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The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2024. This month there are four guidelines that impact upon primary care.
The Menopause: identification and management guideline has been updated. It covers identifying and managing menopause, including in people with premature ovarian insufficiency. This update reviewed the evidence and made new recommendations on:
The Endometriosis: diagnosis and management guideline has been updated. It covers diagnosing and managing endometriosis, including where fertility is a priority. This update reviewed the evidence and made new or updated recommendations on diagnosis. The recommendations on symptoms and signs and information and support were also updated.
The Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN) guideline has been published. It covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks.
The Asthma pathway (BTS, NICE, SIGN) guideline has been published. It links to recommendations and resources from the British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) on diagnosing, monitoring and managing asthma in adults, young people and children.
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.
Bismuth subcitrate potassium / metronidazole / tetracycline (Pylera®) has been accepted for restricted use in combination with omeprazole, for the eradication of Helicobacter pylori and prevention of relapse of peptic ulcers in patients with active or a history of H. pylori associated ulcers. The restriction limits use on the basis that it is in accordance with clinical guidelines for the eradication of H. pylori.
Linzagolix (Yselty®) has been accepted for restricted use in the treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age. The restriction limits use to patients when conventional first-line treatments (such as tranexamic acid, hormonal contraceptives and intrauterine devices) have failed or are considered unsuitable. It should be noted that NICE Guidance has been published for this medication
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 November 2024 (PDF).
This issue reminds clinicians that this week is MedSafetyWeek. This is an annual social media campaign and the theme this year stresses the "importance of using medicines in the right way to prevent side effects, and to report side effects when they do occur". Healthcare professionals are encouraged to support the campaign, report suspected adverse drug reactions and talk to their patients and colleagues about side effects and how to report suspected safety concerns to the Yellow Card scheme.
Lastly, this issue contains a summary of letters to healthcare professionals in October. These generally related to supply issues and recalls but included a letter regarding the small increase in risk of developing meningioma with high doses (injectable and ≥100 mg oral formulations) of medroxyprogesterone acetate and measures to minimise this risk.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During October 2024 Clinical Knowledge Summaries were published or updated in the following areas.
All of the topics have been reviewed and updated with minor structural and layout changes. The Epistaxis (nosebleeds) topic includes a recommendation to consider tranexamic acid for people presenting after a major haemorrhage and there is a new section highlighting potential differential diagnoses. The Premenstrual syndrome topic now includes diagnostic criteria for premenstrual dysphoric disorder and the management section is now structured based on individual tailored management focusing on individual symptoms and goals based on shared decision making. The Teething topic includes the latest recommendations and manufacturers' information on lidocaine-containing teething products. The Varicose veins topic contains three new recommendations regarding assessment. These included asking about red flag symptoms which may be indicative of rare but severe causes of varicose veins, examining the varicose veins for the presence of superficial vein thrombosis, and performing an abdominal examination to assess for an abdominal or pelvic mass.
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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