Issue 37 - July 2020
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Welcome to July's edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.



The Midlands and Lancashire CSU has a dedicated COVID-19 webpage which is updated daily.

Please note that this information is up to date at the time of publication. 

The list of resources will be updated as new material becomes available so please check back regularly for updates.

This page groups the resources by subject matter. The same list of resources is also available grouped by the organisation that issued it.

COVID-19 Resources

Safety Update

Please click here for a summary of safety updates and SPC updates in June.

Cyproterone acetate: new advice to minimise risks of meningioma
29 June 2020
Risk of meningioma with cyproterone acetate increases with increasing cumulative dose

Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
29 June 2020
Remain vigilant for signs and symptoms of bleeding complications during treatment with DOACs (apixaban, dabigatran, edoxaban, rivaroxaban), especially in patients with increased bleeding risks. 


Prescribing News

NICE Guidelines June 2020

There has been one guideline, one medtech innovation briefing and one evidence summary related to COVID-19 published in June 2020 by the National Institute for Clinical Excellence which has impact upon primary care. 

The Vitamin D for COVID-19 evidence summary has been published. The evidence summary notes that there is no evidence supporting the use of taking vitamin D supplements to specifically prevent or treat COVID-19. It recommends that everyone should continue to follow UK Government advice on daily vitamin D supplementation to maintain bone and muscle health during the COVID-19 pandemic. 

Clinicians should be aware of these guidelines and implement any necessary changes to their practice. 

CKS June 2020

During the month of June 2020, the following Clinical Knowledge Summaries were published or updated: The Vitiligo topic has undergone a major restructure and recommendations have been updated in line with current evidence. The topic has now moved in line with the CKS layout and the prescribing information section directs readers to the CKS topic Corticosteroids – topical (skin), nose and eyes.

Clinicians can use the updated and new information when reviewing patients.

The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog 

This section has been adapted from

Drug Availability

Products in Short Supply and Product Discontinuations

The following links provide prescribers with up to date information on commonly prescribed products which are currently in short supply from the manufacturers.
The information held on these lists is not exhaustive. Availability can vary geographically and also between wholesalers. Up-to-date information should be sought from manufacturers, local community pharmacies and suppliers.

Supply Issue Update for Primary and Secondary Care

Registered users can access the monthly drug availability update for primary and secondary care produced by the Department for Health and Social Care (DHSC), on the Specialist Pharmacy Service (SPS) website. 

Please note you must be registered with SPS, with the relevant permissions, and logged in to view this page. Click on ‘sign in’ in the top right hand.

Drug Tariff Changes

Drug tariff price changes for July are summarised as the top 10 price reductions and top 10 price increases since last month, the top 25 increases and decreases compared to three months ago, and the top 50 changes since last year.

Antimicrobial Update

Please click here for a full summary of antimicrobial related guidelines and SPC updates in June.

Metronidazole – is it safe to use with breastfeeding? 
This updated Q&A states that 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. 

Incorrect penicillin allergies labels fuel antibiotic resistance? 
This article notes that vast majority of people with penicillin allergy label are, in fact, not allergic, leading to significant healthcare implications, and experts call for a national “de-labelling” drive to reduce risk of antibiotic resistance and poorer health outcomes. 

Recurrent vulvovaginal candidiasis 
Review highlights symptoms of recurrent vulvovaginal candidiasis, differential diagnoses such as bacterial vaginosis and common predisposing factors including recent antibiotic use and sexual activity. 

Topical terbinafine meets primary endpoint in Phase 3 study of onychomycosis patients 
RCT (n=452) demonstrated non-inferiority of topical terbinafine vs. topical ciclopirox; treatment success (mycological cure and almost or completely clear great toenail) was reached for 21.9% of terbinafine patients vs. 18.9% in the ciclopirox group at 52 weeks. 

Please note that the information in this newsletter is correct at the time of publication.
Clinicians should always refer to the most up to date information.

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