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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - October 2023

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of October 2023. This month there are eight guidelines and two technology appraisals that impact upon primary care.

The following guidelines have all been updated in line with the standards for faster diagnosis of cancer:

The Thyroid disease: assessment and management guideline has been updated. It covers investigating all suspected thyroid disease and managing primary thyroid disease. The update highlights the potential for biotin in dietary supplements to affect the results of thyroid function tests.

The Acute Respiratory Infection in over 16s: Initial assessment and management guideline has been published. It covers assessment of people aged 16 and over with symptoms and signs of an acute respiratory infection (both bacterial and viral) at first remote or in-person contact with NHS services. It also covers the initial management of any infections and aims to support healthcare practitioners in making sure that people’s treatment follows the best care pathway.

The Pneumonia in adults: diagnosis and management clinical guideline has been updated. The update replaced the recommendation on lower respiratory tract infection with links to the new guideline on Acute Respiratory Infection in over 16s.

The Rimegepant for treating migraine technology appraisal has been published. This treatment is recommended as an option for the acute treatment of migraine with or without aura in adults, only if for previous migraines:

  • at least 2 triptans were tried and they did not work well enough or
  • triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

The Tirzepatide for treating type 2 diabetes technology appraisal has been published. This treatment is recommended for treating type 2 diabetes alongside diet and exercise in adults when it is insufficiently controlled only if:

  • triple therapy with metformin and 2 other oral antidiabetic drugs is ineffective, not tolerated or contraindicated, and
  • they have a body mass index (BMI) of 35 kg/m2 or more, and specific psychological or other medical problems associated with obesity, or
  • they have a BMI of less than 35 kg/m2, and:
    • insulin therapy would have significant occupational implications, or
    • weight loss would benefit other significant obesity-related complications.

It is also noted that lower BMI thresholds (usually reduced by 2.5 kg/m2) should be used for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds.

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

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