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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2021

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

The Heavy menstrual bleeding: assessment and management guideline has been updated. It covers assessing and managing heavy menstrual bleeding (menorrhagia). It aims to help healthcare professionals investigate the cause of heavy periods that are affecting a woman’s quality of life and to offer the right treatments, taking into account the woman's priorities and preferences. The update reinstated recommendations on the use of ulipristal acetate (Esmya®) for uterine fibroids in line with updated MHRA safety advice on the risk of serious liver injury.

The Epilepsies: diagnosis and management guideline has been updated. It covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. It offers best practice advice on managing epilepsy to improve health outcomes so that people with epilepsy can fully participate in daily life. The update reviewed and amended recommendations on carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate and zonisamide in line with the MHRA updated safety advice on antiepileptic drugs in pregnancy.

The Headaches in over 12s: diagnosis and management guideline has been updated. It covers advice on the diagnosis and management of tension-type headache, migraine, cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. It aims to improve the recognition and management of headaches, with more targeted treatment to improve the quality of life for people with headaches, and to reduce unnecessary investigations. The update amended our recommendation on topiramate for migraine prophylaxis to include discussion of the potential benefits and risks, and the importance of effective contraception for women and girls of childbearing potential when taking topiramate.

The Crisaborole for treating mild to moderate atopic dermatitis in people 2 years and older technology appraisal has been terminated. This treatment is intended for use in the treatment of mild to moderate atopic dermatitis in people 2 years and older. However, the manufacturer withdrew its evidence submission and therefore no recommendation can be made at this time.

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 - May 2021

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

This month readers are advised that, while generic prescribing of levothyroxine remains appropriate for the majority of patients, in some patients prescribing a specific product, known to be well tolerated by the patient, should be considered if they report persistent symptoms when switching between different levothyroxine tablet formulations. It is further suggested that if symptoms or poor control of thyroid function persist despite adhering to a specific product, the levothyroxine in an oral solution formulation can be used.

This issue also contains an update on COVID-19 vaccines and medicines that includes a statement from the JCVI on the AstraZeneca COVID-19 Vaccine for people aged under 40.

Finally in this issue is a summary of letters to healthcare professionals sent in April that were regarding product recalls and imported medicine supplies.

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

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SMC Update - May 2021

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

Indacaterol / glycopyrronium / mometasone inhaler (Enerzair Breezhaler®) has been accepted for use as a maintenance treatment of asthma in adult patients not adequately controlled with a maintenance combination of a long-acting beta2-agonist and a high dose of an inhaled corticosteroid who experienced one or more asthma exacerbations in the previous year.

Indacaterol / mometasone inhaler (Atectura Breezhaler®) has been accepted for use as a maintenance treatment of asthma in adults and adolescents 12 years of age and older not adequately controlled with inhaled corticosteroids and inhaled short-acting beta2-agonists.

Glycopyrronium / formoterol inhaler (Bevespi Aerosphere®) has been rejected for use as a maintenance bronchodilator treatment to relieve symptoms in adult patients with chronic obstructive pulmonary disease. The manufacturer failed to make a submission for this indication.

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 - April 2021

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

The Chronic Pain topic is new. It is largely based upon the recently published NICE guideline and it covers the assessment and management of people with chronic pain. The other topics have been reviewed and updated in keeping with current guidance with minor layout changes. No major changes have been made within these topics

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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