Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2019

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2019. This month there are two guidelines that impact upon primary care.

The Antenatal care for uncomplicated pregnancies guideline has been updated. The recommendation on screening for German measles (rubella) has been removed as this is no longer offered by the NHS.

The Cough (acute): antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for acute cough associated with an upper respiratory tract infection or acute bronchitis in adults, young people and children. It aims to limit 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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Drug Safety Update - February 2019

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for February 2019 (PDF).

This issue advises clinicians of the increased risk of congenital malformations when carbimazole is used during pregnancy, especially when administered in the first trimester of pregnancy and at high doses. Women of childbearing potential should use effective contraception during treatment with carbimazole and it must only be used during pregnancy when clinically indicated and after a strict individual benefit/risk assessment.

Readers are also advised that carbimazole treatment must be immediately and permanently stopped if acute pancreatitis occurs. Re-exposure to carbimazole may result in life-threatening acute pancreatitis with a decreased time to onset.

Clinicians are also notified of an association between Fournier’s gangrene (necrotising fasciitis of the genitalia or perineum) and the use of sodium-glucose co-transporter 2 (SGLT2) inhibitors. Fournier’s gangrene is a rare but potentially life-threatening infection that requires urgent medical attention. If Fournier’s gangrene is suspected, stop the SGLT2 inhibitor and start treatment urgently.

Finally this month, the summary of letters to healthcare professionals includes a warning that application of creams, patches or sprays under the FreeStyle Libre flash glucose sensor in order to reduce skin reactions may affect device performance. The letter recommends consideration of the suitability of continued use of this device for patients with skin reactions.

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

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SMC Update - February 2019

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

Rivaroxaban (Xarelto®) has been accepted for restricted use when co-administered with acetylsalicylic acid for the prevention of atherothrombotic events in adult patients with coronary artery disease or symptomatic peripheral artery disease who are at high risk of ischaemic events. The restriction limits use to patients with stable coronary artery disease that does not require dual antiplatelet therapy.

Eslicarbazepine (Zebinix®) has been accepted for restricted use as adjunctive therapy in adolescents and children aged above 6 years with partial-onset seizures with or without secondary generalisation. The restriction limits use to patients with highly refractory epilepsy who have been heavily pre-treated and remain uncontrolled with existing anti-epileptic drugs.

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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