News
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
How to minimise the risks of medication errors with rivastigmine patches
This Q&A aims to raise awareness on the types of medication errors reported with rivastigmine patches, as well as highlighting strategies to improve medication safety on the prescribing and administration of these patches.
Q&A Metronidazole – is it safe to use with breastfeeding?
The balance of current evidence and clinical experience, and the consensus of specialist opinion, is that there is no established mutagenic or carcinogenic risk to infants breastfeeding from mothers receiving routine short-course treatment with metronidazole by any route.
Low-dose oral metronidazole, 200-400 mg three times daily, produces milk levels only slightly lower than corresponding levels in maternal plasma (76 to 99%). Doses up to 500 mg three times daily for a 7 to 10 day course are considered to be compatible with breastfeeding.
Q&A Can oral fluconazole be used with breastfeeding?
Fluconazole is often used to treat lactation-associated candidal infections, and has been used to treat serious candidal infections in preterm and full term neonates. There is therefore clinical experience in the exposure of fluconazole to neonates and infants
The combination of these factors, and the common use of fluconazole without reported adverse effects in breastfed infants, suggests that oral fluconazole is safe in mothers breastfeeding full term infants, and no interruption of breastfeeding is necessary, regardless of which dosing regime is used.
Oral fluconazole use in mothers breastfeeding preterm infants should be approached with caution due to no direct evidence of safety and limited clinical experience.
Updated Patient Group Directions
The following Patient Group Directions for hepatitis A, hepatitis B, combined hepatitis A + B, typhoid and combined hepatitis A + typhoid have been updated.
These PGDs has been jointly developed and authorised by North of England Commissioning Support Unit (NECSU) and Cumbria & North East (NHS England), for use by practices and services within the Durham, Darlington, Tees, Cumbria, Northumberland and Tyne & Wear areas.