Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - September 2018

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of September 2018. This month there are three guidelines that impact upon primary care.

The Chronic heart failure in adults guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure.

The Preventing suicide in community and custodial settings guidelinecovers ways to reduce suicide and help people bereaved or affected by suicides. It aims to:

  • help local services work more effectively together to prevent suicide
  • identify and help people at risk
  • prevent suicide in places where it is currently more likely

The Pancreatitis guideline covers managing acute and chronic pancreatitis in children, young people and adults. It aims to improve quality of life by ensuring that people have the right treatment and follow-up, and get timely information and support after diagnosis.

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

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SMC Update - September 2018

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

Denosumab (Prolia®) has been rejected for the treatment of bone loss associated with long-term systemic glucocorticoid therapy in adult patients at increased risk of fracture. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication.

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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Ciclesonide supply interruption

The manufacturer of ciclesonide inhalers (Alvesco®) has written to healthcare professionals advising of an imminent supply interruption to this product.

Ciclesonide is available in 80 microgram and 160 microgram dose strengths. Due to a supply issue affecting one of the components of the inhaler, stock in the UK is running very low and supplies are not assured from the start of August. The 80 microgram strength is expected back in supply by mid-October with the 160 microgram strength due back from mid-September.

Pharmacies are being advised to contact prescribers for an alternative if prescriptions cannot be dispensed. Prescribers are being advised to consider appropriate alternatives where necessary. The BTS/SIGN guideline on the management of asthma is a useful resource for identifying dose equivalence.

Action: Clinicians should be aware of this supply interruption and be prepared to supply appropriate alternatives.

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CKS Updates - August 2018

During August 2018 Clinical Knowledge Summaries were published or updated in the following areas.

New topics were published for:

The following topics were all reviewed:

The majority of reviewed topics have undergone reviews and minor restructures.

The most significant changes were to the Nappy rash topic where complications and prognosis sections have been added and the differential diagnosis section has been expanded. The Sinusitis topic has had sections added on prevalence, complications and antibiotic choice for acute sinusitis.

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 - August 2018

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2018 (PDF).

This issue advises of the risk of serious liver injury and new restrictions introduced for ulipristal acetate (Esmya®). It is now recommended that treatment is initiated and supervised by physicians experienced in the diagnosis and treatment of uterine fibroid for:

  • the intermittent treatment of moderate to severe symptoms of uterine fibroids in women of reproductive age who are not eligible for surgery
  • one treatment course of pre-operative treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age

It is also contraindicated in women with underlying liver disorders and regular liver function monitoring during and immediately after treatment is recommended.

Finally this month, the summary of letters to healthcare professionals includes further information about pregnancy prevention programme materials to support safe use of valproate containing medicines in girls and women of child bearing potential.

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

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