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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - September 2021

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

The Sapropterin for treating hyperphenylalaninaemia in phenylketonuria technology appraisal has been published. This treatment is recommended as an option for treating hyperphenylalaninaemia that responds to sapropterin (response as defined in the summary of product characteristics) in people with phenylketonuria (PKU), only if they are:

  • under 18 and a dose of 10 mg/kg is used, only using a higher dose if target blood phenylalanine levels cannot be achieved at 10 mg/kg
  • aged 18 to 21 inclusive, continuing the dose they were having before turning 18 or at a maximum dose of 10 mg/kg
  • pregnant (from a positive pregnancy test until birth).

It is also noted that sapropterin is recommended only if the company provides it according to the commercial arrangement. It would be expected that treatment would be commenced and supervised by a specialist.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. The update this month adds new recommendations on non-invasive respiratory support and doxycycline, and updated recommendations on heparins. Specifically for primary care it is recommended that doxycycline is not used to treat COVID-19 in the community.

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 - September 2021

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

This issue advises clinicians of rare but severe adverse effects that can occur on stopping treatment with topical corticosteroids. This is more likely after long-term continuous or inappropriate use of moderate to high potency products. To reduce the risks it is recommended that clinicians prescribe the topical corticosteroid of lowest potency needed and ensure patients know how to use it safely and effectively. It is also recommended to:

  • advise patients on the amount of product to be applied; underuse can prolong treatment duration
  • inform patients how long they should use a topical corticosteroid, especially on sensitive areas such as the face and genitals
  • inform patients to return for medical advice if their skin condition worsens while using topical corticosteroid, and advise them when it would be appropriate to re-treat without a consultation
  • for patients currently on long-term topical corticosteroid treatment, consider reducing potency or frequency of application (or both)

Clinicians should also be vigilant for the signs and symptoms of topical steroid withdrawal reactions. The joint statement from the National Eczema Society and British Association of Dermatologists may be useful in guiding practice. And finally, suspected adverse drug reactions should be reported via the Yellow Card scheme, including after discontinuation of topical corticosteroids.

This issue also advises readers of the latest COVID-19 vaccine safety information including data from safety reporting and changes to the Summary of Product Characteristics for some vaccines in regards to storage, precautions and use in 12 to 17 year olds.

Lastly in this issue is a summary of letters to healthcare professionals in August.

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

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SMC Update - September 2021

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

Mercaptamine (Procysbi®) has been rejected for the treatment of proven nephropathic cystinosis. The submitting company's justification of the treatment’s cost in relation to its health benefits was not sufficient and in addition the company did not present a sufficiently robust economic analysis to gain acceptance by SMC.

Amikacin liposomal nebuliser dispersion (Arikayce®) has been rejected for use in the treatment of non-tuberculous mycobacterial (NTM) lung infections caused by Mycobacterium avium Complex (MAC) in adults with limited treatment options who do not have cystic fibrosis. The submitting company’s justification of the treatment’s cost in relation to its health benefits was not sufficient and in addition the company did not present a sufficiently robust economic analysis to gain acceptance by SMC.

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 - August 2021

During August 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 Carpal tunnel syndrome recommendations on follow up in primary care have been amended to reflect pragmatic clinical practice. The Haemorrhoids topic has been updated to recommend that topical preparations for haemorrhoids which should be purchased over the counter in line with NHS Clinical Commissioners (2018). And the Pancreatitis - chronic topic has been updated in line with NICE guidance.

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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