Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - January 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of January 2020. This month there are two guidelines that impact upon primary care.

The Supporting adult carers guideline has been published. It covers support for adults (aged 18 and over) who provide unpaid care for anyone aged 16 or over with health or social care needs. It aims to improve the lives of carers by helping health and social care practitioners identify people who are caring for someone and give them the right information and support. It covers carers' assessments, practical, emotional and social support and training, and support for carers providing end of life care.

The Colorectal cancer guideline has been published. It covers managing colorectal cancer in people aged 18 and over. It aims to improve quality of life and survival for adults with colorectal cancer through management of local disease and management of secondary tumours (metastatic disease).

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 - January 2020

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for January 2020 (PDF).

This month clinicians are invited to report suspected adverse reactions associated with use of e-cigarettes or vaping (including lung injury) to the MHRA via the Yellow Card Scheme. More than 2,600 cases of lung injury have been reported to the US Centers for Disease Control and Prevention (CDC) with 60 fatal cases. Clinicians should have a high index of suspicion in patients presenting with respiratory symptoms where there is a history of e-cigarette use or vaping in the past 30 days.

Clinicians are also notified of a small increased risk of oral clefts following use of ondansetron in the first 12 weeks of pregnancy. This information comes from epidemiological studies in the USA which have some limitations but are sufficiently robust to indicate an increased risk. Ondansetron is not usually used as a first line treatment in hyperemesis gravidarum. Where it is offered, women must be counselled on the potential benefits and risks of use, both to her and to her unborn baby and the final decision should be made jointly.

The summary of letters to healthcare professionals this month includes a further group of letters recalling ranitidine, a letter advising that three presentations of Insuman® are being discontinued and an update on the valproate Pregnancy Prevention Programme.

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

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Ingenol mebutate recalled

The manufacturer of ingenol mebutate (Picato®) has recalled all unexpired stock from wholesalers and pharmacies while investigations are ongoing into the concerns of the possible risk of skin malignancy.

Healthcare professionals are advised to:

  • Stop supplying the above products immediately. Quarantine all remaining stock and return it to your supplier using your supplier’s approved process
  • Stop prescribing Picato and consider other treatment options as appropriate. For patients who have recently been prescribed Picato, advise patients to be vigilant for any skin lesions developing and to seek medical advice promptly should any occur

Action: Clinicians should be aware of this recall and investigation. Alternatives will need to be issued during the remainder of the investigation.

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SMC Update - January 2020

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

Abiraterone (Zytiga®) has been accepted for use in combination with prednisone or prednisolone for the treatment of newly diagnosed high risk metastatic hormone sensitive prostate cancer in adult men in combination with androgen deprivation therapy. This advice applies only in the context of an approved NHSScotland Patient Access Scheme (PAS) arrangement delivering the cost-effectiveness results upon which the decision was based. As such it would normally be prescribed by a specialist.

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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