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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - August 2021

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

The Bronchiolitis in children: diagnosis and management guideline has been updated. It covers diagnosing and managing bronchiolitis in babies and children. It aims to help healthcare professionals diagnose bronchiolitis and identify if babies and children should be cared for at home or in hospital. The update reviewed the evidence and updated the recommendations on oxygen saturation thresholds for referral to hospital.

The Antenatal care guideline has been published. It covers the routine antenatal care that women and their babies should receive. It aims to ensure that pregnant women are offered regular check‑ups, information and support.

The Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s guideline has been published. It covers the diagnosis and management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS) and chronic obstructive pulmonary disease with OSAHS (COPD-OSAHS overlap syndrome) in people over 16. It aims to improve recognition, investigation and treatment of these related conditions.

The Babies, children and young people's experience of healthcare guideline has been published. It describes good patient experience for babies, children and young people, and makes recommendations on how it can be delivered. It aims to make sure that all babies, children and young people using NHS services have the best possible experience of care.

The Chronic kidney disease: assessment and management guideline has been published, replacing previous guidelines. It covers care and treatment for people with, or at risk of, chronic kidney disease (CKD). It aims to prevent or delay the progression and reduce the risk of complications and cardiovascular disease. It also covers managing anaemia and hyperphosphataemia associated with chronic kidney disease.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. The update corrects an error in the recommended dose of prednisolone for children with a greater than 44-week corrected gestational age.

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 - August 2021

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

This issue advises readers of the latest COVID-19 vaccine safety information including data on menstrual disorders and unexpected vaginal bleeding linked with vaccine administration. It is noted that reporting rates are low, the side effect is usually transient and that there is no evidence to suggest that COVID-19 vaccines will affect fertility and the ability to have children. This section also summarises the available data on the safety of COVID-19 vaccines in pregnancy which has identified no side effect patterns to date. The MHRA will, of course, continue to closely monitor safety data.

Lastly in this issue is a summary of letters to healthcare professionals in July. This includes notification that two desogestrel-containing contraceptive pills have been reclassified as Pharmacy medicines as well as links to recall notifications.

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

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SMC Update - August 2021

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

Patiromer sorbitex calcium (Veltassa®) has been accepted for restricted use in the treatment of hyperkalaemia in adults. The restriction limits use to patients with hyperkalaemia (defined as a serum potassium of >6.0mmol/L) with chronic kidney disease (CKD) stage 3b to 5 and/or heart failure, who would otherwise need to down-titrate or discontinue their renin-angiotensin-aldosterone system inhibitor (RAASi) therapy to maintain a clinically acceptable serum potassium level (normokalaemia).

Inclisiran (Leqvio®) has been accepted for restricted use in the treatment of adults with primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia, as an adjunct to diet:

  • in combination with a statin or statin with other lipid lowering therapies in patients who are unable to reach 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 contraindicated

The restriction limits use to patients at high cardiovascular risk as follows:

  • patients with heterozygous familial hypercholesterolaemia (HeFH) and LDL-C ≥ 5.0mmol/L, for primary prevention of cardiovascular events or,
  • patients with HeFH and LDL-C ≥ 3.5mmol/L, for secondary prevention of cardiovascular events or,
  • patients with high risk due to previous cardiovascular events and LDL-C ≥ 4.0mmol/L or,
  • patients with recurrent/polyvascular disease and LDL-C ≥ 3.5mmol/L.

It should also be noted that this recommendation applies only in the context of an approved NHSScotland Patient Access Scheme (PAS) arrangement delivering the cost-effectiveness results upon which the decision was based, or a PAS/ list price that is equivalent or lower. It is therefore expected that this medication would be supplied through secondary care.

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 - July 2021

During July 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 two Contraception topics have been updated to remove retired Quality and Outcomes Framework (QOF) indicators. The Pancreatitis - acute topic has been updated in line with the NICE guideline on Pancreatitis.

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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