Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - January 2020

During January 2020 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Cows' milk protein allergy in children topic has been renamed within the topic area and the recommendations on the assessment and management of suspected cow's milk allergy have been amended in line with current evidence. A new prescribing information section has been added to provide information on prescribing oral antihistamines, in line with the CKS topic on Food allergy. The Tamoxifen - managing adverse effects topic now includes primary prevention of breast cancer in women at moderate or high risk as a licensed indication for tamoxifen in keeping with the product license.

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 - January 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of January 2020. This month there are two guidelines that impact upon primary care.

The Supporting adult carers guideline has been published. It covers support for adults (aged 18 and over) who provide unpaid care for anyone aged 16 or over with health or social care needs. It aims to improve the lives of carers by helping health and social care practitioners identify people who are caring for someone and give them the right information and support. It covers carers' assessments, practical, emotional and social support and training, and support for carers providing end of life care.

The Colorectal cancer guideline has been published. It covers managing colorectal cancer in people aged 18 and over. It aims to improve quality of life and survival for adults with colorectal cancer through management of local disease and management of secondary tumours (metastatic disease).

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

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Ingenol mebutate recalled

The manufacturer of ingenol mebutate (Picato®) has recalled all unexpired stock from wholesalers and pharmacies while investigations are ongoing into the concerns of the possible risk of skin malignancy.

Healthcare professionals are advised to:

  • Stop supplying the above products immediately. Quarantine all remaining stock and return it to your supplier using your supplier’s approved process
  • Stop prescribing Picato and consider other treatment options as appropriate. For patients who have recently been prescribed Picato, advise patients to be vigilant for any skin lesions developing and to seek medical advice promptly should any occur

Action: Clinicians should be aware of this recall and investigation. Alternatives will need to be issued during the remainder of the investigation.

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NICE Guidance - December 2019

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of December 2019. This month there are two guidelines and two technology appraisals that impact upon primary care.

The Acute kidney injury: prevention, detection and management guideline has been published. It covers preventing, detecting and managing acute kidney injury in children, young people and adults. It aims to improve assessment and detection by non-specialists, and specifies when people should be referred to specialist services. This will improve early recognition and treatment, and reduce the risk of complications in people with acute kidney injury.

The Menopause: diagnosis and management guideline has been updated. It covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline aims to improve the consistency of support and information provided to women in menopause. This update includes MHRA safety alert information regarding the risks of breast cancer.

The Cannabidiol with clobazam for treating seizures associated with Dravet syndrome technology appraisal recommends this treatment as an option for treating seizures associated with Dravet syndrome in people aged 2 years and older, only if:

  • the frequency of convulsive seizures is checked every 6 months, and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment
  • the company provides cannabidiol according to the commercial arrangement

The Cannabidiol with clobazam for treating seizures associated with Lennox–Gastaut syndrome technology appraisal recommends this treatment as an option for treating seizures associated with Lennox–Gastaut syndrome in people aged 2 years and older, only if:

  • the frequency of drop seizures is checked every 6 months, and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment
  • the company provides cannabidiol according to the commercial arrangement

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 2019

During November 2019 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Depression in children topic has been updated in line with current NICE guidance. The Styes (hordeola) topic and the Teething topic have seen more significant layout changes and a new Assessment section has been added to the Styes (hordeola) 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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