Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - January 2017

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for January 2017 (PDF).

Healthcare professionals are advised that INR should be monitored closely during treatment of chronic hepatitis C with direct-acting antivirals in patients also receiving vitamin K antagonists (e.g. warfarin), because of possible changes in liver function during treatment.

It is also noted that a review of the evidence from clinical trials and postmarketing cases has suggested a causal association between apremilast (Otezla®) and suicidal thoughts and suicidal behaviour. Any patient presenting with new or worsening depression and suicidal thoughts should have treatment stopped.

There is also a summary of letters sent to healthcare professionals in December including notification of the potential for medication errors associated with overdose with liquid levetiracetam, usually in children. To minimise the risk it is recommended that the dosing directions should specify the dose in milligrams and millilitres and patients should be advised to only use the medicines syringe supplied with the medicine.

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

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SMC Update - January 2017

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

Buprenorphine transdermal patch (Butec®) has been accepted for restricted use in adults, for the treatment of chronic non-malignant pain of moderate intensity when an opioid is necessary for obtaining adequate analgesia. The restriction limits use to elderly patients (over 65 years).

Conjugated oestrogens and bazedoxifene acetate
(Duavive®) has been rejected in the treatment of oestrogen deficiency symptoms in postmenopausal women with a uterus (with at least 12 months since the last menses) for whom treatment with progestin-containing therapy is not appropriate. The manufacturer failed to make a submission.

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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Drug Safety Update - December 2016

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for December 2016 (PDF).

Healthcare professionals are advised of a rare but potentially serious reaction that may occur in the co-administration of a corticosteroid with an HIV-treatment-boosting agent that increases the risk of adrenal suppression due to a pharmacokinetic interaction. There have been several cases reported worldwide of interactions between cobicistat and ritonavir and steroids including triamcinolone and fluticasone. The interaction is still possible when the corticosteroid is administered via the epidural, inhaled, intranasal, intra-articular or ocular routes. It is recommended that co-administration is avoided unless the potential benefit to the patient outweighs the risk and where possible beclomethasone should be considered as the interaction risk may be lower.

Advice issued in February 2016 regarding the concomitant use of spironolactone with an angiotensin converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) has also been re-issued to clarify that the combination must be used with caution. Feedback from the initial advice indicated that some readers interpreted that advice to mean that the combination must not be used.

There is also a summary of letters sent to healthcare professionals in November.

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

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SMC Update - December 2016

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

Ferric maltol (Feraccru®) has been rejected for the treatment of iron deficiency anaemia (IDA) in adult patients with inflammatory bowel disease (IBD). The submitting company did not present sufficiently robust clinical and economic analyses to gain acceptance.

Hydrocortisone (Plenadren®) has been rejected for use in the treatment of adrenal insufficiency in adults. The submitting company did not present a sufficiently robust clinical and economic analysis to gain acceptance.

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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SMC Update - November 2016

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

Dequalinium (Fluomizin®) has been accepted for restricted use in the treatment of bacterial vaginosis where the initial treatment is ineffective or not well tolerated.

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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