Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC response to COVID-19

The Scottish Medicines Consortium has provided an update advising of the decision to adapt their normal ways of working.

Meetings have been suspended until further notice in order to release committee members and staff to support work aligned with COVID-19 resilience. A core team will continue to assess the new medicine submissions already in the system and work on urgent activities around COVID-19 as required.

The submissions that would have been evaluated during this period have been reviewed and the SMC is satisfied that other medicines are available for the relevant patient groups. At this time new submissions or resubmissions are not being accepted. Meetings will resume when allowed by the COVID-19 restrictions.

Action: Clinicians should be aware that, for the time being, the SMC will not be publishing monthly advice for medicines.

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NICE Guidance - May 2020

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

The COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders guideline has been updated. The update highlights factors to take into account when considering temporarily stopping some drugs for children and young people.

The COVID-19 rapid guideline: children and young people who are immunocompromised guideline has been published and updated. It aims to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources. The update highlighted that immunosuppressant medicines should be reviewed if a patient may have COVID-19 or there are other medical concerns.

The COVID-19 rapid guideline: chronic kidney disease guideline has been published. It to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid guideline: interstitial lung disease guideline has been published. It aims to maximise the safety of adults with interstitial lung disease, including idiopathic pulmonary fibrosis and pulmonary sarcoidosis, during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid evidence summary: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19 evidence summary has been published. It aims to determine whether up regulation of angiotensin-converting enzyme 2, potentially as a result of taking ACEIs or ARBs, is associated with an increased risk of developing COVID-19 or developing more severe symptoms. This analysis found two observational studies that were of poor quality and subject to bias and confounding. As such conclusions cannot be drawn without further research.

The COVID-19 rapid evidence summary: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 evidence summary has been published. It aims to determine if long term use of NSAIDs is associated with an increased risk of developing COVID-19 or developing more severe symptoms. A literature search identified no evidence from published scientific studies. However, it is noted that NSAIDs and COVID-19 can both contribute to respiratory, cardiovascular and renal complications.

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 - May 2020

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

This month clinicians are advised of a new dedicated COVID-19 Yellow Card reporting site for medicines and medical devices. The site aims to allow rapid identification of new and emerging side effects and medical device incidents in COVID-19 treatment, including side effects for medicines taken by patients to manage long-term or pre-existing conditions.

Readers are also advised of the temporary guidance to specialists regarding the Valproate Pregnancy Prevention Programme during the coronavirus (COVID-19) pandemic and also temporary advice for management of certain immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide) and the associated pregnancy prevention programme.

The summary of letters to healthcare professionals includes details of a recall of Emerade®, safety letters about change in presentation of ReQuip® and new restrictions in the use of cyproterone acetate and several letters regarding supply contrataints.

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

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Influenza medication guidance deactivated for 2019/20

The Department of Health and Social Care has issued a notification (PDF) advising that antivirals for influenza should no longer be prescribed this season.

The surveillance data from Public Health England (PHE) indicates that circulation of influenza in the community has returned to baseline levels. As such primary care clinicians should no longer prescribe antiviral medicines for the prophylaxis and treatment of influenza on an FP10 prescription form.

Action: Clinicians should be aware of this notification and cease prescribing antiviral drugs for the prevention and treatment of influenza.

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CKS Updates - April 2020

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

All of the topics have been reviewed and undergone minor restructuring. The scope of the Neuropathic pain - drug treatment has been updated to indicate that it does not cover sciatica.

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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