Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CKS Updates - January 2019

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

The majority of topics have undergone reviews and minor restructures. The most significant changes are to the Depression - antenatal and postnatal topic where a section on prevalence has been added and management recommendations have been updated in line with the NICE, the Febrile seizure topic where Assessment and Differential diagnosis sections have been added and management recommendations have been updated in line with current literature and the two Feverish children topics where a section on Prevalence and management recommendations have been updated in line with current literature.

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 2019

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

The Renal and ureteric stones guideline has been published. It covers assessing and managing renal and ureteric stones. It aims to improve the detection, clearance and prevention of stones, so reducing pain and anxiety, and improving quality of life.

The Cerebral palsy in adults guideline has been published. It covers care and support for adults with cerebral palsy. It aims to improve health and wellbeing, promote access to services and support participation and independent living.

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 2019

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

Tiotropium (Spiriva Respimat®) has been accepted for use as add-on maintenance bronchodilator treatment in patients aged 6 years and older with severe asthma who experienced one or more severe asthma exacerbations in the preceding year.

Ertugliflozin (Steglatro®) has been accepted for restricted use in adults aged 18 years and older with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycaemic control:

  • As monotherapy in patients for whom the use of metformin is considered inappropriate due to intolerance or contraindication.
  • In addition to other medicinal products for the treatment of diabetes

The restriction limits use as monotherapy to patients who would otherwise receive a dipeptidyl peptidase-4 inhibitor and in whom a sulphonylurea or pioglitazone is not appropriate.

Semaglutide (Ozempic®) has been accepted for restricted use in the treatment of adults with insufficiently controlled type 2 diabetes mellitus (T2DM) as an adjunct to diet and exercise when used in addition to other medicinal products for the treatment of diabetes. The restriction limits this drug to add on use only as the submission from the manufacturer did not relate to use as monotherapy when metformin is considered inappropriate.

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 - January 2019

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for January 2019 (PDF).

This issue advises clinicians that tapentadol (Palexia®) may increase seizure risk in patients taking other medicines that lower seizure threshold. It is recommended to use with care in patients with a history of seizure disorders or epilepsy. Serotonin syndrome has also been reported when tapentadol is used in combination with serotoninergic antidepressants.

Readers are also advised that the Yellow Card App has been updated to make it easier to use and new features have been added, such as the ability to receive updates via the app.

Finally this month, the summary of letters to healthcare professionals includes notification that aciclovir eye ointment (Zovirax®) is being discontinued globally due to challenges in guaranteeing a sustainable product supply. It is expected current supplies will last until around June 2019. There is no generic direct alternative but ganciclovir has been recommended as an appropriate first-line alternative.

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

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Antiviral Medicines Authorised for Influenza Season 2018/19

The Department of Health has written to healthcare professionals via the Central Alerting System (PDF) to advise that antiviral medicines may now be prescribed at NHS expense due to rising levels in reporting of influenza-like illness.

Surveillance data indicates an increase in influenza cases in the community and as such GPs and other prescribers working in primary care may now prescribe antiviral medicines for the prophylaxis and treatment of influenza. Doses and treatment schedules are contained in existing Public Health England guidance.

Clinicians should remember to endorse the prescription with 'SLS' to ensure that it can be dispensed in community pharmacies without undue delay.

Action: Clinicians should be aware of this letter and familiarise themselves with the current prescribing guidance.

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