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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

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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NICE Guidance - August 2018

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

The Flu vaccination: Increasing uptake guideline has been published. It covers how to increase uptake of the free flu vaccination among people who are eligible. It describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.

The Community pharmacies: promoting health and wellbeing guideline has been published. It covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It may be relevant for people working in related services, for example GP practices and out-of-hours services.

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

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Alzheimer's disease treatments delisted in France

According the Prescrire, a French medical journal, drug treatments for Alzheimer's disease have been delisted in France and will no longer be reimbursed by the national health insurance system.

According to the article, the National Authority for Health (HAS) has previously issued guidance recommended treatments including donepezil, galantamine, rivastigmine and memantine. A review in 2016 of the harm-benefit balance of these treatments by France's Pharmacoeconomic Committee resulted in HAS acknowledging that these drugs have no place in the management of Alzheimer's disease.

Current guidance from NICE still recommends these treatments as options along with a range of other interventions to promote wellbeing and functional ability.

Action: Clinicians should continue to follow current NICE guidance however this move represents an interesting move away from medication in favour of supportive strategies for daily living that includes assistance for caregivers and family members.

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CKS Updates - July 2018

During July 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 topics have undergone reviews and minor restructures.

The most significant changes were to the Fungal skin infection - body and groin topic which has had new nodes on Definition, Risk factors, Prevalence, Complications, and Prognosis added to the Background information section. The Prescribing Information section has also been updated and expanded in line with current CKS style for this topic and the Osteoarthritis topic.

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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