Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - March 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of March 2020. This month there are three guidelines that impact upon primary care. There are also three rapid guideline and evidence reviews related to COVID-19.

The Tinnitus: assessment and management guideline has been published. It covers the assessment, investigation and management of tinnitus in primary, community and secondary care. It offers advice to healthcare professionals on supporting people presenting with tinnitus and on when to refer for specialist assessment and management.

The Abdominal aortic aneurysm: diagnosis and management guideline has been published. It covers diagnosing and managing abdominal aortic aneurysms. It aims to improve care by helping people who are at risk to get tested, specifying how often to monitor asymptomatic aneurysms, and identifying when aneurysm repair is needed and which procedure will work best.

The Venous thromboembolic diseases: diagnosis, management and thrombophilia testing guideline has been published. It covers diagnosing and managing venous thromboembolic diseases in adults. It aims to support rapid diagnosis and effective treatment for people who develop deep vein thrombosis (DVT) or pulmonary embolism (PE). It also covers testing for conditions that can make a DVT or PE more likely, such as thrombophilia (a blood clotting disorder) and cancer.

The COVID-19 rapid guideline: critical care guideline has been published. It aims to maximise the safety of patients who need critical care during the COVID-19 pandemic, while protecting staff from infection. It will also enable services to make the best use of NHS resources.

The COVID-19 rapid guideline: dialysis service delivery guideline has been published. It aims to maximise the safety of patients on dialysis, while protecting staff from infection. It will also enable dialysis services to make the best use of NHS resources and match the capacity of dialysis services to patient needs if these become limited because of the COVID-19 pandemic.

The COVID-19 rapid guideline: delivery of systemic anticancer treatments guideline has been published. It aims to maximise the safety of patients with cancer and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for cancer treatment to patient needs if services become limited because of the COVID-19 pandemic.

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 - March 2020

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

This month clinicians are advised that the license for ulipristal acetate 5mg (Esmya®) has been suspended to protect public health while a safety review is conducted following a further case of liver injury requiring transplant. The product is being removed from the supply chain and it is recommended that patients are contacted and advised to stop treatment as soon as possible with a liver function test performed 2–4 weeks after stopping.

This issue also advises that SGLT2 inhibitor treatment should be interrupted during hospital admissions for major surgical procedures or acute serious medical illnesses and ketone levels measured, preferably in blood rather than urine. Treatment may be restarted when the ketone values are normal and the patient's condition has stabilised.

This month there is also a reminder that benzodiazepines and opioids can both cause respiratory depression, which can be fatal if not recognised in time. It is recommend that they are only prescribed together if there is no alternative and that patients are closely monitored for signs of respiratory depression.

The summary of letters to healthcare professionals this month includes information about Typhim Vi being supplied in an export pack to meet increased demand and a recall of Emerade 150 microgram adrenaline pens due to the potential for device failure. The medical device letters include advice that Cardinal Health Genius 2 and Genius 3 tympanic thermometers should now be calibrated every 25 weeks rather than annually to assure accuracy and reduce the risk of misdiagnosis or delay in treatment.

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

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SMC Update - March 2020

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

Cinacalcet granules (Mimpara®) have been rejected for use in secondary hyperparathyroidism, parathyroid carcinoma and primary hyperparathyroidism in adults. The manufacturer failed to make a submission for these indications. NICE recommends cinacalcet for refractory secondary hyperparathyroidism in patients with end-stage renal disease under specific conditions.

Mexiletine (Namuscla®) has been rejected for the symptomatic treatment of myotonia in adult patients with non-dystrophic myotonic disorders. The justification of the treatment's cost in relation to its health benefits was not sufficient and in addition the company did not present a sufficiently robust economic analysis to gain acceptance by SMC.

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 - February 2020

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

All of the topics have been reviewed and undergone minor restructuring. The most significant changes are to the Hyperthyroidism and Hypothyroidism topics which have been updated in line with the NICE clinical guideline Thyroid disease: assessment and management. Both of these topics have had sections expanded or updated while some areas have been deleted and incorporated into other sections.

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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