Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - December 2018

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

This issue notes that oral lidocaine-containing products for infant teething are now only to be available under the supervision of a pharmacist. This is to ensure that appropriate guidance about managing infant teething symptoms can be given and lidocaine-containing products only be used when simple measures have failed to provide sufficient relief.

This issue also reports that compliance with the new valproate measures for pregnancy prevention currently appears to be variable by CCG. All healthcare professionals must continue to identify and review all female patients on valproate and provide them with the patient information materials every time they attend their appointments or receive their medicines.

Readers are also advised the packaging and patient information leaflets for emollients will soon be updated warning about the risk of severe and fatal burns. These warnings are being are being extended to all paraffin-based emollients regardless of paraffin concentration and also for paraffin-free emollients where there is still a risk.

This issue also notes that direct-acting antivirals for chronic hepatitis C have been associated with an increased risk of hypoglycaemia in patients with diabetes. It is suggested the glucose levels are monitored more closely, particularly in the first 3 months of treatment, with diabetic treatment adjusted accordingly.

Also, this issue advises that hydrocortisone muco-adhesive buccal tablets should not be used off-label for adrenal insufficiency in children. This is due to serious risks of insufficient cortisol absorption and life-threatening adrenal crisis. Licensed hydrocortisone products for adrenal replacement therapy are available and should be used.

Finally this month, the summary of letters to healthcare professionals includes a letter circulated about the risk of aortic aneurysm and dissection, particularly on older patients, using fluoroquinolones and notification that Quadrivalent Influenza Vaccine (under the brand name VaxigripTetra®▼) intended for export to Europe has been authorised for use in the UK to satisfy higher than expected demand.

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

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NICE Guidance - December 2018

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

The Antenatal care for uncomplicated pregnancies guideline has been updated. The recommendations on alcohol consumption in pregnancy have been removed and replaced by a link to the UK CMOs' low-risk drinking guidelines.

The Post-traumatic stress disorder guideline has been published and replaces prior guidance from 2005. It covers recognising, assessing and treating post-traumatic stress disorder (PTSD) in children, young people and adults. It aims to improve quality of life by reducing symptoms of PTSD such as anxiety, sleep problems and difficulties with concentration. Recommendations also aim to raise awareness of the condition and improve coordination of care.

The Chronic obstructive pulmonary disease in over 16s guideline has been published and replaces prior guidance from June 2010. It covers diagnosing and managing chronic obstructive pulmonary disease (COPD) in people aged 16 and older, which includes emphysema and chronic bronchitis. It aims to help people with COPD to receive a diagnosis earlier so that they can benefit from treatments to reduce symptoms, improve quality of life and keep them healthy for longer.

The Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for acute exacerbations of chronic obstructive pulmonary disease (COPD). It aims to optimise antibiotic use and reduce antibiotic resistance.

The Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for managing and preventing acute exacerbations of bronchiectasis (non-cystic fibrosis). It aims to optimise antibiotic use and reduce antibiotic resistance.

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

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SMC Update - December 2018

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

Brivaracetam (Briviact®) has been accepted for restricted use as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in children from 4 years to ≤15 years of age with epilepsy. The restrictions limits use to patients with refractory epilepsy and treatment should be initiated by physicians who have appropriate experience in the treatment of epilepsy.

Ciclosporin eye drops (Verkazia®) have been accepted for use in the treatment of severe vernal keratoconjunctivitis (VKC) in children from 4 years of age and adolescents (until the age of 18)

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 - November 2018

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

The following topics were all reviewed:

All of reviewed topics have undergone reviews and minor restructures.

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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