☀️     🌓

Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - July 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of July 2021. This month are two guidelines, four technology appraisals and one COVID-19 rapid guideline that impact upon primary care.

The Type 1 diabetes in adults: diagnosis and management guideline has been updated. It covers care and treatment for adults (aged 18 and over) with type 1 diabetes. It includes advice on diagnosis, education and support, blood glucose management, cardiovascular risk, and identifying and managing long-term complications. This updated amended the recommendations on long-acting insulin therapy.

The Clostridioides difficile infection: antimicrobial prescribing guideline has been published. It sets out an antimicrobial prescribing strategy for managing Clostridioides difficile infection in adults, young people and children aged 72 hours and over in community and hospital settings. It aims to optimise antibiotic use and reduce antibiotic resistance.

The Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The Apixaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation technology appraisal has been updated. This update amended recommendation 1.2 to include consideration of the risks and benefits of this and other anticoagulants approved by NICE.

The COVID-19 rapid guideline: vaccine-induced immune thrombocytopenia and thrombosis (VITT) guideline has been published. It covers vaccine-induced immune thrombocytopenia and thrombosis (VITT), a syndrome which has been reported in rare cases after COVID-19 vaccination. There is limited evidence available to inform clinical management, identification and management of the condition is evolving quickly as the case definition becomes clearer. This guideline was produced to support clinicians to diagnose and manage this newly recognised syndrome.

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

Share 'NICE Guidance - July 2021' on Email Share 'NICE Guidance - July 2021' on Delicious Share 'NICE Guidance - July 2021' on Digg Share 'NICE Guidance - July 2021' on Facebook Share 'NICE Guidance - July 2021' on reddit Share 'NICE Guidance - July 2021' on Twitter

SMC Update - July 2021

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

Delafloxacin (Quofenix®) has been rejected for use in the treatment of community-acquired pneumonia (CAP) in adults when it is considered inappropriate to use other antibacterial agents that are commonly recommended for the initial treatment of these infections. The manufacturer failed to make a submission for this indication. The SMC advised that consideration should be given to official guidance on the appropriate use of antibacterial agents.

Bempedoic acid (Nilemdo®) has been accepted for restricted use in adults with primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia, as an adjunct to diet:

  • In combination with a statin, or a statin with other lipid-lowering therapies in patients unable to reach low-density lipoprotein cholesterol (LDL-C) goals with the maximum tolerated dose of a statin or
  • Alone or in combination with other lipid-lowering therapies in patients who are statin-intolerant, or for whom a statin is contra-indicated

The restriction limits use, in combination with ezetimibe, in patients who are:

  • statin intolerant or for whom a statin is contra-indicated, and
  • where ezetimibe alone does not appropriately control LDL-C, and
  • where proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors are not appropriate

Furthermore, this advice applies only in the context of an approved NHSScotland Patient Access Scheme (PAS) similar to existing NICE guidance that applies in England and Wales.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

Share 'SMC Update - July 2021' on Email Share 'SMC Update - July 2021' on Delicious Share 'SMC Update - July 2021' on Digg Share 'SMC Update - July 2021' on Facebook Share 'SMC Update - July 2021' on reddit Share 'SMC Update - July 2021' on Twitter

Drug Safety Update - July 2021

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

This month readers are advised that, following a review of the available toxicological data, chloramphenicol eye drops can be safely administered to children aged 0 to 2 years where antibiotic eye drop treatment is indicated. Some licences for chloramphenicol eye drop products containing borax or boric acid buffers were recently updated to restrict use in children younger than 2 years of age to reflect warnings on maximum daily limits for boron exposure. The product information for affected chloramphenicol products is being updated to reflect the revised advice and remove restrictions for use in infants. In the meantime, healthcare professionals should reassure parents and carers that these products can be safely given to children aged 0 to 2 years at the time of prescribing.

Readers are also reminded to be vigilant for suspected adverse reactions to herbal and homeopathic medicines and to report them to the Yellow Card scheme. It is recommended to specifically ask patients who present with adverse reaction symptoms if they are taking a herbal or homeopathic medicines.

This issue also contains an update on COVID-19 vaccines and medicines that includes emerging information on a very small risk of myocarditis and pericarditis associated with the Modern and Pfizer/BioNTech vaccines. It seems to affect younger men after the second vaccine is administered and cases are typically mild with affected individuals tending to recover within a short time following standard treatment and rest. The advice continues to be that the benefits of getting vaccinated outweigh the risks in the majority of people.

Finally in this issue is a summary of letters to healthcare professionals sent in June that were regarding product recalls. There were also letters noting a change in appearance and formulation for the ViePax 150 XL® brand of venlafaxine and release of some Clenil® inhalers with no dose counter.

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

Share 'Drug Safety Update - July 2021' on Email Share 'Drug Safety Update - July 2021' on Delicious Share 'Drug Safety Update - July 2021' on Digg Share 'Drug Safety Update - July 2021' on Facebook Share 'Drug Safety Update - July 2021' on reddit Share 'Drug Safety Update - July 2021' on Twitter

CKS Updates - June 2021

During May 2021 Clinical Knowledge Summaries were updated in the following areas.

All topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Vitamin D deficiency in adults topic has updated the recommendation on who should take year-round vitamin D supplementation for the prevention of vitamin D deficiency, in line with PHE guidance. And the Vitamin D deficiency in children topic has changed the recommended dose for vitamin D supplementation for prevention of vitamin D deficiency in line with ROS guidance.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

Share 'CKS Updates - June 2021' on Email Share 'CKS Updates - June 2021' on Delicious Share 'CKS Updates - June 2021' on Digg Share 'CKS Updates - June 2021' on Facebook Share 'CKS Updates - June 2021' on reddit Share 'CKS Updates - June 2021' on Twitter

Prescribing Advice for GPs is powered by ClassicPress.
Connect to our RSS or Atom Feeds.

vipers