The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for September 2023 (PDF).
This issue notifies clinicians that there has been a very small number of reports of new-onset or aggravation of pre-existing myasthenia gravis associated with of statins. Based on the UK reports, the majority of patients recover fully on stopping treatment but it seems recurrence has also been reported when an alternative statin was trialled. It is recommended that all patients are advised to monitor for and report symptoms of myasthenia gravis when commencing treatment with statins.
Clinicians are also reminded to be alert for psychiatric reactions associated with the use of quinolone antibiotics. This reminder comes after the MHRA received a Coroner's report following the death of a patient who died by suicide after being treated with ciprofloxacin.
Lastly in this issue is a summary of letters to healthcare professionals in August. These generally related to supply issues and recalls with one letter covering recommended actions to address the global shortage of GLP-1 receptor agonists.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of September 2023. This month there is one clinical guideline and one technology appraisal that impact upon primary care.
The Cirrhosis in over 16s: assessment and management guideline has been updated. It covers assessing and managing suspected or confirmed cirrhosis in people who are 16 years or older. The update adds new or updated recommendations on safe prescribing and use of carvedilol and propranolol in people with cirrhosis, preventing bleeding from medium or large varices, preventing spontaneous bacterial peritonitis and primary prevention of decompensation.
The Semaglutide for managing overweight and obesity technology appraisal has been updated. The update includes an additional requirement that this treatment is available in accordance with a commercial arrangement that discounts the acquisition cost for the NHS.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.
Rimegepant (Vydura®) has been accepted for restricted use as preventive treatment of episodic migraine in adults who have at least four migraine attacks per month. The restrictions limits use to patients who have at least 4 migraine attacks per month, but fewer than 15 headache days per month and who have had prior failure on three or more migraine preventive treatments.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
During August 2023 Clinical Knowledge Summaries were published or updated in the following areas.
The topics have all been reviewed and updated with minor structural and layout changes. The Carbon monoxide poisoning topic has been updated to include sections about potential differential diagnoses and managing self-harm. The Lyme disease topic has been updated to include new information about differential diagnosis and persisting non-specific symptoms. The Tuberculosis topic has been updated in line with the latest NICE and World Health Organisation guidance.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
