Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - May 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of May 2020. This month there are four rapid guideline and evidence reviews and two evidence summaries related to COVID-19 that impact upon primary care.

The COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders guideline has been updated. The update highlights factors to take into account when considering temporarily stopping some drugs for children and young people.

The COVID-19 rapid guideline: children and young people who are immunocompromised guideline has been published and updated. It aims to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources. The update highlighted that immunosuppressant medicines should be reviewed if a patient may have COVID-19 or there are other medical concerns.

The COVID-19 rapid guideline: chronic kidney disease guideline has been published. It to maximise the safety of adults with chronic kidney disease during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid guideline: interstitial lung disease guideline has been published. It aims to maximise the safety of adults with interstitial lung disease, including idiopathic pulmonary fibrosis and pulmonary sarcoidosis, during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.

The COVID-19 rapid evidence summary: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in people with or at risk of COVID-19 evidence summary has been published. It aims to determine whether up regulation of angiotensin-converting enzyme 2, potentially as a result of taking ACEIs or ARBs, is associated with an increased risk of developing COVID-19 or developing more severe symptoms. This analysis found two observational studies that were of poor quality and subject to bias and confounding. As such conclusions cannot be drawn without further research.

The COVID-19 rapid evidence summary: Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) for people with or at risk of COVID-19 evidence summary has been published. It aims to determine if long term use of NSAIDs is associated with an increased risk of developing COVID-19 or developing more severe symptoms. A literature search identified no evidence from published scientific studies. However, it is noted that NSAIDs and COVID-19 can both contribute to respiratory, cardiovascular and renal complications.

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

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Drug Safety Update - May 2020

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for May 2020 (PDF).

This month clinicians are advised of a new dedicated COVID-19 Yellow Card reporting site for medicines and medical devices. The site aims to allow rapid identification of new and emerging side effects and medical device incidents in COVID-19 treatment, including side effects for medicines taken by patients to manage long-term or pre-existing conditions.

Readers are also advised of the temporary guidance to specialists regarding the Valproate Pregnancy Prevention Programme during the coronavirus (COVID-19) pandemic and also temporary advice for management of certain immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide) and the associated pregnancy prevention programme.

The summary of letters to healthcare professionals includes details of a recall of Emerade®, safety letters about change in presentation of ReQuip® and new restrictions in the use of cyproterone acetate and several letters regarding supply contrataints.

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

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Influenza medication guidance deactivated for 2019/20

The Department of Health and Social Care has issued a notification (PDF) advising that antivirals for influenza should no longer be prescribed this season.

The surveillance data from Public Health England (PHE) indicates that circulation of influenza in the community has returned to baseline levels. As such primary care clinicians should no longer prescribe antiviral medicines for the prophylaxis and treatment of influenza on an FP10 prescription form.

Action: Clinicians should be aware of this notification and cease prescribing antiviral drugs for the prevention and treatment of influenza.

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CKS Updates - April 2020

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

All of the topics have been reviewed and undergone minor restructuring. The scope of the Neuropathic pain - drug treatment has been updated to indicate that it does not cover sciatica.

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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Drug Safety Update - April 2020

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for April 2020 (PDF).

This month clinicians are provided with a summary of the key advice and guidance issued so far on medicines safety and pharmacovigilance during the Coronavirus (COVID-19) pandemic. This includes a reminder to make use of the Yellow Card system to notify all suspected side effects. Advice on medicines use issued during COVID-19 includes:

Ibuprofen and NSAIDs
There is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and susceptibility to contracting COVID-19 or the worsening of its symptoms.

Antihypertensives
The is no evidence from clinical or epidemiological studies to support the concern that treatment with angiotensin-converting-enzyme inhibitors (ACE inhibitors or ACE-i) or angiotensin-receptor blockers (ARBs) might worsen COVID-19 infection

Chloroquine and hydroxychloroquine.
It is advised that trials are underway, and until there is clear, definitive evidence that these treatments are safe and effective these agents should only be used for this purpose within a clinical trial.

Interestingly, the Journal of the American Medical Association has recently published research advising against using high-dose chloroquine due to "safety concerns regarding QTc interval prolongation and increased lethality".

The summary of letters to healthcare professionals includes information about a recall of Emerade auto-injectors as some pens to fail to activate and deliver adrenaline and a recall of Esmya 5mg tablets following a new case of liver failure requiring liver transplant in a patient taking the medicine.

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

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