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Prescribing Advice for GPs

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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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