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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2022

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2022. This month there is one guideline that impacts upon primary care.

The Type 2 diabetes in adults: management guideline has been updated. The update reviewed the evidence on drug treatment and made new recommendations. The new recommendations place SGLT2 inhibitors earlier in drug treatment for patients with established atherosclerotic cardiovascular disease and heart failure. It is specifically recommended to offer an SGLT2 inhibitor with proven cardiovascular benefit in addition to metformin to such patients. It is also recommended to consider this intervention in patients at high risk of CVD characterised as a QRISK2 ≥ 10%. In patients who do not meet either of these criteria, SGLT2 inhibitors remains a second line treatment option along with DPP‑4 inhibitors, pioglitazone and sulfonylureas.

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 - February 2022

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for February 2022 (PDF).

This issue notes that a UK COVID-19 Antivirals Pregnancy Registry has been created. The safety of COVID-19 antivirals in pregnancy has not been established and information is therefore requested for any pregnancies which occur during use of an antiviral, including paternal use. Reports are welcomes from healthcare professionals, pregnant women and partners of pregnant women.

This issue also highlights an observed increased risk of cardiovascular events in patients with rheumatoid arthritis following co-administration of azithromycin with hydroxychloroquine. Based on this data, healthcare professionals are advised to carefully consider the benefits and risks before prescribing systemic azithromycin or other systemic macrolide antibiotics (erythromycin or clarithromycin) to patients being treated with hydroxychloroquine or chloroquine. Clinicians are also reminded to be vigilant for psychiatric reactions associated with hydroxychloroquine or chloroquine, especially in the first month of treatment.

This issue contains the latest COVID-19 vaccine and medicine information including the recent approval of the Nuvaxovid® COVID-19 vaccine developed by Novavax. The update also advises that weekly summaries of Yellow Card reporting events associated with coronavirus vaccine continues to be published.

Lastly in this issue is a summary of letters to healthcare professionals in January. These generally related to supply issues and recalls as well as details of the consultation proposal to make estradiol 10 microgram vaginal tablets available from pharmacies.

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

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SMC Update - February 2022

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

Cannabidiol (Epidyolex®) has been accepted for use as adjunctive therapy of seizures associated with tuberous sclerosis complex (TSC) for patients 2 years of age and older. This advice applies only in the context of an approved NHSScotland Patient Access Scheme and it is therefore expected that this medication will be supplied direct from the specialist. There is existing NICE and SMC advice on the use of this medicine for seizures associated with Dravet syndrome and Lennox–Gastaut syndrome.

Cenobamate (Ontozry®) has been accepted for restricted use as an adjunctive treatment of focal-onset seizures with or without secondary generalisation in adult patients with epilepsy who have not been adequately controlled despite treatment with at least 2 anti-epileptic medicinal products. The restriction limits use to patients with drug-resistant epilepsy as a second-line adjunctive anti-seizure medicine, after the failure of the first adjunctive anti-seizure medicine.

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 - January 2022

During January 2022 Clinical Knowledge Summaries were published or updated in the following areas.

The Safeguarding adults in care homes topic is new. The remaining topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Nausea/vomiting in pregnancy topic has been updated in line with current NICE guidance, the definition of hyperemesis gravidarum has been amended and two additional treatments have been added to the Management section.

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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