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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Drug Safety Update - March 2024

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2024 (PDF).

This issue only contains a summary of letters to healthcare professionals in February. These generally related to supply issues and recalls but also includes a letter warning that pseudoephedrine has been very rarely associated with posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS), as reported last month.

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

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NICE Guidance - March 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of March 2024. This month there are four guidelines and one technology appraisal that impact upon primary care.

The Vitamin B12 deficiency in over 16s: diagnosis and management guideline has been published. It covers recognising, diagnosing and managing vitamin B12 deficiency in people aged 16 and over, including deficiency caused by autoimmune gastritis. It also covers monitoring for gastric cancer in people with autoimmune gastritis.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. It covers managing COVID-19 in babies, children, young people and adults in community and hospital settings. The update aligns the therapeutics section with a recently updated Technology Appraisal.

The Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management guideline has been published. It covers recognising, diagnosing and managing bacterial meningitis and meningococcal disease in babies, children, young people and adults. It aims to reduce death and disability by helping healthcare professionals recognise meningitis and treat it quickly and effectively.

The Ovarian cancer: identifying and managing familial and genetic risk guideline has been published. It covers assessing the familial and genetic risk of having a pathogenic variant associated with ovarian cancer in adults.

The Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19 technology appraisal has been updated. This update includes additional groups eligible for treatment with nirmatrelvir plus ritonavir.

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

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SMC Update - March 2024

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

Pitolisant (Wakix®) has been rejected for use to improve wakefulness and reduce excessive daytime sleepiness (EDS) in adult patients with obstructive sleep apnoea (OSA) whose EDS has not been satisfactorily treated by, or who have not tolerated, OSA primary therapy, such as continuous positive airway pressure (CPAP). The manufacturer failed to make a submission for this indication.

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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CKS Updates - February 2024

During February 2024 Clinical Knowledge Summaries were published or updated in the following areas.

The Adult malnutrition topic is new. The remaining topics have all been reviewed and updated with minor structural and layout changes. The Amenorrhoea topic has had the definitions of primary and secondary amenorrhoea have been amended to reflect expert opinion in guidelines. The DVT prevention for travellers topic has been updated to remove the moderate risk category in line with the latest guidelines. The Sepsis topic has been updated in line with NICE Guideline after it was updated in January.

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 - February 2024

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2024. This month there is one guideline thats impacts upon primary care.

The Tuberculosis guideline has been updated. It covers preventing, identifying and managing latent and active tuberculosis (TB) in children, young people and adults. This update has removed family history of TB in the past 5 years from the list of criteria for BCG vaccination in neonates in low-incidence areas in line with national recommendations. It is also noted that antibiotic recommendations are being reviewed following the MHRA drug safety update regarding fluoroquinolone antibiotics.

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

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