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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

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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CKS Updates - April 2022

During April 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 Headache - tension-type topic has been updated with recommendations on management in primary care to include the option of physiotherapy, regular exercise, cognitive behavioural therapy, and/or relaxation techniques for some people. Also, the QIPP section on nonsteroidal anti-inflammatory drugs (NSAIDs) has been removed. The Trigeminal neuralgia topic has been updated with the addition of a differential diagnosis section, minor changes based on drug literature and an update to the supporting evidence for the topic.

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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NICE Guidance - April 2022

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

The Epilepsies in children, young people and adults guideline has been published. It covers diagnosing and managing epilepsy in children, young people and adults in primary and secondary care, and referral to tertiary services. It aims to improve diagnosis and treatment for different seizure types and epilepsy syndromes, and reduce the risks for people with epilepsy.

The Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults guideline has been published. It covers general principles for prescribing and managing withdrawal from opioids, benzodiazepines, gabapentinoids, Z‑drugs and antidepressants in primary and secondary care.

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

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