Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - April 2021

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

Dapagliflozin (Forxiga®) has been accepted for use in adults for the treatment of symptomatic chronic heart failure with reduced ejection fraction.

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 - March 2021

During March 2021 Clinical Knowledge Summaries were published or updated in the following areas.

The Platelets - abnormal counts and cancer topic is new. The other topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Contraception - progestogen-only methods topic has been updated in line with Faculty of Sexual and Reproductive Healthcare (FSRH) guidance and references to some retired QOF indicators have been removed. The Itch - widespread topic has been updated to recommend the use of non-sedating oral antihistamines first line unless there is a history of troublesome nocturnal itch. As such new sections on cetirizine, loratadine and fexofenadine have been added to the section on Prescribing information.

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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NICE Guidance - March 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of March 2021. This month are four guidelines that impact upon primary care.

The Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for secondary bacterial infection of eczema and covers infection of other common skin conditions. It aims to optimise antibiotic use and reduce antibiotic resistance.

The Atopic eczema in under 12s: diagnosis and management guideline has been updated. It covers diagnosing and managing atopic eczema in children under 12. The update links to the new guideline covering management of secondary bacterial infection of eczema.

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. The update highlights the importance of including advice in the personalised action plan on minimising indoor air pollution and reducing exposure to outdoor air pollution.

The Cannabis-based medicinal products guideline has been updated. It covers prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy. The update clarified recommendations for the use of unlicensed cannabis-based medicinal products for severe treatment-resistant epilepsy.

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 2021

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2021 (PDF).

This month readers are advised of an increased risk of non-melanoma skin cancer and progressive multifocal encephalopathy (PML) in patients taking bendamustine (Levact®). Bendamustine is an anti-cancer medicine so it is expected that this advice applies to specialists however patients may present in primary care if they are not aware of the link. As such primary care clinicians should be aware and signpost to the specialist for advice.

This issue also contains an update on COVID-19 vaccines and medicines that includes links to updated patient information leaflets and a report that summarises information received via the Yellow Card scheme. So far, the majority of reported side effects are mild and short-lasting and indicate a normal immune response to vaccines.

Finally in this issue is a summary of letters to healthcare professionals sent in February that were generally regarding product recalls.

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

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No Smoking Day - 2021

Tomorrow is No Smoking Day. The theme and support materials for this year have been developed in collaboration between ASH and Breathe 2025. The theme this year is that "Quitting smoking doesn’t have to be stressful" with the evidence supporting improved health and well-being after stopping smoking.

Key messages for this year are:

  • Quitting smoking doesn't have to feel painful – stop smoking aids can really help
  • Quitting isn't always easy but getting the right stop smoking aids and support can stop you feeling like you need a cigarette all the time
  • Today is the Day to put smoking behind you. Smokers who quit for 6 weeks or more are happier and experience less anxiety and depression than those who carry on smoking
  • Research shows that people who have quit smoking for a year are happier than those who continue to smoke

Action: The above online resources may be an appropriate place to signpost individuals interested in stopping smoking or may be a useful source for support materials to aid local smoking cessation efforts.

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