Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - June 2018

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

This issue advises that there is an increased risk of neural tube defects in women who become pregnant while taking dolutegravir for the treatment of HIV. If pregnancy is confirmed in the first trimester their specialist should consider switching to an alternative treatment.

This issue also notifies readers of two emerging concerns regarding denosumab (Xgeva® ▼). Rebound hypercalcaemia have been reported up to 9 months after discontinuation of denosumab. Periodic monitoring of serum calcium is recommended. A pooled analysis has also shown an increased incidence of new primary malignancies in patients treated with denosumab compared to zoledronic acid. All suspected adverse reactions for denosumab should be reported, including any new primary malignancies.

Finally this month, the summary of letters to healthcare professionals includes a reminder of false readings seen with certain batches of Accu-Chek test strips, as reported last month.

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

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NICE Guidance - June 2018

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of June 2018. This month there is one guideline and one technology appraisal that impact upon primary care.

The Dementia guideline has been published. It replaces a previous guideline from 2006 and covers diagnosing and managing dementia (including Alzheimer's disease). It aims to improve care by making recommendations on training staff and helping carers to support people living with dementia.

The Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease technology appraisal has been updated with the recommendations in section 1.3 replaced by the guideline above.

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

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SMC Update - June 2018

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

Fluticasone / Formoterol (Flutiform k-haler®) has been accepted for use in the regular treatment of asthma where the use of a combination product is an appropriate treatment. This inhaler is a breath-actuated inhaler that is bioequivalent to Flutiform metered-dose inhaler (pMDI) and costs the same.

Eslicarbazepine (Zebinix®) has been rejected for use as monotherapy in the treatment of partial-onset seizures, with or without secondary generalisation, in adults with newly diagnosed epilepsy. The manufacturer failed to make a submission for 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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CKS Updates - May 2018

During May 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 to the Fungal skin infection - scalp and Smoking cessation topics. The Fungal skin infection - scalp topic has had complications and prognosis nodes added to the background information section and a differential diagnosis node has been added to the diagnosis section. The Smoking cessation topic has had information added on very brief advice on smoking cessation for adults and pregnant women and recommendations regarding e-cigarettes have been added.

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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