The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2025 (PDF).
This issue advises healthcare professionals that indication for the treatment of post-operative pain has been removed from the licences of all prolonged release opioids due to the increased risk of persistent post-operative opioid use (PPOU) and opioid-induced ventilatory impairment (OIVI). Hospitals are recommended to explain the risks before operative procedures. At discharge, a pain management plan should be shared with the primary care and the patient should be provided with an adequate supply of immediate-release opioids to treat acute post-operative pain to minimise the risk of PPOU, dependence, stock piling of unused opioids and potential for diversion. Primary care clinicians should be vigilant for post-operative opioid use and ensure that pain management plans are reviewed and implemented accordingly including the plan for end of treatment.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During February 2025 Clinical Knowledge Summaries were published or updated in the following areas.
The Hypokalaemia topic is new. All of the other topics have been reviewed and updated with minor structural and layout changes. The Hypertension in pregnancy topic has been updated with a recommendation to provide reassurance where inadvertent exposure to an ACEi or ARB has occurred; this is due to the lack strong evidence that use in the first trimester poses a teratogenic risk to the foetus. Recommendations for culture and sensitivity testing for women with asymptomatic bacteriuria were aligned with the latest guidance from NHS England. The Obesity topic has been updated in line with the new NICE Overweight and obesity management guideline.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for February 2025 (PDF).
This issue advises healthcare professionals that review by two specialists remains in place for patients initiating valproate under 55 years of age but the Commission on Human Medicines (CHM) has advised that it will not be required for men (or males) currently taking valproate. To aid the decision making process for initiation and review, three infographics have been produced, for female patients under 55 years old, for male patients under 55 years old and for male and female patients 55 years and older. Patients are recommended to continue taking valproate until reviewed by their specialist.
Lastly, this issue contains a summary of letters to healthcare professionals in January. These generally related to supply issues and recalls.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of February 2025. This month there is one guideline that impacts upon primary care.
The Tobacco: preventing uptake, promoting quitting and treating dependence guideline has been updated. It covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. This update reviewed the evidence for cytisinicline (sometimes referred to as cytisine) and made new and updated recommendations in the section on stop-smoking interventions.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During January 2025 Clinical Knowledge Summaries were published or updated in the following areas.
The Cushing's syndrome topic is new. All of the topics have been reviewed and updated with minor structural and layout changes. The Asthma topic has been updated in line with the joint BTS/NICE/SIGN guideline including recommendations on objective testing during diagnosis and management with AIR therapy or MART. The Hyperthyroidism and Hypothyroidism topics have both been updated in line with the NICE clinical guideline Thyroid disease: assessment and management. The Incontinence - urinary, in women topic has been restructured and now includes vibegron as a treatment option in accordance with the NICE technology appraisal.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
