Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - December 2019

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

The Acute kidney injury: prevention, detection and management guideline has been published. It covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury.

The Menopause: diagnosis and management guideline has been updated. It covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause. This update includes MHRA safety alert information regarding the risks of breast cancer.

The Cannabidiol with clobazam for treating seizures associated with Dravet syndrome technology appraisal recommends this treatment as an option for treating seizures associated with Dravet syndrome in people aged 2 years and older, only if:

  • the frequency of convulsive seizures is checked every 6 months, and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment
  • the company provides cannabidiol according to the commercial arrangement

The Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome technology appraisal recommends this treatment as an option for treating seizures associated with Lennox–Gastaut syndrome in people aged 2 years and older, only if:

  • the frequency of drop seizures is checked every 6 months, and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment
  • the company provides cannabidiol 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 - December 2019

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

This month clinicians are advice that domperidone is no longer licensed for use in children younger than 12 years or those weighing less than 35 kg. Results from a placebo-controlled study in children younger than 12 years with acute gastroenteritis failed to demonstrate any difference in efficacy at relieving nausea and vomiting compared with placebo. It is recommended that alternative treatments to domperidone are used in children younger than 12 years of age who need relief of symptoms of nausea and vomiting.

The summary of letters to healthcare professionals this month includes further links to letters recalling ranitidine, Emerade® adrenaline auto-injectors and several other pharmacy level drug recalls.

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 2019

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

Prasterone (Intrarosa®) has been rejected for use in the treatment of vulvar and vaginal atrophy in postmenopausal women having moderate to severe symptoms. The manufacturer did not make a submission to the SMC and as such it cannot be recommend.

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 2019

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

All of the topics have been reviewed and undergone minor restructuring. The Depression in children topic has been updated in line with current NICE guidance. The Styes (hordeola) topic and the Teething topic have seen more significant layout changes and a new Assessment section has been added to the Styes (hordeola) 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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Antiviral Medicines Authorised for Influenza Season 2019/20

The Department of Health has written to healthcare professionals via the Central Alerting System (PDF) to advise that antiviral medicines may now be prescribed at NHS expense due to rising levels in reporting of influenza-like illness.

Surveillance data indicates an increase in influenza cases in the community and as such GPs and other prescribers working in primary care may now prescribe antiviral medicines for the prophylaxis and treatment of influenza. NICE has issued guidance on the treatment and prevention of influenza with antiviral medication. A treatment algorithm and dose schedules are contained in Public Health England guidance.

Clinicians should remember to endorse the prescription with 'SLS' to ensure that it can be dispensed in community pharmacies without undue delay.

Action: Clinicians should be aware of this letter and familiarise themselves with the current prescribing guidance.

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