Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - October 2019

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of October 2019. This month there is one technology appraisal and five guidelines that impact upon primary care.

The Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease technology appraisal has been published. Rivaroxaban plus aspirin is recommended within its marketing authorisation, as an option for preventing atherothrombotic events in adults with coronary artery disease or symptomatic peripheral artery disease who are at high risk of ischaemic events. For people with coronary artery disease, high risk of ischaemic events is defined as:

  • aged 65 or over, or
  • atherosclerosis in at least 2 vascular territories (such as coronary, cerebrovascular, or peripheral arteries), or
  • 2 or more of the following risk factors:
    • current smoking
    • diabetes
    • kidney dysfunction with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min (note that rivaroxaban is contraindicated if the eGFR is less than 15 ml/min)
    • heart failure
    • previous non-lacunar ischaemic stroke

The End of life care for adults: service delivery guideline has been published. It covers organising and delivering end of life care services, which provide care and support in the final weeks and months of life (or for some conditions, years), and the planning and preparation for this. It aims to ensure that people have access to the care that they want and need in all care settings. It also includes advice on services for carers.

The Diabetic foot problems guideline has been updated. It covers preventing and managing foot problems in children, young people and adults with diabetes. The update follows a review of the evidence for antimicrobial prescribing for diabetic foot infections.

The Gastro-oesophageal reflux disease and dyspepsia in adults guideline has been updated. It covers investigating and managing gastro-oesophageal reflux disease (GORD) and dyspepsia in people aged 18 and over. The update makes changes to recommendations on eradicating H pylori and updated footnotes in this guideline to reflect new restrictions and precautions for the use of fluoroquinolone antibiotics.

The Epilepsies: diagnosis and management guideline has been updated. It covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. The update amended footnotes to reflect a change in the law relating to pregabalin and gabapentin now being classed as controlled drugs.

The Familial hypercholesterolaemia: identification and management guideline has been updated. It covers identifying and managing familial hypercholesterolaemia (FH), a specific type of high cholesterol that runs in the family, in children, young people and adults. The update changed the first recommendation on case finding and diagnosis to be clearer about when to suspect familial hypercholesterolaemia.

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

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