Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2018

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

The Pancreatic cancer in adults guideline has been published. It covers diagnosing and managing pancreatic cancer in adults aged 18 and over. It aims to improve care by ensuring quicker and more accurate diagnosis, and by specifying the most effective treatments for people depending on how advanced their cancer is.

The Heavy menstrual bleeding clinical guideline has been updated to include signposting to the temporary safety measures as part of an ongoing review of ulipristal acetate (Esmya®) for uterine fibroids.

The Peripheral arterial disease clinical guideline has been updated with two new recommendations in diagnosing peripheral arterial disease in people with diabetes.

The Raloxifene for the primary prevention of osteoporotic fragility fractures in postmenopausal women technology appraisal has been updated to reflect the current recommendations. Guidance on strontium ranelate and etidronate have been removed because these drugs are no longer marketed in the UK. Some recommendations have also been replaced by newer guidance.

The Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women technology appraisal has been updated to reflect the current recommendations as detailed above. Some recommendations have also been replaced by newer guidance.

The Bisphosphonates for treating osteoporosis technology appraisal has also been updated in line with the amendments to the two technology appraisals listed above.

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

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CKS Updates - January 2018

During January 2018 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 Burns and scalds topic that now has a new Assessment section and prescribing details have been replaced with a link to the Cellulitis topic. In the Tennis Elbow topic there is a new differential diagnosis section and the Vestibular neuronitis topic now contains more detailed prescribing information.

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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SMC Update - February 2018

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

Fluticasone furoate / umeclidinium / vilanterol (Trelegy Ellipta®) 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 beta-agonist. The restriction limits use to patients with severe COPD (forced expiratory volume in one second [FEV1] < 50% predicted normal).

Lacosamide (Vimpat®) has been accepted for restricted use as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adolescents and children from 4 years of age with epilepsy. The restriction limits use to patients with refractory epilepsy and should be initiated by physicians who have appropriate experience in the treatment of epilepsy.

Levonorgestrel (Kyleena®) has been accepted for use as a contraceptive for up to 5 years.

Sevelamer carbonate (Renvela®) has been accepted for restricted use to control of hyperphosphataemia in paediatric patients (>6 years of age and a Body Surface Area of >0.75m2) with chronic kidney disease. The restriction limits use to second-line management of hyperphosphataemia in patients receiving haemodialysis and treatment would normally be initiated by a specialist.

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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Drug Safety Update - February 2018

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

This issue advises clinicians that mycophenolate mofetil or mycophenolic acid have teratogenic and genotoxic effects and while the current evidence does not indicate an increased risk of malformations or miscarriage in pregnancies while fathers were taking these medicines but is insufficient to rule out a risk. As a precaution it is recommended that men taking these drugs, or their female partner, should use effective contraception.

This issue also contains a summary of recent drug and device alerts, including a potential defect with midazolam (Buccolam®) oral syringed as reported last month, notification that a shortage of UK zanamivir (Relenza®) will be filled by stock from abroad and a warning that all Philips HeartStart MRx monitors/defibrillators will be affected by a significant delay in the fulfilment of orders for new batteries.

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

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