Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - August 2020

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

This month readers are advised that clozapine blood levels may need to be monitored more frequently in certain situations, for example if a patient starts or stops smoking, if taking concomitant medications that impact on blood levels or if pneumonia or another serious infection is present. Monitoring will usually be carried out by a specialist service.

Readers are also advised that denosumab 60mg (Prolia®), a treatment for osteoporosis, has been linked with an increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment. It is recommended that risk factors are assessed before starting treatment, particularly in those with a history of vertebral fracture. It is noted that the optimal duration of denosumab treatment for osteoporosis has not been established and it is recommended that patients should not stop denosumab without specialist review.

Readers are also made aware of an increased risk of diverticulitis seen in patients taking baricitinib (Olumiant®▼), particularly when concomitantly taking medicines associated with an increased risk of diverticulitis (non-steroidal anti-inflammatory drugs, corticosteroids and opioids). It is recommended that patients on baricitinib to seek immediate medical care if they experience severe abdominal pain especially accompanied with fever, nausea and vomiting or other symptoms of diverticulitis.

This update also contains links to resources that promote awareness of the risk of severe and fatal burns in emollient users. The resources raise awareness to avoid naked flames and heat sources that may act as a source of fire ignition.

The summary of letters to healthcare professionals includes information regarding handling errors that have been reported with leuprorelin-containing depot medicinal products, potentially resulting in lack of efficacy. The manufacturers stress that the instructions for reconstitution and administration in the product information must be followed.

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

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NICE Guidance - August 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2020. This month is one guideline and one COVID-19 rapid guideline that impact upon primary care.

The Surgical site infections: prevention and treatment guideline has been updated. It covers preventing and treating surgical site infections in adults, young people and children who are having a surgical procedure involving a cut through the skin. It focuses on methods used before, during and after surgery to minimise the risk of infection. This update links to new guidance on perioperative care.

The COVID-19 rapid guideline: children and young people who are immunocompromised guideline has been 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 removes a link to withdrawn government guidance on safeguarding.

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

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SMC Update - August 2020

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

Hydroxycarbamide oral solution (Xromi®) has been accepted for restricted for use in the prevention of vaso-occlusive complications of Sickle Cell Disease in patients over 2 years of age. The restriction limits use to children who are too young to be able to swallow capsules / tablets and adults and adolescents who have difficulty in swallowing solid oral dosage forms.

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 - July 2020

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

All of the topics have been reviewed and undergone minor restructuring. The Coeliac disease topic has been significantly restructured and several sections have been relocated. The Rosacea topic has been renamed, formerly it was Acne Rosacea. This topic has also been restructured and recommendations on diagnosis and management are now in keeping with international consensus and should be based on individual clinical features. Antibiotic choices have been updated and the option to use topical ivermectin in primary care has been included.

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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