Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2020

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

The Asthma: diagnosis, monitoring and chronic asthma management guideline has been updated. It covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks. The advice on self-management for children and young people with deteriorating asthma control has been updated.

The Epilepsies: diagnosis and management guideline has been updated. It covers covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. The update has amended recommendations in line with the MHRA guidance on valproate use by women and girls.

The Bipolar disorder: assessment and management guideline has been updated. It covers recognising, assessing and treating bipolar disorder (formerly known as manic depression) in children, young people and adults. The update has amended recommendations in line with the MHRA guidance on valproate use by women and girls.

The Antenatal and postnatal mental health guideline has been updated. It covers recognising, assessing and treating mental health problems in women who are planning to have a baby, are pregnant, or have had a baby or been pregnant in the past year. The update has amended recommendations in line with the MHRA guidance on valproate use by women and girls.

The Dapagliflozin with insulin for treating type 1 diabetes technology appraisal has been published. It recommends dapagliflozin with insulin as an option for treating type 1 diabetes in adults with a BMI of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if:

  • they are on insulin doses of 0.5 units/kg of body weight/day or more and
  • they have completed a structured education programme that is evidence based, quality assured, delivered by trained educators and includes information about diabetic ketoacidosis, such as:
    • how to recognise its risk factors, signs and symptoms
    • how and when to monitor blood ketone levels
    • what actions to take for elevated blood ketones and
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes treatment, and haemoglobin A1c (HbA1c) levels are assessed after 6 months and regularly after this.
  • It is also recommended that the dapagliflozin is stopped if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol).

The Sotagliflozin with insulin for treating type 1 diabetes technology appraisal has been published. It recommends sotagliflozin with insulin as an option for treating type 1 diabetes in adults with a BMI of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if:

  • sotagliflozin is given as one 200 mg tablet daily
  • they are on insulin doses of 0.5 units/kg of body weight/day or more and
  • they have completed a structured education programme that is evidence based, quality assured, delivered by trained educators and includes information about diabetic ketoacidosis, such as:
    • how to recognise its risk factors, signs and symptoms
    • how and when to monitor blood ketone levels
    • what actions to take for elevated blood ketones and
  • treatment is started and supervised by a consultant physician specialising in endocrinology and diabetes treatment, and haemoglobin A1c (HbA1c) levels are assessed after 6 months and regularly after this.
  • It is also recommended that the sotagliflozin is stopped if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol).

The Leg ulcer infection antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for adults with leg ulcer infection. It aims to optimise antibiotic use and reduce antibiotic resistance.

The Impetigo antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for adults, young people and children aged 72 hours and over with impetigo. It aims to optimise antibiotic use and reduce antibiotic resistance.

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

Share 'NICE Guidance - February 2020' on Email Share 'NICE Guidance - February 2020' on Delicious Share 'NICE Guidance - February 2020' on Digg Share 'NICE Guidance - February 2020' on Facebook Share 'NICE Guidance - February 2020' on reddit Share 'NICE Guidance - February 2020' on Twitter

Drug Safety Update - February 2020

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

This month clinicians are advised that the licence for ingenol mebutate gel (Picato®) has been suspended as precautionary measure due to risk of skin malignancy. The European Medicines Agency (EMA) continues to investigate these concerns.

This issue also advises of the distribution last month of updated educational materials to support the valproate pregnancy prevention programme. Valproate is contraindicated in girls and women of childbearing potential, unless the conditions of the pregnancy prevention programme are met.

The insertion site and method for etonogestrel (Nexplanon®) contraceptive implants has been amended to avoid this risk of deep insertion. This is following concerns regarding reports of neurovascular injury and implants migrating to the vasculature.

Readers are also encouraged to support ADR awareness week between 17–23 February 2020 by sharing material on social media and discussing with colleagues and patients the importance of reporting suspected side effects.

The summary of letters to healthcare professionals this month includes links to letters warning of the risks of congenital malformation with modafinil and potentially fatal dosing errors with methotrexate as well as letters regarding some of the items above. The medical device letters highlights a risk of stoma injury, bleeding and leakage under the skin barrier with specific batches of convex two-piece skin barriers that have been incorrectly manufactured with off-centre starter/stoma hole. Identification and return of affected devices is recommended.

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

Share 'Drug Safety Update - February 2020' on Email Share 'Drug Safety Update - February 2020' on Delicious Share 'Drug Safety Update - February 2020' on Digg Share 'Drug Safety Update - February 2020' on Facebook Share 'Drug Safety Update - February 2020' on reddit Share 'Drug Safety Update - February 2020' on Twitter

SMC Update - February 2020

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

Sodium zirconium cyclosilicate (Lokelma®) has been rejected for use in the treatment of hyperkalaemia in adult patients. The submitting company did not present a sufficiently robust economic analysis to gain acceptance by SMC.

Update: Thanks to an observant reader (see comments below), I must clarify that NICE guidance exists that applies to England and Wales for this medicine which should be followed in those member countries.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

Share 'SMC Update - February 2020' on Email Share 'SMC Update - February 2020' on Delicious Share 'SMC Update - February 2020' on Digg Share 'SMC Update - February 2020' on Facebook Share 'SMC Update - February 2020' on reddit Share 'SMC Update - February 2020' on Twitter

CKS Updates - January 2020

During January 2020 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Cows' milk protein allergy in children topic has been renamed within the topic area and the recommendations on the assessment and management of suspected cow's milk allergy have been amended in line with current evidence. A new prescribing information section has been added to provide information on prescribing oral antihistamines, in line with the CKS topic on Food allergy. The Tamoxifen - managing adverse effects topic now includes primary prevention of breast cancer in women at moderate or high risk as a licensed indication for tamoxifen in keeping with the product license.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

Share 'CKS Updates - January 2020' on Email Share 'CKS Updates - January 2020' on Delicious Share 'CKS Updates - January 2020' on Digg Share 'CKS Updates - January 2020' on Facebook Share 'CKS Updates - January 2020' on reddit Share 'CKS Updates - January 2020' on Twitter

Prescribing Advice for GPs is powered by ClassicPress.
Subscribe for Free to our RSS or Atom Feeds for New Entries.

vipers