Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - December 2016

During December 2016 Clinical Knowledge Summaries were updated for the following topics:

The following topics were all reviewed:

The shingles topic updated changed recommendations with respect to the choice of drugs for neuropathic pain and also added sections on prevalence, risk factors, and differential diagnosis. There were also minor changes to the prescribing information section on antiviral drugs. The remaining changes for the other topics were minor structural changes.

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 - December 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2016. This month there are two guidelines and one technology appraisal that impact upon primary care.

The HIV testing guideline covers how to increase the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, promote awareness of HIV testing and increase opportunities to offer testing to people who may have undiagnosed HIV.

The End of life care for infants, children and young people with life-limiting conditions guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

The Ticagrelor for preventing atherothrombotic events after myocardial infarction technology appraisal recommends this treatment as an option for preventing atherothrombotic events in adults who had a myocardial infarction and who are at high risk of a further event. Treatment should be stopped when clinically indicated or at a maximum of 3 years.

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

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CKS Updates - November 2016

During November 2016 Clinical Knowledge Summaries were updated for the following topics:

Two new topics were added:

The following topics were all reviewed:

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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BNF 72

The 72nd Edition of the British National Formulary has recently been published. As previously noted, hard copies of the BNF will now only be distributed annually in the NHS.

Some of the significant content updates in this edition include:

  • New safety information about the risk of abnormal pregnancy outcomes with sodium valproate and valproic acid
  • Updated guidance for conditions including asthma, obesity, coeliac disease, irritable bowel syndrome and prostate cancer
  • New drug monographs including edoxaban, albiglutide, dulaglutide, dasabuvir, and vortioxetine
  • Updated pregnancy-prevention advice for patients taking mycophenolate mofetil
  • Updated guidance on the risk of hepatitis B reactivation with BCR-ABL tyrosine kinase inhibitors, and pomalidomide
  • Advice about the risk of ulceration with nicorandil treatment
  • NICE guidelines including the use of vedolizumab for treating moderately to severely active Crohn’s disease
  • New guidance on suspected or confirmed drug allergy
  • Evidence grading of BNF recommendations

The web version is updated monthly and can be accessed via NHS computers or via NICE Evidence Services. The printed version is also available for purchase.

Action: All clinicians should start using BNF 72 via electronic methods were possible. The web version can be used to access the latest information if necessary.

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NICE Guidance - November 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2016. This month there are two guidelines and three technology appraisals that impact upon primary care.

The Hypertension in adults guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over. It has been updated to include two MHRA drug safety alerts regarding ACE inhibitor use during pregnancy and breastfeeding.

The Diabetes in children and young people guideline covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. It has been updated to add information on when eye screening should begin and referral for eye screening should happen.

The Dapagliflozin in triple therapy for treating type 2 diabetes technology appraisal replaces existing advice (see below). Triple therapy regimen is recommended as an option for treating type 2 diabetes in adults only in combination with metformin and a sulfonylurea.

The Dapagliflozin in combination therapy for treating type 2 diabetes technology guideline has been updated to including sign-posting to the new guidance above covering triple therapy.

The Apremilast for treating moderate to severe plaque psoriasis technology appraisal is recommended as an option for treating chronic plaque psoriasis in adults whose disease has not responded to other systemic therapies, including ciclosporin, methotrexate and PUVA (psoralen and ultraviolet‑A light). Treatment should be initiated by specialists.

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

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