare professionals are advised that hyoscine butylbromide (Buscopan®) injection can cause serious adverse effects including tachycardia, hypotension and anaphylaxis that can result in a fatal outcome in patients with underlying cardiac disease, such as those with heart failure, coronary heart disease, cardiac arrhythmia or hypertension. It should be used with caution in such patients and is contraindicated in tachycardia.

Readers are also notified that Yellow Card reporting has been added to a second clinical software system. Integrated reporting is now available in Vision in addition to SystmOne. All suppliers of primary care systems must integrate electronic Yellow Card facilities into their clinical software in the future as required by the NHS GP Systems of Choice Programme.

There is also a summary of letters sent to healthcare professionals in January including notification of the end of supply shortages affecting Insuman®, an insertion tube defect affecting batch TU01BPE of Mirena® and a reminder about the Pregnancy Register for reporting pregnancies exposed to ellaOne®.

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

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SMC Update - February 2017

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

Desmopressin (Noqdirna®) has been rejected for use in the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults. The submitting company did not present sufficiently robust clinical and economic analyses to gain acceptance.

Evolocumab (Repatha®) has been accepted for restricted use in adults with primary hypercholesterolaemia (heterozygous familial hypercholesterolaemia and non-familial) or mixed dyslipidaemia, as an adjunct to diet, in combination to reach treatment goals or alone when other treatments are not tolerated. The restriction limits use to specialist use in patients at high cardiovascular risk.

Pitolisant (Wakix®) has been rejected for the treatment of narcolepsy with or without cataplexy in adults. 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 - January 2017

During January 2017 Clinical Knowledge Summaries were updated for the following topics:

The following topics were all reviewed:

The majority of topics have undergone minor restructures. More significant changes are as follow:

  • Edoxaban was added to the Anticoagulation - oral topic along with the MHRA information about the interaction between vitamin K antagonists and hepatitis C treatments
  • A section on end of life care was added to the Delirium topic
  • The Palliative Care topics were updated in line with NICE 2015 guidance Care of dying adults in the last days of life
  • Aspiration and corticosteroid injection are no longer recommended as treatments in primary care in the Pre-patellar Bursitis topic
  • The Temporomandibular disorders topic has been updated in line with recommendation from the Royal College of Surgeons Faculty of Dental Surgery

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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