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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - April 2021

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

The Chronic pain (primary and secondary) in over 16s guideline has been published. It covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease.

The Neonatal infection: antibiotics for prevention and treatment guideline has been published. It covers preventing bacterial infection in healthy babies of up to and including 28 days corrected gestational age, treating pregnant women whose unborn baby is at risk of infection, and caring for babies of up to and including 28 days corrected gestational age with a suspected or confirmed bacterial infection. It aims to reduce delays in recognising and treating infection and prevent unnecessary use of antibiotics.

The Postnatal care guideline has been published. It covers the routine postnatal care that women and their babies should receive in the first 8 weeks after the birth. It includes the organisation and delivery of postnatal care, identifying and managing common and serious health problems in women and their babies, how to help parents form strong relationships with their babies, and baby feeding. The recommendations on emotional attachment and baby feeding also cover the antenatal period.

The Atrial fibrillation: diagnosis and management guideline has been published. It covers diagnosing and managing atrial fibrillation in adults. It includes guidance on providing the best care and treatment for people with atrial fibrillation, including assessing and managing risks of stroke and bleeding.

The Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia technology appraisal has been published. This treatment recommended as an option for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia as an adjunct to diet in adults. It is recommended only if:

  • statins are contraindicated or not tolerated,
  • ezetimibe alone does not control low-density lipoprotein cholesterol well enough, and
  • the company provides bempedoic acid and bempedoic acid with ezetimibe according to the commercial arrangement

It is noted that bempedoic acid with ezetimibe can be used as separate tablets or a fixed-dose combination.

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 - April 2021

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

This month readers are advised of the greater risk of aspiration when polyethylene glycol (PEG)-based laxatives are thickened with a starch-based thickener. The efficacy of the thickener is reduced by the laxative so it is recommended to avoid combining these products. It may be more appropriate to use a gum-based thickener or a different laxative.

This issue also contains an update on COVID-19 vaccines and medicines that includes information on the extremely rare risk of blood clots that are associated with the AstraZeneca COVID-19 Vaccine as well as updated information on patients who should now not receive this vaccine.

Finally in this issue is a summary of letters to healthcare professionals sent in March 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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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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