Over the past few months, the UK’s regulator of medicines (Medicines & Healthcare products Regulatory Agency) has issued a series of alerts relating to Emerade adrenaline pens. These are devices used in the emergency treatment of severe allergic reactions or ‘anaphylaxis’. Tests indicated that approximately 13% of pens needed a higher than normal force to activate which could lead to doses not being delivered.
Initial advice to patients was to always carry two pens, to press the device firmly if used and to try again if it failed to activate. Now there are sufficient stocks of alternative brands so patients are able to replace their Emerade pens with an alternative. The alternative brands come in a maximum strength of 300mcg but don’t worry if you had an Emerade 500mcg pen – the evidence suggests that an Epipen or Jext 300mcg pen will be a suitable replacement for you and these actually deliver a similar amount of drug.
We have identified affected patients on our clinical system and have issued new prescriptions for Epipen or Jext. Patients should return their Emerade brand pens to the pharmacy when they go to collect.
If you have Emerade pens at home and have not received a text message from us, please contact the practice to arrange a replacement.
For further information, see www.anaphylaxis.org.uk/tag/emerade
General Practices in England will generally not be able to give you an NHS prescription for medicines that are available to buy in pharmacies and supermarkets.
NHS England changed the rules on treatments for minor and self-limiting conditions in 2018 with the aim of prioritising prescriptions for more serious or long-term health problems. Prior to this the NHS was spending around £136 million a year on prescriptions for treatments that can be purchased over the counter.
Please ask your local pharmacy for advice if you may need treatment for conditions such as:
• coughs, colds & sore throats • mild to moderate hay fever • conjunctivitis • dry eyes • dandruff • nappy rash • cradle cap • teething • travel sickness • head lice • indigestion • dry skin • warts and verrucae • insect bites • ear wax • mouth ulcers • threadworms • athlete’s foot
Exceptions can be made at the discretion of the treating practitioner, for example where over the counter treatments have not worked, in more severe forms of the illness, or where the licence does not allow the product to be sold to certain groups e.g. women who are pregnant or children under a certain age. Please speak to the practice if you need further information.
Jubilee Street Practice has a comprehensive repeat prescribing policy to ensure the safety of our patients and to make sure we are using medicines appropriately. Our policy is regularly reviewed to ensure we keep up to date with the latest guidance.
Key information for our patients:
- Our standard repeat prescription duration is up to two months (usually this will be 56 days). In exceptional circumstances, NHS England allows us to issue up to a 12 week maximum supply.
- We aim to review all prescription requests within two working days but if your request is straightforward they will often be issued earlier than this.
- If you request a medicine that is not on your repeat list, or order it earlier than it appears to be due, your request may be rejected and you may be contacted by the practice and asked to provide more information. This will usually be via text message.
- For safety reasons, some medications may not appear on your repeat list. This may be because we need to review how well they are working for you with regular monitoring, or because they are a higher risk or ‘controlled’ medication.
- Please be aware that ‘Repeat dispensing’ refers to a batch prescription that you do not need to order each time. Normal ‘repeat’ medications will need to be requested each time you require them.
- It is best practice for ALL repeat medications to be reviewed on at least an annual basis. Sometimes your GP or pharmacist will be able to do this from your notes but we may also call you to discuss or ask you to attend an appointment if you take more than 10 medicines regularly or take medicines that require blood tests or other monitoring. This is an opportunity to ask questions about your medicines and to discuss how well they are working for you.
Proton Pump Inhibitors (or PPIs) are a group of medicines used to reduce stomach acid and include omeprazole, lansoprazole, esomeprazole and pantoprazole. These medicines are very commonly prescribed but many patients continue taking them for longer than they may need. Usually a course of two to three months is sufficient to help heartburn or indigestion to settle.
As with any prescription medication, PPIs can cause side effects which are more likely if you take a high dose or use them for a long period of time. More and more evidence is coming out that suggests this group of medications may be linked to more problems than we knew about previously. We are therefore re-assessing which of our patients these medicines remain the best choice for.
- Increased risk of serious stomach infections including Clostridium difficile
- Increased risk of bone fractures
- Decreased absorption of nutrients including magnesium, calcium, and vitamins
- Reduce the effectiveness of other medicines you may take including medicines used to prevent heart attack and stroke
- May increase risk of kidney disease, pneumonia, dementia and certain cancers – more research is being done on all these possible links.
Always speak to your GP or pharmacist before stopping prescribed medicines. PPIs should be reduced slowly to minimise rebound symptoms. If you have a history of stomach ulcers or bleeding, or have severe symptoms it is likely that continuing your PPI is the best option – your GP can help you to make this decision.
For information on what you can do to help with heartburn and indigestion yourself, see our Self Care and Common Conditions section of the website for some useful links.
These are known as ‘emollients’ and are really important for the maintenance and treatment of dry skin conditions where they need to be used frequently to prevent dryness and itching – often up to four or five times a day.
Funding on the NHS is only for diagnosed skin conditions. Mild dry skin is something most people experience from time to time and simple emollients (moisturisers) can be purchased from any supermarket, health shop or pharmacy.
Due to the large quantities of these products prescribed by GP practices, we are asked to prescribe from an approved list of cost-effective products. Many of these contain exactly the same ingredients as more well-known brands, for example ‘Zerodouble’ is the same as ‘Doublebase’ and ‘Aproderm’ is very similar to ‘Aveeno’.
Bath and shower emollients are no longer recommended on the NHS because a large UK study on children with eczema found that using these products made no difference to the improvement of eczema compared to just using leave on emollients. Instead, we recommend using your normal emollient as a soap or dissolved in bath water. You can find more information about the study here: https://www.nhs.uk/news/pregnancy-and-child/bath-oils-childhood-eczema-provide-no-clinical-benefit/
Ranitidine (brand name Zantac) is a medicine commonly used to treat ‘gastric symptoms’ including indigestion and heartburn. As a precaution, all ranitidine products have been recalled due to possible contamination with an impurity. Where possible, we will offer patients an alternative, but this may not be an option for everyone, depending on your other medicines and health conditions.
HERE ARE SOME TIPS FOR MANAGING YOUR SYMPTOMS:
- Reduce caffeine, alcohol and fizzy drinks
- Lose weight if you’re over weight
- Eat your evening meal at least 3 hours before going to bed
- Ask your local pharmacy about over-the counter antacids
- Do not smoke
- Avoid overly rich, spicy and fatty foods
- Avoid using ibuprofen and aspirin as these can irritate the stomach more
You can find more information @ www.nhs.uk https://www.nhs.uk/conditions/indigestion/
There is no need to be concerned if you have been taking ranitidine as levels of the possible contaminant are likely to be very low.
Clothing, bedding, dressings and bandages with skin cream dried on them can catch fire easily causing severe and fatal burns.
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