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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2022

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

The Vaccine uptake in the general population guideline has been published. It aims to increase the uptake of all vaccines provided on the NHS routine UK immunisation schedule by everyone who is eligible.

The Sleepio to treat insomnia and insomnia symptoms medical technologies guidance has been published. Sleepio is is a self-help sleep improvement programme based on cognitive behavioural therapy for insomnia. It is recommended as a cost saving option for treating insomnia and insomnia symptoms in primary care for people who would otherwise be offered sleep hygiene or sleeping pills. A medical assessment is recommended before referral for people who may be at higher risk of other sleep disorder conditions.

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

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Plendil brand discontinued

According to the Electronic Medicines Compendium, Plendil is discontinued. This has been confirmed with the manufacturing company via the medical information department.

A letter was reportedly sent in September 2021 advising that this medication would be discontinued with effect from the end of December 2021. Continued availability of this medicine from other manufacturers would indicate that there are no safety concerns. The brand has most likely been discontinued for commercial reasons.

Action: Clinicians should be aware of this product being discontinued. It would be prudent to run clinical system searches to identify any patients who are currently prescribed this product to ensure a suitable alternative is arranged.

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Drug Safety Update - May 2022

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

This issue advises clinicians that denosumab 60mg (Prolia®) should not be used in patients under 18 years due to the risk of serious hypercalcaemia. Cases of serious and life-threatening hypercalcaemia has been reported with denosumab 60mg in children and adolescents in clinical trials for osteogenesis imperfecta and during off-label use. Patients already on this treatment who are younger than 18 years, and their parents or caregivers, are encouraged talk to their specialist about what this means for them.

This issue contains the latest COVID-19 vaccine and medicine information including notification that the 15-minute observation period following vaccination with COVID-19 Vaccine Pfizer/BioNTech or Moderna has been removed for individuals aged 12 years and over who have no history of a severe allergic reaction.

Lastly in this issue is a summary of letters to healthcare professionals in April. 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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Prescription Charges for 2022

The Department of Health and Social Care has announced that NHS prescription charges will be frozen for the first time in 12 years to help with the cost of living.

Charges for prescriptions will remain at £9.35 for a single charge or £30.25 for a 3-month prescription prepayment certificate (PPCs). 12 month PPCs will remain at £108.10 and can be paid for in instalments, meaning people can get all the medicines they need for just over £2 a week.

The prescription freeze will also apply to NHS wigs and fabric supports. The current exemption categories remain unchanged and the NHS Low Income scheme remains in place.

Action: Clinicians should be aware of the current prescription charge and also the value for money represented by pre-payment certificates.

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SMC Update - May 2022

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

Liraglutide (Saxenda®) has been accepted for restricted use as an adjunct to a reduced-calorie diet and increased physical activity for weight management in adult patients with an initial Body Mass Index (BMI) of:

  • ≥30kg/m2 (obese), or
  • ≥27kg/m² to <30kg/m2 (overweight) in the presence of at least one weight-related comorbidity such as dysglycaemia (prediabetes or type 2 diabetes mellitus), hypertension, dyslipidaemia or obstructive sleep apnoea

The restriction limits use to patients at high risk of type 2 diabetes or cardiovascular disease and notes that patients should be treated in a specialist weight management service.

Dapagliflozin (Forxiga®) has been accepted for restricted use in the treatment of chronic kidney disease. The restriction limits use to patients who meet all of the following criteria:

  • estimated glomerular filtration rate of ≥25 to ≤75 mL/min/1.73m2 at treatment initiation
  • receiving an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (unless these are not tolerated or contraindicated)
  • urine albumin creatinine ratio of at least 23mg/mmol, or type 2 diabetes mellitus or both

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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