Shared Care Protocol for the prescribing and monitoring of maintenance doses of azathioprine in Inflammatory Bowel Disease
|
|
- Flora Sparks
- 5 years ago
- Views:
Transcription
1 Bedfrdshire and Lutn Jint Prescribing Cmmittee Shared Care Prtcl fr the prescribing and mnitring f maintenance dses f azathiprine in Inflammatry Bwel Disease This prtcl applies t patients under the care f Bedfrd Hspital. Azathiprine Therapy Brief Summary The Sandz brand f azathiprine is licensed fr the treatment f inflammatry bwel disease hwever ther brands are nt licensed fr this indicatin. The use f azathiprine in inflammatry bwel disease is widely established and is supprted by natinal guidelines (BSG 2011 and NICE Crhn s disease CG 152). Clinicians shuld cnsult the full Shared Care Guideline, current BNF and SPC fr full infrmatin. T ensure the safe use f azathiprine it is crucial that there is a gd, rbust 2-way cmmunicatin f prescribing infrmatin and bld test results between the Specialist and the GP. It is als imprtant that the patient cmmunicates with bth the Specialist and the GP. Under this shared care agreement, the GP accepts respnsibility fr the prescribing AND mnitring f the required n-ging bld tests nce the patient is n a stable maintenance dse f azathiprine. The GP as the prescribing clinician is therefre respnsible fr ensuring that the relevant bld test mnitring is carried ut at the required frequency and the results are checked PRIOR t issuing a prescriptin fr the medicatin. NB: Althugh the Specialist will nt rutinely check bld test results, they may wish t access bld test results at sme pint (i.e. when patient attends ut-patients, when cntacted by GP fr advice in the event f an abnrmal bld test). If the bld tests are prcessed at Bedfrd hspital, then the Specialist can access the results electrnically. If the bld tests are prcessed in a different hspital labratry, the GP shuld rutinely send a paper cpy f the bld test results t the Specialist fr infrmatin Patient s Name: Date f Birth: NHS Number: Page 1 f 8
2 Patient s Address: Cnsultant s Name: Cnsultant s Cntact Details: GP s Name: GP s Cntact Details: Patient s diagnsis: Severe r mderately severe inflammatry bwel disease (Crhn s r Ulcerative Clitis) in patients wh are intlerant t sterids r wh are dependent n sterids and in whm the therapeutic respnse is inadequate despite treatment with high dses f sterids Drug dse, frmulatin and frequency: Usually started at 50mg and increased t between 2 2.5mg /kg daily by muth (exact maintenance dse will depend n patient s TPMT level, clinical respnse, side effect prfile and haematlgical tlerance). Available as 25mg and 50mg film-cated tablets. Tablets cntain lactse. (NB If tablets need t be halved, advise that the tablets need t be handled in strict accrdance with guidance fr handling cyttxic agents.) Cntra-indicatins TPMT deficiency (exact level will vary depending n hspital labratry) Haemtlgical impairment (see bld test mnitring sectin) Hypersensitivity t azathiprine, 6-mercaptpurine (metablite f azathiprine) r t any f the excipients. Severe infectins. Severely impaired hepatic r bne-marrw functin. Severe hepatic impairment Pancreatitis. Any live vaccine e.g. ral pli, MMR, BCG, yellw fever. Pregnancy unless the benefits utweigh the risks (see SpC) Lactatin Patients with hereditary hypxanthine-guanine-phsphribsyl transferase deficiency (Lesch-Nyhan syndrme). Patients with rare hereditary prblems f galactse intlerance, the Lapp lactase deficiency r glucse-galactse malabsrptin (as tablets cntain lactse). Cautins Bld test mnitring is essential when prescribing azathiprine. Renal impairment Bth a reductin in dse and increased Page 2 f 8
3 frequency f bld test mnitring may be required. Mild t mderate hepatic impairment - Bth a reductin in dse and increased frequency f bld test mnitring may be required. Patients must infrm GP / Specialist immediately abut ral ulceratins, ulceratins f the thrat, recurrent sre thrats, fever, infectins, bruising, bleeding r ther signs f myelsuppressin. Cautin if c-prescribe with certain medicatins (see drug interactin sectin) Patients wh have nt had expsure t Varicella zster (patient shuld reprt any expsure t chickenpx r shingles urgently t GP. Advise patient t use sunscreens and prtective clthing t reduce risk f skin cancer Cautin in withdrawal f azathiprine as may result in a severe wrsening f disease. Withdrawal shuld be a gradual prcess under clse mnitring. (If immediate withdrawal needed due t abnrmal bld results / side effects, discuss with Specialist) Pregnancy & Lactatin The SPC states that azathiprine is cntraindicated in pregnancy unless the benefits utweigh the risks. The SPC als states azathiprine is cntraindicated in breastfeeding. The British Sciety f Gastrenterlgists (BSG) fllws different recmmendatins. GP s shuld refer any pregnant patients/ breastfeeding patients r patients cnsidering pregnancy t the Specialist. Side effects: Refer t BNF /SPC fr further side effects. Hypersensitivity reactins - (including malaise, dizziness, vmiting, diarrhea, fever, rigrs, myalgia, arthralgia, rash, hyptensin and interstitial nephritis calls fr immediate withdrawal) Bne marrw suppressin (leucpenia, anaemia, thrmbcytpenia) Increased risk f pprtunistic infectins Liver impairment Chlestatic jaundice Hepattxicity (hepatic necrsis, biliary stasis) Anrexia, nausea, vmiting Oral ulceratin, rarely gastrintestinal ulceratin Increase risk f certain types f skin cancer / lymphma (see SPC fr mre details) Pancreatitis, interstitial nephritis, pneumnitis, hepatic vencclusive disease, lymphma, red cell aplasia Alpecia Drug interactins Refer t BNF / SpC fr further Drug interactins Serius Interactins Allpurinl, (xipurinl r thipurinl*) NB: Due t severity f interactin, GPs shuld cntact the Specialist fr advice befre starting a patient n Page 3 f 8
4 allpurinl, (xipurinl r thipurinl*). (* xipurinl and thipurinl are nt licensed in the UK but culd pssibly be btained n a named patient basis) Trimethprim / c-trimxazle Clse mnitring f FBC is required (increased risk f haematlgical txicity). Warfarin anticagulant effects f warfarin and ther cumarins pssible reduced. The dse f warfarin may need t be adjusted when starting r stpping azathiprine. Ribavarin myelsuppressive effects f azathiprine are pssibly enhanced. Febuxstat AVOID cncmitant use with azathiprine. Clzapine - AVOID cncmitant use with azathiprine as increased risk f agranulcyctsis. (NB This interactin is nt specifically listed fr azathiprine hwever it is listed as a serius interactin under the 6-mercaptpurine entry in the BNF). Other interactins Clse mnitring f bld cunts is required with cncmitant use : Allpurinl, (xipurinl, thipurinl*) (see abve) Aminsalicylates e.g. mesalazine, lsalazine r sulfasalazine ACE inhibitrs Cimetidine Indmethacin (NB: Patients with IBD shuld nt be prescribed indmethacin) Agents with cyttxic/myelsuppressive prperties GP TO ARRANGE BLOOD TESTS AT THE REQUIRED FREQUENCY AND CHECK THE RESULTS PRIOR TO ISSUING A PRESCRIPTION ONCE PATIENT IS ON A STABLE MAINTENANCE DOSE Bld Test Mnitring requirements and frequency TO BE ARRANGED BY GP GP shuld nly take ver bth the prescribing and bld test mnitring f azathiprine nce the patient is n a stable maintenance dse. Mnitr FBC, U&E, LFT, every 3 mnths Mnitr TFT every 6 mnths After a dse change: Revised frequency f bld test mnitring required discuss with Specialist Situatins where mre frequent bld mnitring may be required cntinuing dwnward trend in WBC r neutrphil cunt After a dse change Renal impairment Mild t mderate hepatic impairment Elderly patients Cncmitant drug therapy with certain drugs (see drug Page 4 f 8
5 interactins abve) Frequency f bld tests in the abve situatins shuld be agreed between the Specialist and the GP. NB: Urgent FBC shuld be prcessed if the patient cmplains f intercurrent illness. Althugh the Specialist will nt rutinely check bld test results, they may wish t access bld test results at sme pint (i.e. when patient attends ut-patients, when cntacted by GP fr advice in the event f an abnrmal bld test). If the bld tests are prcessed at Bedfrd hspital, then the Specialist can access the results electrnically. NB: If the bld tests are prcessed in a different hspital labratry, the GP shuld rutinely send a paper cpy f the bld test results t the Specialist fr infrmatin. Actin t be taken by GP in event f abnrmal bld test results r if patient experiences certain symptms / adverse events Refer t tables 1) and 2) at end f this dcument fr actin t be taken by GP Prescribing A prescriptin shuld nly be issued if recent bld tests have been dne and the results are within acceptable limits. GP shuld ensure that a rbust system is in place t deal with repeat prescriptins as azathiprine is a high risk drug that requires regular bld test mnitring. Ensure that an apprpriate quantity f tablets are issued (usually nly sufficient t last until the next bld test will be reprted and the next prescriptin issued). When t refer back t Specialist: Reprt t and seek advice n any abnrmal bld test results (see table 1 belw). Reprt t and seek advice if patient experiences any f the symptms / adverse events listed in table 2 belw. Seek advice if cnsidering starting a patient n allpurinl, (xipurinl r thipurinl*) therapy (due t severity f interactin). Reprt t and seek advice n any aspect f patient care that is f cncern t the GP and may affect treatment. Refer all pregnant patients/ patients wh wish t breastfeed and patients cnsidering pregnancy. Refer any patient wh des nt cmply with bld test mnitring. Page 5 f 8
6 Hw ften will the patient be reviewed by the specialist? Frequency will vary between individual patients. Regardless f disease severity, ALL patients shuld be reviewed at least annually by the Specialist. Cmmunicatin The dsage regimen and the required frequency f bld test mnitring shuld be clearly explained t the patient. Results f bld tests arranged by the GP shuld be recrded in the GP medical recrds and the GP shuld ensure that the Specialist can access the results (either electrnically r paper cpy depending n availability f electrnic access t bld test results. Althugh the Specialist will nt rutinely check bld test results, they may wish t access bld test results at sme pint (i.e. when patient attends ut-patients, when cntacted by GP fr advice in the event f an abnrmal bld test). (If the bld tests are prcessed at Bedfrd hspital, then the Specialist can access the results electrnically. If the bld tests are prcessed in a different hspital labratry, the GP shuld rutinely send a paper cpy f the bld test results t the Specialist fr infrmatin.) Results f bld tests if arranged by the Specialist and any dse adjustments made by the Specialist shuld be recrded in the hspital recrds and full details sent t the GP (either electrnically r paper cpy depending n availability f electrnic access t bld test results) GP s shuld cntact the Specialist fr advice if any dse adjustments are required r if the need t stp the drug arises. GP t seek advice frm Specialist in the event f an abnrmal bld test (see table1) r if patient experiences any f the symptms / adverse events as highlighted in table 2. Patient shuld be tld t infrm the prescribing clinician immediately if any ral ulceratins, ulceratins f the thrat, recurrent sre thrats, fever, bruising, bleeding r ther signs f myelsuppressin ccur. Patient shuld be advised t reprt any ther side effects t the prescribing clinician. Patient shuld be advised t reprt any suspected pregnancy t the GP and / r Specialist. Patient shuld be advised t avid excessive sun expsure and t use sunscreens and prtective clthing. Patients wh have nt had expsure t Varicella-zster, shuld be advised t avid cntact with peple wh have active chickenpx r shingles and reprt any such cntact urgently t their GP r Specialist. Table 1) ACTION TO BE TAKEN BY GP if the fllwing ccurs:- White Bld Cells < 3.5 x 10 9 /l Discuss with Specialist White Bld Cells < 2.5 x 10 9 /l Stp azathiprine and discuss with Specialist Page 6 f 8
7 Neutrphils x 10 9 /l Discuss with Specialist Neutrphils < 1.5 x 10 9 /l Stp azathiprine and discuss with Specialist Platelets < 150 x 10 9 /l Stp azathiprine and discuss with Specialist Hb If haemglbin is lw, haematinics shuld be checked and discussed with the specialist ALP > 250 IU /l ALT >100 IU / l Stp azathiprine and discuss with Specialist Significant reductin in renal functin Stp azathiprine and discuss with Specialist MCV > 105 fl Check TSH, B12, Flate If B12, flate lw, start apprpriate supplementatin PLEASE NOTE THAT IN ADDITION TO ABSOLUTE VALUES FOR HAEMATOLOGICAL INDICES, A RAPID FALL OR RISE, OR A CONSISTENT UPWARD OR DOWNWARD TREND IN ANY VALUE SHOULD PROMPT CAUTION AND EXTRA VIGILANCE. Table 2 Symptms / Adverse events Rash (significant and new) Abnrmal bruising r bleeding Oral ulceratins, ulceratins f the thrat,, recurrent sre thrats, infectins, fever, chills Any ther signs f myelsuppressin Cntact Specialist fr advice. If cncerned, stp azathiprine and check FBC Check FBC and cntact Specialist fr advice Check FBC and cntact Specialist fr advice. NB If severe, stp azathiprine and discuss with Specialist Check FBC and cntact Specialist fr advice Severe abdminal pain Nausea and /r vmiting Stp treatment and cnsider pancreatitis. Check amylase and cntact Specialist fr advice. Advice t take drug at night. If persists, advise patient t divide dse and take with fd. If n imprvement, discuss a pssible dse reductin with Specialist. Page 7 f 8
8 Persistent /wrsening diarrhea Hair lss Cntact Specialist fr advice. Mild cnsider dse reductin n advice f the Specialist. If severe, stp azathiprine and discuss with Specialist. IF IN ANY DOUBT ABOUT ANY ASPECT OF PRESCRIBING AZATHIOPRINE and /r BLOOD TEST MONITORING ETC, PLEASE CONTACT THE GASTROENTEROLOGY TEAM: Bedfrd Hspital: Dr R Harvey: Dr J Harvey: Dr S Musa: Dr Y-Al Naeeb: Clrectal Nurse Specialists): Page 8 f 8
Shared Care Protocol for the prescribing and monitoring of maintenance doses of azathioprine in Inflammatory Bowel Disease
Apprved by the Bedfrdshire and Lutn Jint Prescribing Cmmittee (JPC) December 2013, Review date December 2016 Bedfrdshire and Lutn Jint Prescribing Cmmittee Shared Care Prtcl fr the prescribing and mnitring
More informationORAL AND PARENTERAL METHOTREXATE RHEUMATOLOGY LOCAL SAFETY MONITORING SCHEDULE
ORAL AND PARENTERAL METHOTREXATE RHEUMATOLOGY LOCAL SAFETY MONITORING SCHEDULE This lcal safety-mnitring schedule supprts clinicians under the Lcal Enhanced Service fr High Risk Drug Mnitring (frmerly
More informationIntravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion
Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment r prphylaxis. Evidence supprting this guidance is detailed belw.
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE. RHEUMATOLOGY SHARED CARE GUIDELINE for DMARDs
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE RHEUMATOLOGY SHARED CARE GUIDELINE fr DMARDs There are currently 6 Disease-mdifying anti rheumatic drugs (DMARDs) in rutine use by the Lutn & Dunstable
More informationAnnex III. Amendments to relevant sections of the Product Information
Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t
More informationIntravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion
Intravenus Vancmycin Use in Adults Intermittent (Pulsed) Infusin Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment
More informationPackage leaflet: Information for the patient Imuran Powder for Solution for Injection or Infusion 50mg azathioprine
Package leaflet: Infrmatin fr the patient Imuran Pwder fr Slutin fr Injectin r Infusin 50mg azathiprine Read all f this leaflet carefully befre yu start taking this medicine because it cntains imprtant
More informationYou may have a higher risk of bleeding if you take warfarin sodium tablets and:
MEDICATION GUIDE Warfarin (WAR-far-in) Sdium (SO-dee-um) Tablets USP The 7.5 mg tablets cntain FD&C Yellw N. 5 (tartrazine), which may cause allergic-type reactins (including brnchial asthma) in certain
More informationWARNING: FATAL AND SERIOUS TOXICITIES: SEVERE DIARRHEA AND CARDIAC TOXICITIES
INDICATION FARYDAK (panbinstat) capsules, a histne deacetylase inhibitr, in cmbinatin with brtezmib and dexamethasne, is indicated fr the treatment f patients with multiple myelma wh have received at least
More informationPain relief after surgery
Pain relief after surgery Imprtant infrmatin fr patients www.mchft.nhs.uk We care because yu matter This leaflet is designed t help yu cntrl any pain yu may have at hme fllwing yur peratin. Please read
More informationPART III: CONSUMER INFORMATION
IMPORTANT: PLEASE READ PART III: CONSUMER INFORMATION Pr ZERIT Stavudine This leaflet is Part III f a three-part Prduct Mngaph published when ZERIT was apprved fr sale in Canada and is designed specifically
More informationMy Symptoms and Medical History for Adult Chronic Immune Thrombocytopenia (ITP)
My Symptms and Medical Histry fr Adult Chrnic Immune Thrmbcytpenia (ITP) Call t talk t a registered nurse 1-855-7Nplate (1-855-767-5283), Mnday Friday, 9:00 AM 9:00 PM ET Indicatin Nplate is a man-made
More informationSwindon Joint Strategic Needs Assessment Bulletin
Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical
More informationA Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.
SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument
More informationUse of sacubitril valsartan for the treatment of symptomatic chronic heart failure with reduced ejection fraction. Shared Care Protocol
Oxfrdshire Clinical Cmmissining Grup Use f sacubitril valsartan fr the treatment f symptmatic chrnic heart failure with reduced ejectin fractin. Shared Care Prtcl This prtcl prvides prescribing and mnitring
More informationPACKAGE LEAFLET INFORMATION FOR THE PATIENT
PACKAGE LEAFLET INFORMATION FOR THE PATIENT AMPICILLIN 125mg/5ml and 250mg/5ml ORAL SUSPENSION Please read all f this leaflet carefully befre yu start taking this medicine because it cntains imprtant infrmatin
More informationMEDICATION GUIDE REVLIMID (rev-li-mid) (lenalidomide) capsules What is the most important information I should know about REVLIMID?
MEDICATION GUIDE REVLIMID (rev-li-mid) (lenalidmide) capsules What is the mst imprtant infrmatin I shuld knw abut REVLIMID? Befre yu begin taking REVLIMID, yu must read and agree t all f the instructins
More informationMEDICATION GUIDE. (fingolimod) capsules
MEDICATION GUIDE GILENYA (je-len-yah) (finglimd) capsules Read this Medicatin Guide befre yu start using GILENYA and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take the
More informationName of Shared Care Agreement: AZATHIOPRINE/6-MERCAPTOPURINE: Oral immunomodulating drugs for inflammatory bowel disease. Reference number: 01/2008
Name of Shared Care Agreement: AZATHIOPRINE/6-MERCAPTOPURINE: Oral immunomodulating drugs for inflammatory bowel disease. Reference number: 01/2008 Shared care agreement has been developed appropriately
More informationTOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH
Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues,
More informationMEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injection for intravenous infusion
MEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injectin fr intravenus infusin Read this Medicatin Guide befre yu start receiving LEMTRADA and befre yu begin each treatment curse. There may be new
More informationIf you have any doubts or queries about your medication, please contact your doctor or pharmacist.
Bayer plc Bayer Huse Strawberry Hill Newbury Berkshire RG14 1JA United Kingdm Telephne: +44 (0)1635 563 000 Facsimile: +44 (0)1635 563 393 Cmpany Web Site: http://www.bayer.c.uk Due t regulatry changes,
More informationVaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE
Vaccine Infrmatin Statement: LIVE INTRANASAL INFLUENZA VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationAppendix 1 Example of Homely Remedy Policy
Appendix 1 Example f Hmely Remedy Plicy Hmely Remedy Plicy - EXAMPLE This plicy applies t (insert name f Care Hme) Definitin A hmely (r husehld) remedy is a medicinal prduct fr the shrt-term treatment
More informationCompleting the NPA online Patient Safety Incident Report form: 2016
Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject
More informationProstatitis - chronic - Management
Prstatitis - chrnic - Management Scenari: Diagnsis f chrnic prstatitis Hw shuld I diagnse chrnic prstatitis? Diagnse chrnic prstatitis if: The man has pain in the perineum r pelvic flr and lwer urinary
More informationRoActemra (tocilizumab) for Giant Cell Arteritis (GCA) subcutaneous (SC) formulation
RActemra (tcilizumab) fr Giant Cell Arteritis (GCA) subcutaneus (SC) frmulatin What yu shuld knw abut RActemra This brchure prvides key infrmatin t assist in the patient s understanding f the benefits
More informationFrequently Asked Questions: IS RT-Q-PCR Testing
Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld
More informationVaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE
Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationPackage leaflet: Information for the user. GASTROGRAFIN GASTROENTERAL SOLUTION Sodium amidotrizoate and meglumine amidotrizoate
Due t regulatry changes, the cntent f the fllwing Patient Infrmatin Leaflet may vary frm the ne fund in yur medicine pack. Please cmpare the 'Leaflet prepared/revised date' twards the end f the leaflet
More informationCONSENT FOR KYBELLA INJECTABLE FAT REDUCTION
CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,
More informationRead all of this leaflet carefully before you start taking this medicine.
Due t regulatry changes, the cntent f the fllwing Patient Infrmatin Leaflet may vary frm the ne fund in yur medicine pack. Please cmpare the 'Leaflet prepared/revised date' twards the end f the leaflet
More informationGeneric Immunosuppressants in the Specialist Area of Transplantation Consensus on Implications and Practical Recommendations
Dear Clleague Generic Immunsuppressants in the Specialist Area f Transplantatin Cnsensus n Implicatins and Practical Recmmendatins Executive Summary Slid-rgan transplants are the best pssible treatment
More informationMEDICATION GUIDE. (canagliflozin) Tablets
MEDICATION GUIDE INVOKANA (in-v-kahn-uh) (canagliflzin) Tablets What is the mst imprtant infrmatin I shuld knw abut INVOKANA? INVOKANA can cause imprtant side effects, including: Dehydratin. INVOKANA can
More informationITP typically presents with the sudden appearance of a petechial rash, spontaneous bruising and/or bleeding in an otherwise well child.
Acute Immune Thrmbcytpenia Purpura (ITP) Backgrund Primary immune thrmbcytpenia (ITP) is an acquired immune mediated disrder characterised by islated thrmbcytpenia, defined as a peripheral bld platelet
More informationAzathioprine Shared Care Guideline for GPs
Indication: Azathioprine Shared Care Guideline for GPs Active rheumatoid arthritis and other types of inflammatory arthritis, systemic lupus erythematosus, dermatomyositis and polymyositis, vasculitis
More informationInfluenza (Flu) Fact Sheet
Influenza (Flu) Fact Sheet What is the flu? The flu is a cntagius respiratry illness caused by influenza viruses. It can cause mild t severe illness, and at times can lead t death. Sme peple, such as lder
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER
(Sanfi-Aventis France), NT001 Suppliers submissin f the SRA apprved text Octber 2016 Name f the medicinal prduct Text bx PACKAGE LEAFLET: INFORMATION FOR THE USER NOTEZINE 100 mg, scred tablets Diethylcarbamazine
More informationTendon problems can happen in people of all ages who take levofloxacin. Tendons are tough cords of tissue that connect muscles to bones.
Medicatin Guide LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION, 25 mg/ml and LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION in 5% Dextrse fr Intravenus Use Read this Medicatin Guide befre yu start taking levflxacin
More informationHead and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth.
DENTAL EXTRACTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that
More informationALCAT FREQUENTLY ASKED QUESTIONS
1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age
More informationNORTH AND EAST DEVON HEALTHCARE COMMUNITY SHARED CARE PRESCRIBING GUIDELINE
NORTH AND EAST DEVON HEALTHCARE COMMUNITY SHARED CARE PRESCRIBING GUIDELINE http://www.devonpct.nhs.uk/treatments/ne_devon_shared_care_guidelines.aspx#a Azathioprine Treatment of rheumatological conditions
More informationCONSUMER MEDICINE INFORMATION
CONSUMER MEDICINE INFORMATION What is in this leaflet This leaflet answers sme cmmn questins abut CEFTRIAXONE lcp. It des nt cntain all the available infrmatin. It des nt take the place f talking t yur
More informationMEDICATION GUIDE. Reference ID:
MEDICATION GUIDE GLYXAMBI (glik-sam-bee) (empagliflzin and linagliptin) Tablets Read this Medicatin Guide carefully befre yu start taking GLYXAMBI and each time yu get a refill. There may be new infrmatin.
More informationMEDICATION GUIDE Pioglitazone and Metformin Hydrochloride (PYE o GLI ta zone and met FOR min HYE-droe- KLOR-ide)Tablets, USP
MEDICATION GUIDE Piglitazne and Metfrmin Hydrchlride (PYE GLI ta zne and met FOR min HYE-dre- KLOR-ide)Tablets, USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride
More informationAsthma inhalers, medicines and treatments
Asthma inhalers, medicines and treatments Reliever inhalers Yur Emergency Rescue Reliever Everyne with asthma shuld ALWAYS carry a reliever (blue inhaler) inhaler at all the time s it s n hand in an emergency
More informationBP Thresholds for Medical Review
BP Threshlds fr Medical Review Wmen presents t GP pstnatally with high bld pressure r referred t GP by midwife GP t review patient n the same day if BP>150/100. If BP (dne by midwife) persistently 140-149/90-99,
More informationCONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS
CONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS Yu want t take teststerne t masculinize yur bdy. Befre taking it, there are several things yu need t knw abut. They are the pssible advantages, disadvantages,
More informationSHARED CARE GUIDELINE For
SHARED CARE GUIDELINE Fr Lithium therapy Implementatin Date: 21.6.2011 Review Date: 21.3.2013 This guidance has been prepared and apprved fr use within Gateshead, Suth Tyneside and Sunderland in cnsultatin
More informationUnderstanding Blood Counts
Understanding Bld Cunts PMH This pamphlet is fr patients at Princess Margaret Hspital. It will help yu t read and understand the bld cunt infrmatin yu get frm the bld lab. Patient Educatin Imprving Health
More informationHealth Screening Record: Entry Level Due: August 1st MWF 150 Entry Year
Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic
More informationMEDICATION GUIDE Pioglitazone (pie-oh-glit-ah-zohn) and Metformin (met-fore-min) Hydrochloride Tablets USP
MEDICATION GUIDE Piglitazne (pie-h-glit-ah-zhn) and Metfrmin (met-fore-min) Hydrchlride Tablets USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride tablets
More informationMEDICATION GUIDE Levofloxacin (lee-voe-flox-a-sin) Tablets, USP 250 mg Tablets, 500 mg Tablets, and 750 mg Tablets
MEDICATION GUIDE Levflxacin (lee-ve-flox-a-sin) Tablets, USP 250 mg Tablets, 500 mg Tablets, and 750 mg Tablets Read this Medicatin Guide befre yu start taking levflxacin tablets and each time yu get a
More informationPackage leaflet: Information for the user. Fragmin Graduated Syringe 10,000 IU/ml Solution for Injection dalteparin sodium
Package leaflet: Infrmatin fr the user Fragmin Graduated Syringe 10,000 IU/ml Slutin fr Injectin dalteparin sdium Read all f this leaflet carefully befre yu start using this medicine because it cntains
More informationAdult Preventive Care Guidelines
Adult Preventive Care Guidelines Gundersen is yur partner fr better health. We want t wrk with yu t make sure that yu and yur family are as healthy as pssible. That can be accmplished best if we wrk tgether
More informationPATIENT INFORMATION. Rosuvastatin calcium tablets are used along with diet to:
PATIENT INFORMATION Rsuvastatin Calcium (re-soo-va-stat-in KAL-see-um) Tablets Read this Patient Infrmatin carefully befre yu start taking rsuvastatin calcium tablets and each time yu get a refill. If
More informationPATIENT INFORMATION. (methotrexate) injection, for subcutaneous use
What is Rasuv? PATIENT INFORMATION RASUVO (ruh-soo-vh) (methtrexate) injectin, fr subcutaneus use Rasuv is a single-dse manually-triggered aut-injectr cntaining a prescriptin medicine, methtrexate. Methtrexate
More informationTriumeq (abacavir, dolutegravir and lamivudine) Product Backgrounder for US Media
Triumeq (abacavir, dlutegravir and lamivudine) Prduct Backgrunder fr US Media What is Triumeq and wh is Triumeq fr? Triumeq (abacavir 600mg, dlutegravir 50mg and lamivudine 300mg) is the first dlutegravir-based
More informationBedfordshire and Hertfordshire DRAFT Priorities forum statement Number: Subject: Prostatism Date of decision: January 2010 Date of review:
Bedfrdshire and Hertfrdshire DRAFT Pririties frum statement Number: Subject: Prstatism Date f decisin: January 2010 Date f review: Referral criteria Mst men with lwer urinary tract symptms due t benign
More informationSignificance of Chronic Kidney Disease in 2015
1 Significance f Chrnic Kidney Disease in 2015 There is still a requirement within QOF t keep a register f peple with CKD stages 3-5. The ther CKD QOF targets have been retired. This is because CKD care
More information/0515 Medication Guide Aripiprazole Tablets
8415721/0515 Medicatin Guide Aripiprazle Tablets (air-eh-pip-rah-zle) Read this Medicatin Guide befre yu start taking aripiprazle tablets and each time yu get a refill. There may be new infrmatin. This
More informationPackage leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate
Package leaflet: Infrmatin fr the user Daceptn 5 mg/ml Slutin fr infusin Apmrphine hydrchlride hemihydrate Read all f this leaflet carefully befre yu start using this medicine because it cntains imprtant
More informationGetting started with. For treating RA, pjia, and psoriasis with a single, weekly injection under the skin
Getting started with Fr treating RA, pjia, and psriasis with a single, weekly injectin under the skin What is Rasuv (methtrexate) injectin? Rasuv (methtrexate) injectin is a single-dse aut-injectr cntaining
More informationInfection Control Guidelines for Cabin Crew Members on Commercial Aircraft
Infectin Cntrl Guidelines fr Cabin Crew Members n Cmmercial Aircraft PURPOSE These guidelines prvide cabin crew members (flight attendants) with practical measures t prtect themselves, passengers, and
More informationSECTION O. MEDICATIONS
SECTION O. MEDICATIONS 1. NUMBER OF MEDICA TIONS (Recrd the number f different medicatins used in the last 7 days; enter "0" if nne used) O1. Number f Medicatins (7-day lk back) Intent: Prcess: Cding:
More informationUS Public Health Service Clinical Practice Guidelines for PrEP
Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S
More informationo New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
MEDICATION GUIDE FLUOXETINE CAPSULES, USP (fl xʹ e teen) 10 mg and 20 mg Read the Medicatin Guide that cmes with fluxetine capsules befre yu start taking it and each time yu get a refill. There may be
More informationPATIENT INFORMATION. effective for the treatment of the flu in people with long-time (chronic) heart problems or breathing problems.
PATIENT INFORMATION capsules, fr ral use fr ral suspensin What is TAMIFLU? TAMIFLU is a prescriptin medicine used t: treat the flu (influenza) in peple 2 weeks f age and lder wh have had flu symptms fr
More informationMEDICATION GUIDE XARELTO (zah-rel-toe) (rivaroxaban) tablets
MEDICATION GUIDE XARELTO (zah-rel-te) (rivarxaban) tablets Read this Medicatin Guide befre yu start taking XARELTO and each time yu get a refill. There may be new infrmatin. This Medicatin Guide des nt
More informationUniversity College Hospital. Pump school Starting on an insulin pump. Children and Young People s Diabetes Service
University Cllege Hspital Pump schl Starting n an insulin pump Children and Yung Peple s Diabetes Service 2 If yu wuld like this dcument in anther language r frmat, r require the services f an interpreter,
More informationCommissioning Policy: South Warwickshire CCG (SWCCG)
Cmmissining Plicy: Suth Warwickshire CCG (SWCCG) Treatment Indicatin Criteria FreeStyle Libre Flash Cntinuus Glucse Mnitring System Type I Diabetes Prir apprval must be requested frm the Individual Funding
More informationDIABETES AND PANCREATIC EXOCRINE INSUFFICIENCY
YOU AND YOUR BODY DIABETES AND PANCREATIC EXOCRINE INSUFFICIENCY kk WHY IS THIS LEAFLET FOR YOU? Pancreatic excrine insufficiency (PEI) is imprtant t understand in diabetes care due t the changing functins
More informationDRAFT Policy for the Management of Ear Wax
Clinical Cmmissining Grup (CCG) Treatment Plicy NHS Birmingham and Slihull Clinical Cmmissining Grup NHS Sandwell and West Birmingham Clinical Cmmissining Grup DRAFT Plicy fr the Management f Ear Wax 1
More informationShared care guidelines for azathioprine in adults. General principles. Presentation/Dose/Administration Oral: 25mg and 50mg tablets
Shared care guidelines for azathioprine in adults General principles This agreement outlines suggested ways in which the responsibilities for managing the prescribing of the drug treatment and clinical
More informationAzathioprine and Mercaptopurine
This guideline is currently under review. In the interim, the guideline remains valid; if GPs have any specific concerns or questions, they should seek advice from the specialist with whom they have agreed
More informationMEDICATION GUIDE. (Interferon alfa-2b)
MEDICATION GUIDE INTRON A (In-trn-aye) (Interfern alfa-2b) Read this Medicatin Guide befre yu start taking INTRON A, and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take
More informationH1N1 Influenza 09 Guidance for Residential Aged Care
H1N1 Influenza 09 Guidance fr Residential Aged Care 11 June 2009 As knwledge abut H1N1 Influenza 09 develps, further advice will be prvided. Please check www.healthemergency.gv.au fr the latest infrmatin.
More informationNew Zealand Consumer Medicine Information. Tramadol hydrochloride immediate release capsules (50 mg) and solution for injection (50 mg/ml, 100 mg/2ml)
New Zealand Cnsumer Medicine Infrmatin TRAMAL Tramadl hydrchlride immediate release capsules (50 mg) and slutin fr injectin (50 mg/ml, 100 mg/2ml) What is in this leaflet Please read this leaflet carefully
More informationWidening of funding restrictions for rituximab and eltrombopag
20 February 2014 Widening f funding restrictins fr rituximab and eltrmbpag PHARMAC is pleased t annunce the apprval f prpsals t widen the restrictin n rituximab use in DHB hspitals and expand the funding
More informationReferral Criteria: Inflammation of the Spine Feb
Referral Criteria: Inflammatin f the Spine Feb 2019 1 5.7. Inflammatin f the Spine Backgrund Ankylsing spndylitis and axial spndylarthrpathy are fund in arund 0.3-1.2% f the ppulatin. Spndylarthritis encmpasses
More informationMedical Student Immunization Requirements
Medical Student Immunizatin Requirements The State f Illinis cde, Reference: (110 ILCS 20) Cllege Student Immunizatin Act, requires students t prvide prf f immunity: Measles (Rubela), Mumps, Rubella (German
More informationDrug Therapy Guidelines
Applicable* Medical Benefit x Effective: 2/15/19 Pharmacy- Frmulary 1 Next Review: 12/19 Pharmacy- Frmulary 2 Date f Origin: 4/1/05 Pharmacy- Frmulary 3/Exclusive Review Dates: 4/1/05, 2/1/06, 10/15/06,
More informationImaging tests allow the cancer care team to check for cancer and other problems inside the body.
IMAGING TESTS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu
More informationMedication Guide MORPHINE SULFATE (mor-pheen) Oral Solution (CII)
Medicatin Guide MORPHINE SULFATE (mr-pheen) Oral Slutin (CII) IMPORTANT: Keep Mrphine Sulfate Oral Slutin in a safe place away frm children. Accidental use by a child is a medical emergency and can cause
More informationPackage leaflet: Information for the user. Fragmin 10,000 IU/1 ml and 10,000 IU/4 ml Solution for injection dalteparin sodium
Package leaflet: Infrmatin fr the user Fragmin 10,000 IU/1 ml and 10,000 IU/4 ml Slutin fr injectin dalteparin sdium Read all f this leaflet carefully befre yu start using this medicine because it cntains
More informationMethadone Maintenance Treatment for Opioid Dependence
POLICY STATEMENT Methadne Maintenance Treatment fr Opiid Dependence APPROVED BY COUNCIL: May 2010 PUBLICATION DATE: Dialgue, Issue 2, 2010 Disclaimer: As f May 19, 2018 physicians n lnger require an exemptin
More informationInjury, Incident & Illness Procedure
Injury, Incident & Illness Prcedure Injury / Incident Includes any child, adult, r emplyee injured n site. A first aid kit will be available at all times. It will be maintained in accrdance with criterin
More informationCambridge Breast Unit Protocols for anticoagulant management prior to breast or axillary biopsies or excisions.
Prtcl CBU/POL/ JOINT POLICIES/008 Octber 2017 Prtcls fr anticagulant management prir t breast r axillary bipsies r excisins. 1. Scpe Fr use in the in bth screening and symptmatic breast services. 2. Purpse
More informationRituximab PROTOCOL FOR PAEDIATRIC RHEUMATOLOGY
Rituximab PROTOCOL FOR PAEDIATRIC RHEUMATOLOGY 1. Backgrund and indicatins Rituximab is a mnclnal antibdy that wrks by remving B-cells (a type f white bld cell that prduce antibdies). The aim f the B cell
More informationTick fever is a cattle disease caused by any one of the following blood parasites:
Tick fever Tick fever is a cattle disease caused by any ne f the fllwing bld parasites: Babesia bvis Babesia bigemina Anaplasma marginale These parasites are all transmitted by the cattle tick (Bphilus
More informationAdvantage EAP Employee Assistance Program
Advantage EAP Emplyee Assistance Prgram July 2014 In This Issue What might we face? Symptms f SAD Seasnal changes in biplar disrder Tips fr cmbating summer truble When t seek help Tips fr helping thse
More informationBenepali (etanercept): Brief training on additional Risk Minimisation Measures
Benepali (etanercept): Brief training n additinal Risk Minimisatin Measures Slide Deck fr Healthcare Prfessinal (HCP) Training Versin 9.0; 22 January 2016 UK/IE 1 Benepali (etanercept) This medicine is
More informationGuidelines for the Admission of Children and Young People with an Eating Disorder
Guidelines fr the Admissin f Children and Yung Peple with an Eating Disrder This dcument is designed t be used by clinicians lcated in hspitals f wards withut specialist eating disrder facilities, t guide
More information454-8 (Insert) MEDICATION GUIDE ZUBSOLV (Zub-solve) (buprenorphine and naloxone) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place
MEDICATION GUIDE ZUBSOLV (Zub-slve) (buprenrphine and nalxne) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place away frm children. Accidental use by a child is a medical emergency and
More informationWHAT IS HEAD AND NECK CANCER FACT SHEET
WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice
More informationKey Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.
Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. The United States is currently experiencing a natinwide utbreak f entervirus D68 (EV-D68) assciated with severe
More informationChronic Fatigue Syndrome
Chrnic Fatigue Syndrme (Als knwn as Myalgic encephalmyelitis/encephalmyelpathy) What is CFS/ME? CFS/ME cmprises a range f symptms that include fatigue, malaise, headaches, sleep disturbances, difficulties
More informationHospital Preparedness Checklist
Hspital Preparedness Checklist http://pandemicflu.gv Preparedness Subject 1. Structure fr planning and decisin making An internal, multidisciplinary planning cmmittee fr influenza preparedness has been
More informationName of procedure: Removal of submandibular salivary gland
Oral facial surgery Surgical prcedure infrmatin leaflet Name f prcedure: Remval f submandibular salivary gland This leaflet explains sme f the benefits, risks and alternatives t the peratin. We want yu
More information