Memos and Alerts

SGLT2 inhibitors: updated MHRA advice on increased risk of lower-limb amputation (mainly toes)

Canagliflozin may increase the risk of lower-limb amputation (mainly toes) in patients with type 2 diabetes. Evidence does not show an increased risk for dapagliflozin and empagliflozin, but the risk may be a class effect. Preventive foot care is important for all patients with diabetes.

Harm reporting system for new psychoactive substances (NPS) launched

Public Health England have launched a new online system to report illicit drug reaction, to improve knowledge of the harmful effects of new psychoactive substances.

The ban on these new substances has been successful in reducing their easy availability but there are still many new ones circulating. The chemical content of these substances frequently changes and their effects can be dangerous and unpredictable. That is why they are so risky. This information – reported directly and easily onto the system by those at the frontline dealing with the casualties – will help shed more light on both the immediate and longer term harms of these new drugs.

NHS Prescription Charges from April 2017

The government has announced an increase to the NHS prescription charge of 20 pence, to £8.60 per prescription item. This change will come into effect from 1 April 2017.

Cochrane review of long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD)

In a Cochrane review of 11 studies, which included 9839 participants with stable chronic COPD, LAMA+LABA treatment had fewer exacerbations, […]

Ensuring appropriate polypharmacy: Patients with frailty or moving towards end of life care

This PrescQIPP bulletin focuses on frailty and end of life and the specific considerations that would apply to this group of patients when reviewing medicines or considering stopping medicines. Medicines that should usually be continued and those with increased potential to cause harm are highlighted in the full bulletin with evidence-based tools to help the review process.

Q&A Is there an interaction between erythromycin and statins?

This updated Medicines Q&A evaluates the evidence for an interaction between erythromycin and statins. It concludes that if co-prescription with a drug that increases systemic exposure to statins is unavoidable, it is particularly important to start on the lowest statin dose.

Q&A Is there an interaction between bisphosphonates and proton pump inhibitors?

This updated Medicines Q&A concludes that whilst there is not a recognised interaction between bisphosphonates (B) and PPIs, a common side effect of bisphosphonates is gastro-intestinal disturbance. Additionally the SPCs for B and PPIs highlight an increased risk of fractures.

NICE Evidence Summary: Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide

This evidence summary discusses 2 small randomised controlled trials that compared glycopyrronium bromide with placebo for the treatment of severe sialorrhoea in children and young people with chronic neurological conditions. The majority of participants had cerebral palsy.

Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease

Prescribing information has been updated to help to minimise the risk of serious adverse reactions in patients with cardiac disease.

Advice for healthcare professionals:
– hyoscine butylbromide injection can cause serious adverse effects including tachycardia, hypotension, and anaphylaxis
– these adverse effects can result in a fatal outcome in patients with underlying cardiac disease, such as those with heart failure, coronary heart disease, cardiac arrhythmia, or hypertension
– hyoscine butylbromide injection should be used with caution in patients with cardiac disease
– monitor these patients, and ensure that resuscitation equipment, and personnel who are trained how to use this equipment, are readily available
– hyoscine butylbromide injection remains contraindicated in patients with tachycardia