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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - June 2022

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of June 2022. This month there are seven guidelines and one Medical technologies guidance that impact upon primary care.

The Peristeen Plus transanal irrigation system for managing bowel dysfunction medical technologies guidance has been updated. It covers use of this transanal irrigation system for managing bowel dysfunction. The update reflects 2021 costs and revises cost-saving estimates.

The Reducing sexually transmitted infections guideline has been published. It covers interventions to prevent sexually transmitted infections (STIs) in people aged 16 and over. It aims to reduce the transmission of all STIs, including HIV, and includes ways to help increase the uptake of STI testing and vaccines for human papillomavirus (HPV) and hepatitis A and B.

The Gout: diagnosis and management guideline has been published. It covers the diagnosis and management of gout. It includes recommendations on diagnosing gout, managing flares, long-term management of gout and referral to specialist services.

The Multiple sclerosis in adults: management guideline has been published. It covers diagnosing and managing multiple sclerosis in people aged 18 and over. It aims to improve the quality of life for people with multiple sclerosis by promoting prompt and effective symptom management and relapse treatment, and comprehensive reviews.

The Depression in adults: treatment and management guideline has been published. It covers identifying, treating and managing depression in people aged 18 and over. It recommends treatments for first episodes of depression and further-line treatments, and provides advice on preventing relapse, and managing chronic depression, psychotic depression and depression with a coexisting diagnosis of personality disorder.

Additionally, three guidelines on diabetes have all been updated with new recommendations on periodontitis. The affected guidelines are:

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 - June 2022

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

This issue advises clinicians that vitamin B12 deficiency is now considered to be a common side effect in patients on metformin treatment. The risk increases with higher dose or longer treatment duration and in those with existing risk factors. Checking vitamin B12 serum levels is recommended in patients being treated with metformin who have symptoms suggestive of vitamin B12 deficiency, this may include megaloblastic anaemia or new-onset neuropathy. It is also advised that periodic monitoring for patients with risk factors for vitamin B12 deficiency should be considered.

Clinicians are also notified that a National Patient Safety Alert has been issued following serious reports of harm associated with insulin leakage during use of the Accu-Chek Insight Insulin pump with NovoRapid PumpCart prefilled insulin cartridges. It is recommended that patients should be moved onto alternative insulin pumps where possible.

This issue contains the latest COVID-19 vaccine and medicine information including an updated shelf life for Comirnaty® to 12 months and a warning on the risk of flare-ups of capillary leak syndrome in patients who already have this syndrome following Spikevax® use.

Lastly in this issue is a summary of letters to healthcare professionals in May. 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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SMC Update - June 2022

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

Relugolix / estradiol / norethisterone tablets (Ryeqo®) have been accepted for restricted use in the treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The restriction limits use to patients who have not responded to or are unsuitable for conventional therapies (first line treatments), such as tranexamic acid, hormonal contraceptives and intrauterine delivery systems.

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 - May 2022

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

All of these topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Eczema - atopic topic now includes a prescribing information section for topical calcineurin inhibitors and the supporting evidence now incorporates the latest literature. The Headache - cluster topic now includes expanded prescribing information for the use of sumatriptan and zolmitriptan preparations for acute treatment of cluster headache. And the Irritable bowel syndrome topic recommendations on the diagnosis and management of irritable bowel syndrome have been updated in line with guidance from the National Institute for Health and Care Excellence and the British Society of Gastroenterology.

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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