Useful advice

Freestyle Libre

The CCG Medicines Optimisation Team has been made aware that different providers in the area are asking GP practices to switch patients from Freestyle Libre to Freestyle Libre 2 (FSL2) sensors. The letters may indicate that the practice should batch switch all patients to FSL2 sensors, however this is not currently what we recommend. The switch should happen gradually and each patient should be reviewed individually (by diabetes specialist) as FSL2 is not suitable for all patients.

Our recommendations can be found here.


Treatment of patients with ACE Inhibitors and Angiotensin II Receptor Blockers in relation to COVID-19

There has been a lot of speculation in the media regarding prescribing of ACE inhibitors and ARBs and their safety in patients with COVID-19. This has led to some patients inappropriately stopping their medication and suffering deterioration in their condition.

This is an evolving situation, however there is no evidence-base to stop ACE/ARBs.

The Primary Care Cardiovascular Society has published advice for prescribers and patients which can be accessed via this link.


Heart UK – Useful Information

Website link: https://www.heartuk.org.uk/news/coronavirus-information-for-gps-and-prescribers

For those healthcare professionals responsible for these areas, we would encourage the following steps are taken:

    1. Patients with suspected familial hypercholesterolaemia (high cholesterol in the absence of secondary causes and a family history of premature cardiovascular disease) should be started on a statin as recommended in NICE (CG71). The recommended minimum for most otherwise healthy individuals would be 20mg of Atorvastatin OD.
    2. Patients due to have a follow-up cholesterol test following lifestyle changes may need to have their treatment decision delayed. They should, however, continue with lifestyle changes, unless their most recent result met the criteria for familial hypercholesterolaemia screening. These patients would usually be advised to receive 20mg of Atorvastatin OD .
    3. Patients due to have a follow-up cholesterol test after starting statins who are symptom-free may have to have their appointment deferred depending on the capacity of your service, but should continue their medication.
    4. Patients experiencing side effects should be offered a telephone appointment to review their symptoms, their dose and/or type of statin.

Ibruprofen and Paracetamol Covid-19 Update

Ibruprofen

The Commission on Human Medicines’ Expert Working Group on coronavirus (COVID-19) has concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19.

Patients can take paracetamol or ibuprofen when self-medicating for symptoms of COVID-19, such as fever and headache, and should be advised to follow NHS advice if they have any questions or if symptoms get worse.

(PDF.) Ibuprofen and COVID-19 (CMO Update)

Paracetamol

Although retail outlets are selling paracetamol faster than they can re-stock the shelves, there is sufficient paracetamol in the supply system. Please do not prescribe large quantities of paracetamol to cover use for minor ailments – this may create stock shortage. Community pharmacies can provide appropriately labelled packs for over the counter sale using dispensary stock.


Provision of effective contraception during the Pandemic

Medicines Optimisation team has received several queries regarding ongoing prescribing of contraceptives under the current circumstances. A number of these queries can be addressed using FSRH CEU clinical advice to support provision of effective contraception during the COVID-19 outbreak below:

(PDF.) FSRH CEU Clinical Advice


Medicine Optimisation update : Oral Vitamin B12- additional resource for you information.

Specialist Pharmacy Service (SPS) have produced a document to be used in conjunction with previous guidance given by Medicine Optimisation CCG team for vitamin b12 prescribing.

This document can be accessed via this link:https://www.sps.nhs.uk/wp-content/uploads/2020/06/UKMI_QA_Oral-Vitamin-B12-preparations_May-2020.pdf

Vitamin B12 (Hydroxocobalamin 1000mcg) Intramuscular Injections

(PDF.) INTERIM RECOMMENDATION FOR DRUG ADMINISTRATION DURING THE COVID-19 PERIOD