The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2016. This month there are four clinical guidelines that impact upon primary care.
The Heavy menstrual bleeding clinical guideline was updated to include new recommendations for drug treatments for women with large fibroids based on new evidence.
The Autism spectrum disorder in adults clinical guideline was reviewed and while no new recommendations were made, two research recommendations were removed.
The Fertility problems clinical guideline has been reviewed in particular on intrauterine insemination however the new evidence did not justify a change to the recommendation.
The Palliative care for adults: strong opioids for pain relief clinical guideline was reviewed and updated to include links to the Controlled drugs: safe use and management guideline. Two out of date research recommendations were also deleted.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.
Alirocumab (Praluent®) has been accepted for restricted use in adults with primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia, as an adjunct to diet and other medication, if tolerated. The restriction limits use specialist lipid clinics in patients at high cardiovascular risk. This advice is also contingent upon the continuing availability of the PAS in NHS Scotland or a list price that is equivalent or lower.
Insulin degludec (Tresiba®) has been accepted for use in the treatment of diabetes mellitus in adults.
Levofloxacin (Quinsair®) has been accepted for restricted use in the management of chronic pulmonary infections due to Pseudomonas aeruginosa in adult patients with cystic fibrosis. The restriction limits use to third line after colistimethate sodium (first line) and tobramycin (second line).
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for August 2016 (PDF).
Following early termination of a clinical trial it is recommended that riociguat (Adempas®) should not be used to treat patients with pulmonary hypertension associated with idiopathic interstitial pneumonias. This medication should be under specialist supervision.
There is also a summary of letters sent to healthcare professionals in July including a letter advised that posaconazole (Noxafil®) tablets and suspension are not interchangeable and that inadvertent changes between the two formulations has led to under-dosing or over-dosing.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During July 2016 Clinical Knowledge Summaries were updated for the following topics:
There were no major changes other than to the Head injury topic that was updated in line with NICE guidance.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
