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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - November 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2020. This month is one guideline and one medtech innovation briefing that impact upon primary care.

The Human and animal bites: antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for human and animal bites (excluding insect bites) in adults, young people and children aged 72 hours and over. It aims to optimise antibiotic use and reduce antibiotic resistance.

The Dexcom G6 for real-time continuous glucose monitoring medtech innovation briefing has been published. This briefing notes that the intended place in therapy is as an alternative to routine blood glucose monitoring in people (over 2 years old), including pregnant women, with type 1 or type 2 diabetes, who use multiple daily insulin injections or use insulin pumps and are self-managing their diabetes. The available evidence notes that this device reduces interstitial fluid glucose levels and the time spent in hypoglycaemia compared with self-monitoring of blood glucose using finger-prick testing. It is noted that lifetime costs for this device are likely to be higher compared to finger-prick testing but this may be balanced by avoiding the costs associated with short-term and long-term clinical outcomes of poorly managed diabetes.

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 - November 2020

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

This month readers are advised that modafinil potentially increases the risk of congenital malformations when used in pregnancy. Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Additionally, pirfenidone (Esbriet®) has been linked with an increased risk of serious liver injury. Updated advice on liver function testing has been issued that recommends monthly checks during the first 6 months of treatment and every 3 months thereafter.

Ferric carboxymaltose (Ferinject®) has been linked with an increased risk of symptomatic hypophosphataemia leading to osteomalacia and fractures. Additional monitoring of phosphate levels is recommended for patients requiring multiple administrations at higher doses, on long-term treatment or with pre-existing risk factors for hypophosphataemia.

Finally in drug safety news, bupropion (Zyban®) has been associated with several cases of serotonin syndrome, especially when used with other serotonergic drugs or in cases of overdose. It is recommended that patients are informed about the milder symptoms of serotonin syndrome at initiation of treatment. If serotonin syndrome is suspected the dose of bupropion should be decreased or treatment withdrawn depending on the severity of the symptoms.

The summary of letters to healthcare professionals were generally regarding product recalls or supply disruptions.

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

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SMC Update - November 2020

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

Patiromer (Veltassa®) has been rejected for use in the treatment of hyperkalaemia in adults. The submitting company did not present a sufficiently robust economic analysis to gain acceptance by SMC. It should be noted the NICE Guidance exists for England and Wales that contains specific recommendations for use.

Romosozumab (Evenity®) has been accepted for restricted use in the treatment of severe osteoporosis in postmenopausal women at high risk of fracture. The restriction limits use to women who have experienced a fragility fracture and are at imminent risk of another fragility fracture (within 24 months).

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 - October 2020

During October 2020 Clinical Knowledge Summaries were updated in the following areas.

All of the topics have been reviewed and updated in keeping with current NICE guidance with minor layout changes. The Gastroenteritis topic has undergone major restructuring, with several nodes merged to improve clarity and navigation.

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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