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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

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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SMC Update - March 2021

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

Beclometasone / formoterol / glycopyrronium (Trimbow®) has been accepted for use as a maintenance treatment of asthma, in adults not adequately controlled with a maintenance combination of a long-acting beta2-agonist and medium dose of inhaled corticosteroid, and who experienced one or more asthma exacerbations in the previous year.

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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Aminophylline and Morphine Granules to be discontinued

The MHRA Central Alerting System has issued two alerts warning that aminophylline tablets and morphine sulphate prolonged release granules for oral suspension are both being discontinued.

Aminophylline (Phyllocontin®) modified release tablets are being discontinued in both the 225mg and 350mg strengths. Remaining supplies in the distribution chain are expected to be exhausted by early April 2021. Theophylline (Uniphyllin®) tablets remain available and may provide a suitable alternative or inhaled therapies could be reviewed and optimised.

Morphine sulphate (MST Continus®) prolonged release granules for oral suspension are currently available in 20mg, 30mg, 60mg, 100mg and 200mg strengths. All strengths are being permanently discontinued during 2021 due to difficulty sourcing a key excipient. The alerts notes that alternative morphine presentations, both prolonged release and immediate release, remain available and will be able to support increased demand. The full document contains specific advice on which products can be opened and taken with food in the case of swallowing difficulties or via gastric or gastrostomy tubes.

Action: Clinicians should be aware of these products being discontinued. It would be prudent to run clinical system searches to identify any patients who are currently prescribed these products to allow a review and arrangements made to identify suitable alternatives.

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