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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - November 2019

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

The Fever in under 5s: assessment and initial management guideline has been published. It covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.

The Cannabis-based medicinal products guideline has been published. It covers the prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.

The Thyroid disease: assessment and management guideline has been published. It covers investigating all suspected thyroid disease and managing primary thyroid disease (related to the thyroid rather than the pituitary gland). It does not cover managing thyroid cancer or thyroid disease in pregnancy. It aims to improve quality of life by making recommendations on diagnosis, treatment, long-term care and support.

The Diverticular disease: diagnosis and management guideline has been published. It covers the diagnosis and management of diverticular disease in people aged 18 years and over. It aims to improve diagnosis and care and help people get timely information and advice, including advice about symptoms and when to seek help.

The Familial breast cancer guideline has been updated. It covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer. The update revised the recommendations on the topics that should be discussed with a person before making a decision on whether to have annual mammographic surveillance and includes links to patient decision aids.

The Multiple sclerosis in adults: management guideline has been updated. It covers diagnosing and managing multiple sclerosis in people aged 18 and over. This update replaced the recommendation on using Sativex (a THC:CBD spray) to treat spasticity in people with multiple sclerosis with a cross-reference to recommendations on THC:CBD spray in the NICE guideline on cannabis-based medicinal products.

The Pentosan polysulfate sodium for treating bladder pain syndrome technology appraisal has been published. The treatment is recommended as an option for treating bladder pain syndrome with glomerulations or Hunner's lesions in adults with urinary urgency and frequency, and moderate to severe pain, only if:

  • their condition has not responded to an adequate trial of standard oral treatments
  • it is not offered in combination with bladder instillations
  • any previous treatment with bladder instillations was not stopped because of lack of response
  • it is used in secondary care and
  • the company provides pentosan polysulfate sodium according to the commercial arrangement.

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 - November 2019

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

Clinicians are advised of stronger precautions in people with weakened immunity and in those aged 60 years or older when using the yellow fever vaccine. Strict adherence to contraindications and precautions is essential. New and updated contraindications and strengthened precautions aim to protect those with a weakened immune systems (including for people aged 60 years or older) and standardised risk-benefit evaluation procedures are advised across UK yellow fever vaccination centres to ensure that people only receive the vaccine after a thorough risk assessment. It is recommended that only healthcare professionals specifically trained in benefit-risk evaluation of yellow fever vaccine should administer the vaccine, following their individualised assessment of a person's travel itinerary and suitability to receive the vaccine.

The summary of letters to healthcare professionals this month includes several links to letters recalling ranitidine containing products from pharmacies and also a letter confirming that permission has been given to supply and use Quadrivalent Influenza Vaccine (split virion, inactivated) in packs designed for export in order to meet demand.

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

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SMC Update - November 2019

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

Imiquimod (Zyclara®) has been accepted for restricted use in the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic, visible or palpable actinic keratosis of the full face or balding scalp in immunocompetent adults when other topical treatment options are contraindicated or less appropriate. The restriction limits use to the treatment of large field actinic keratosis (>25cm2).

Pentosan polysulfate sodium (Elmiron®) has been accepted for the treatment of bladder pain syndrome characterised by either glomerulations or Hunner’s lesions in adults with moderate to severe pain, urgency and frequency of micturition. It is noted that this decision takes account of the benefits of a Patient Access Scheme (PAS) that improves the cost-effectiveness of pentosan polysulfate sodium. This advice is contingent upon the continuing availability of the PAS in NHSScotland or a list price that is equivalent or lower.

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 - October 2019

During October 2019 Clinical Knowledge Summaries were published or updated in the following areas.

The Hearing loss in adults topic is new. The Halitosis topic has been updated in line with current evidence. The Shingles topic contains updated recommendations on antiviral treatment. It is recommended that antiviral treatment should be considered for all people aged over 50 years because while it has a low risk of complications, it does not significantly reduce the incidence of post-herpetic neuralgia. The other 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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