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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - December 2021

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

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 (including migraine with aura and menstrual-related migraine), cluster headache and medication overuse headache in young people (aged 12 years and older) and adults. This update changed the strength of the recommendations on metoclopramide or prochlorperazine for acute migraine from 'offer' to 'consider', to better reflect the balance of benefits and risks of these treatments.

The Suspected cancer: recognition and referral guideline has been updated. It covers identifying children, young people and adults with symptoms that could be caused by cancer. This update reviewed the evidence on fixed and age-adjusted thresholds for prostate-specific antigen testing and updated the recommendations on referral for suspected prostate cancer.

The Pelvic floor dysfunction: prevention and non-surgical management guideline has been published. It covers the prevention, assessment and non-surgical management of pelvic floor dysfunction in women aged 12 and over. It is noted that this guideline uses the term 'women' throughout, but this should be taken to include those who do not identify as women but who have female pelvic organs.

The Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders technology appraisal has been published. This treatment is recommended, within its marketing authorisation, as an option for treating the symptoms of myotonia in adults with non-dystrophic myotonic disorders. It is recommended only if the company provides mexiletine (Namuscla®) according to the commercial arrangement. Based on the commercial arrangement it is expected that treatment will be issued by secondary care.

The Liraglutide for managing obesity in people aged 12 to 17 years technology appraisal has been terminated. The manufacturer did not provide an evidence submission and as such NICE is unable to make a recommendation.

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

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SMC Update - December 2021

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

Olopatadine / mometasone nasal spray (Ryaltris®) has been accepted for restricted in adults and adolescents 12 years of age and older for the treatment of moderate to severe nasal symptoms associated with allergic rhinitis. The restriction limits use to patents where monotherapy with either intranasal antihistamine or glucocorticoid is not considered sufficient.

Tirbanibulin ointment (Klisyri®) has been accepted for use in the field treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis (Olsen grade 1) of the face or scalp in adults.

Nitisinone capsules (Orfadin®) has been rejected for use in adult patients with alkaptonuria (AKU). The manufacturer failed to make a submission for this indication. The SPC notes that treatment should be initiated and supervised by a physician experienced in the treatment of AKU patients.

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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Drug Safety Update - December 2021

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

This issue reminds clinicians that elderly patients are at an increased risk of adverse neurological and cardiac effects when being treated with haloperidol for delirium. This reminder follows an analysis of Yellow Card Reports. It is recommended that the lowest possible dose of haloperidol should be used for the shortest possible time, and cardiac and extrapyramidal adverse effects should be closely monitored.

This issue also advises that the indication for dapagliflozin has withdrawn the indication for type 1 diabetes mellitus as previously reported.

This issue contains the latest COVID-19 vaccine information including information on the expanded vaccination programme and minor updates to the Summary of Product Characteristics.

Lastly in this issue is a summary of letters to healthcare professionals in November. These generally related to supply issues and recalls.

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

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CKS Updates - November 2021

During November 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 Otitis externa topic has updated to remove information on oral flucloxacillin and clarithromycin because oral antibiotics are not routinely needed in primary care for the management of uncomplicated acute otitis externa. The Stroke and TIA topic has removed a recommendation that suspected transient ischaemic attack (TIA) taking anticoagulants should not be given an immediate dose of aspirin 300mg. This intervention is likely to carry a low risk of causing or aggravating bleeding and aspirin can now be given.

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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