Indication for orlistat nice cks 0 kg/m2 or more with associated risk factors a View orlistat information, including dose, uses, side-effects, pregnancy, breast feeding, contra-indications and drug action. Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. Clinical judgement should be used to determine how long to wait before lifestyle changes are considered ineffective as this will depend on the type of lifestyle change and the person's wishes and needs [NICE, 2023a]. See the section on Management for more information. Last revised in August 2023. View orlistat information, including dose, uses, side-effects, pregnancy, breast feeding, contra-indications and drug action. Are any of these low-risk factors present, which indicate it is safe to assess range of movement of the neck: •involved in a simple rear–end motor vehicle collision •is comfortable in a sitting position in the emergency department •has been ambulatory at any time since injury •absence of midline cervical tenderness People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. 0 kg/m2 or more with associated risk The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Possible drug interactions with proton pump inhibitors (PPIs) include: Citalopram and escitalopram — co-exposure to omeprazole or esomeprazole can lead to increased levels of citalopram and escitalopram. Alternatively, start with 300 mg three times a day on day 1, then increase according to response in steps of 300 mg (in three divided doses) every 2–3 days up to maximum of 3600 mg a day The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Vitamin D 3 (colecalciferol) is the vitamin D preparation of choice for treatment of vitamin D deficiency []. If initial treatment is effective, reinforce lifestyle modification advice and arrange review depending on clinical judgement. Doses are as follows: Montelukast — 10 mg once daily in adults and children aged 15 years and older, 5 mg once daily in children aged 6–14 years, and 4 mg once daily in children aged 6 months to 5 years. Warfarin has been used for decades as an anticoagulant. Hepatitis B vaccine, Prescribing information, Hepatitis B, CKS. Covers the management of an epididymal cyst or spermatocele. Last revised in May 2024. People ; treated with pregabalin should be monitored for signs and symptoms of pregabalin misuse, abuse or dependence, such as development of tolerance, dose escalation and drug-seeking behaviour. Refer people who are overweight or obese to a weight management service if appropriate. Note: for detailed prescribing information on inhaled corticosteroids, see the CKS topic on Corticosteroids - inhaled. See the CKS topic on Insomnia for more information on management strategies. This results in suboptimal treatment of dry skin and eczema, and may increase the occurrence of flares [NICE, 2007a]. Definitions NICE; CKS; Health topics A to Z; Atrial fibrillation; Prescribing information; Digoxin; Atrial fibrillation: Digoxin. The dose range specified for amitriptyline for the indication of migraine prophylaxis in adults in the BNF and the Summary of Product Characteristics is 25-75 mg at night. 73 m 2, repeat the test within 2 weeks to exclude causes of acute Assessment, Diagnosis, Sprains and strains, CKS. orlistat should be prescribed only as part of an overall plan for managing obesity in adults who meet one of the following criteria: a BMI of 28. A practical guide for primary healthcare professionals in Europe [Matthews, 2016] and UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015 [BASHH, 2016]. The recommendation to arrange a chest X-ray for people with recurrent chest infections is pragmatic, based on what CKS considers to be good medical practice. Aciclovir is generally well tolerated. The recommendations on management are largely based on the National Institute for Health and Care Excellence (NICE) clinical guideline Psoriasis: assessment and management [], the Scottish Intercollegiate Guidelines Network (SIGN) clinical guideline Diagnosis and management of psoriasis and psoriatic arthritis in adults [SIGN, 2010a], a concise guideline on psoriasis NICE guidance - management of dyspepsia in adults in primary care (summary section) Dyspepsia guidelines (BSG) Create an account to add page annotations. There are limited data on the use of pregabalin in women who Key drug interactions with atorvastatin include: Amlodipine — atorvastatin concentrations may be increased by amlodipine; a case of rhabdomyolysis has been reported. 5, modify risk factors where possible, treat any underlying conditions, and repeat the DXA at an interval appropriate The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). The aim of laxatives is to increase stool frequency or ease of stool passage by increasing stool water content (directly by osmotic or intestinal secretory mechanisms) or by accelerating bowel transit. Last revised in October 2024. 0 kg/m2 or more with associated risk When initiating oral corticosteroids, take into account the person's individual risk factors for adverse effects, including: Age — children and older people are more susceptible to the adverse effects of corticosteroids. Ritonavir — the manufacturers summary of product characteristics explains a potential interaction between ritonavir and Although not specifically licensed for the neuropathic pain, tramadol is licensed for the treatment of moderate to severe pain [ABPI, 2020e]. The recommendations on investigations in primary care are largely based on the BMJ Best Practice guideline Ulcerative colitis [BMJ Best Practice, 2023], the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults [Lamb 1, 2019], the National Institute for Health and Care Excellence (NICE) clinical The initial dose is 10 to 25 mg amitriptyline a day (taken at night), gradually titrated up in 10 to 25 mg steps every 3–7 days in one to two divided doses to an effective dose or the person's maximum tolerated dose (no higher than 75 mg a day). 1 Recommendations . Hyperkalaemia — monitor serum electrolytes 1–2 weeks after starting an ACE inhibitor, after each increase in dose, and Orlistat might affect the absorption of concurrently administered oral drugs—consider separating administration. No additional benefit, in terms of delayed recurrence or improved survival, has been demonstrated with higher doses. The information below is up-to-date at the time of publication of this CKS topic. ; Offer written information and advice on the symptoms, self-care, and management options for dyspepsia, such as the NHS A-Z patient Orlistat might affect the absorption of concurrently administered oral drugs—consider separating administration. Obesity; NICE CKS, August 2023 (UK access only) Obesity: identification, assessment and management; NICE Clinical guideline, November 2014 - last updated July 2023; The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Nervous system disorders: headache (common), dizziness, lethargy (uncommon), syncope, memory disturbance, restless legs syndrome, and poor quality sleep (rare). ; Soluble guanylate cyclase stimulators (such as riociguat) — concomitant use with nicorandil is contraindicated, as it can lead to serious hypotension. For the adrenocorticotrophic hormone (ACTH) stimulation (Synacthen ®) test (in secondary care):. These recommendations are based on the British Medical Journal (BMJ) Best Practice guide Assessment of dyspnoea [], the British Thoracic Society (BTS) guideline for oxygen use in adults in healthcare and emergency settings [], the National Institute for Health and Care Excellence (NICE) guidelines Sepsis: recognition, diagnosis and early management [] and Chronic The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Doses vary depending on the person's age, response to treatment and the preparation prescribed. uk) information Primary care guidance for more information on the criteria for a third primary dose of COVID-19 vaccine, booster doses of vaccine, and the indicate acute mastoiditis or mastoid osteitis when present as an isolated finding. The NICE guideline notes that if there is confirmed or suspected clinically significant portal hypertension, a person with cirrhosis may be offered specialist treatment with carvedilol or propranolol for the primary prevention of decompensation. If the eGFR is less than 60 mL/min/1. Emollients are typically under-prescribed and under-used. For further information on This guidance has been replaced by NICE guideline CG43. pylori) infection is one of the most common causes of peptic ulcer disease, with 95% of duodenal and 70–80% of gastric ulcers associated with it. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), When nebulized 0. Warner, G. 9 kg/m 2 and also meet the NICE criteria for referral to a specialist weight management service, the cost-effectiveness estimates for semaglutide are likely to be within what is normally considered a cost-effective use of NHS resources. For more information see the CKS topic on Obesity. 1. Lack of sleep. Be cautious when considering the Dix-Hallpike manoeuvre if the person has a neck or back problem, or cardiovascular problems such as carotid sinus syncope, as it involves turning the head and extending the neck. Moghul, L. For a list of medicinal forms of colecalciferol, see the British National Formulary (BNF) section on Colecalciferol. Both NICE and the EAU Fluconazole inhibits the metabolism of drugs metabolized by the cytochrome P450 enzymes CYP2C9 (potently), CYP3A4 (moderately), and CYP2C19. Varicose veins are thought to be caused by incompetent valves in the affected vein, which result in reflux of blood and increased pressure in the vein distally. This may occur within 1 month of starting treatment, or dose increases, and is reversible upon discontinuation or dose decrease []. For more information see the CKS topic on Heart failure - chronic. For detailed prescribing information on amitriptyline, see the CKS topic on Depression. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. Nearly a third of the fat that you eat is blocked by orlistat. e Orlistat) as an option for the management of obesity for people who have not 1. 1 Generic principles of care. Orlistat can help you to lose weight if you are overweight. pylori is also associated with acute and chronic gastritis, gastric [uknsc, 2018; phe, 2021; nice, 2023] The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care) . Common adverse effects include gastrointestinal adverse effects (such as nausea, vomiting, diarrhoea, and abdominal pain), headache, dizziness, fatigue, fever, and skin rashes (including photosensitivity and urticaria). This may result in a higher and/or prolonged action of these drugs, including adverse effects. History and examination. Collin, K. The recommendations on management are largely based on the National Institute for Health and Care Excellence (NICE) clinical guidelines Coeliac disease: recognition, assessment and management [NICE, 2015b] and Suspected cancer: recognition and referral []; the joint British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) and Coeliac UK Expert opinion in a review article notes that diagnosis of chronic pancreatitis in the early stages can be difficult, as pancreatic function may be preserved, and laboratory or imaging studies may only be minimally abnormal [Gupte, 2018]. Bulk-forming laxatives (containing soluble fibre) act by retaining fluid within the stool and increasing faecal mass, stimulating peristalsis; also have stool-softening properties. Fast titration (usually suitable for otherwise healthy younger adults). Initially, 300 mg once a day on day 1, then 300 mg twice a day on day 2, then 300 mg three times a day on day 3. 5 mL to 5 mL four times a day as needed and before physiotherapy [Twycross, 2016]. Baseline prothrombin measurements should be taken before starting treatment with warfarin. Women at high risk are those with any of the following: hypertensive disease during a previous pregnancy Possible drug interactions with proton pump inhibitors (PPIs) include: Citalopram and escitalopram — co-exposure to omeprazole or esomeprazole can lead to increased levels of citalopram and escitalopram. pylori infection, further increasing the risk of peptic ulceration and bleeding. H. Semaglutide is recommended as an option for weight management, including weight loss and weight maintenance, alongside a reduced-calorie diet and Summary points of the guidance on the use of orlistat for the treatment of obesity in adults: orlistat should be prescribed only as part of an overall plan for managing obesity in adults who meet one of the following criteria: a BMI of 28. A 10-year fracture risk of 10% is considered to be the threshold for arranging a dual-energy X-ray absorptiometry (DXA) scan in men and women. Particular care should be taken with antiepileptics, antiretrovirals, oral contraceptives, and drugs that have a narrow therapeutic index. A low starting dose (5 mg) is often more suitable for frail or elderly people, people with a low body weight, people with liver disease or cardiac failure, and people at high risk of The recommendations on the management of short-duration constipation have been taken from expert opinion in the BMJ Best Practice document Constipation [BMJ Best Practice, 2020], the European Society for Neurogastroenterology and Motility's Guidelines on functional constipation in adults [Serra, 2020], and the Consensus statement on constipation in older people For people who have at least 1 weight-related comorbidity and a BMI of at least 35 kg/m 2 or a BMI of 30 kg/m 2 to 34. Evidence from cross-sectional studies of people with traumatic lacerations showed that an increased likelihood of wound infection was associated with wound contamination and the presence of a foreign body This information is largely taken from the National Institute for Health and Care Excellence (NICE) guidelines Type 1 diabetes in adults: diagnosis and management [NICE, 2016a] and Diabetes (type 1 and type 2) in children and young people: diagnosis and management [NICE, 2016b], the Clinical Practice Consensus Guidelines 2018: insulin treatment in children and adolescents Tamoxifen is always initiated in secondary care by a specialist. Create a free account. 5–1 mg) orally and titrate in increments if necessary, after an interval of 2 hours until there is a clinical response [Inouye, 2014; British Geriatrics Society, 2019]. The information on pulmonary causes of chest pain is based on expert opinion in the British Thoracic Society (BTS) guideline The management of community acquired pneumonia [British Thoracic Society, 2009], the BTS and the Scottish Intercollegiate Guidelines Network (SIGN) British guideline on the management of asthma [BTS/SIGN, 2019], the BMJ Best Practice The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Pregabalin should be avoided unless the benefit to the mother outweighs the risk to the fetus — exposure during the first trimester may cause major birth defects [ABPI, 2022b]. NICE; CKS; Health topics A to Z; Gastrointestinal tract (lower) cancers - recognition and referral; Gastrointestinal tract (lower) cancers - recognition and referral. 1 Equip specialist settings for treating people who Orlistat is a lipase inhibitor which prevents the absorption of fats from the gastrointestinal and can also be used as an adjunct to lifestyle modifications for weight loss and chronic weight Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. Doses to be taken in the evening. The typical induction dose of warfarin is 10 mg daily for 2 days, but this should be tailored to individual requirements. Consider issuing a steroid treatment card [] to:People using prolonged high doses of inhaled corticosteroids. Summary; A previous expert reviewer of this CKS topic, however, advised that usually no more than 1000 micrograms (1 mg) is needed in 24 hours. Before initiating a statin, perform baseline blood tests to ensure that lipid-modification treatment is appropriate. Orlistat may be considered for individuals with a BMI of ≥ 30 kg/m 2 in whom diet, exercise and behavioural changes fail to achieve an adequate reduction in weight, or for individuals with a Adverse effects of angiotensin-converting enzyme (ACE) inhibitors include: Renal impairment — check renal function and electrolytes before starting and 1–2 weeks after starting an ACE inhibitor, after each increase in dose, and regularly throughout treatment. Dose adjustment may be necessary depending on side-effects. This treatment summary topic describes obesity. The National Institute for Health and Care Excellence (NICE) recommend pharmacological treatment (i. Heart failure. If a diagnosis of chronic kidney disease (CKD) is suspected, arrange initial investigations in primary care. Advise people to have a diet that is rich in fruit and vegetables and consider the use of a multivitamin supplement. Azole antifungals — atorvastatin concentrations may be increased by azole antifungals (such as fluconazole, ketoconazole, The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Our expert clinical advisers commend the ‘alternative regimen’ for digoxin infusion in the BNF, because it is simple, safe and more practical. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). It can take 48–72 hours before HIV can be detected within regional lymph nodes and up to 5 days before These recommendations are largely based on the Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers published by the Working Group of the Resuscitation Council (UK) [Resuscitation Council UK, 2021a] and the European Academy of Allergy and Clinical Immunology (EAACI) guidelines [EAACI Guidelines, 2021] and expert opinion from review The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). Concomitant use of labetalol is contraindicated with: Calcium antagonists such as verapamil and to a lesser extent diltiazem — may reduce cardiac contractility and atrio-ventricular conduction. The maximum dose in 24 hours should not exceed 2 mg [Healthcare Improvement Scotland, 2014]. Different hepatitis B vaccine products, doses, and primary dosing schedules are recommended depending on the person's age, risk factors, how rapidly protection is required, and the likelihood of compliance. 0 kg/m2 or more with associated risk Indications and dose For acetazolamide Reduction of intra-ocular pressure in open-angle glaucoma, Reduction of intra-ocular pressure in secondary glaucoma, Reduction of intra-ocular pressure perioperatively in angle-closure glaucoma for acetazolamide By mouth using immediate-release medicines, or by intravenous injection, or by intramuscular injection There can be variation in the licensing of different medicines containing the same drug. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, Inhaled corticosteroids (ICS) used in the treatment of asthma include beclometasone, budesonide, ciclesonide, fluticasone, and mometasone. Immunological evaluation may be warranted in children with recurrent episodes of AOM leading to mastoiditis Authors: E. The dose of orlistat should be omitted if a meal is Indication - 'in conjunction with a mildly hypocaloric diet for the treatment of obese patients with a body mass index (BMI) greater or equal to 30 kg/m^2, or overweight patients (BMI >= 28 Pregnancy. The recommendations on management are largely based on the National Institute for Health and Care Excellence (NICE) guideline Low back pain and sciatica in over 16s: assessment and management [], the National Spine Network guidance Early recognition of cauda equina syndrome. Abdominal ultrasound can be used to identify complications of chronic pancreatitis such as fluid collections, pseudocysts and The recommendations on how to initially manage a person with a head injury and the risk factors for a serious complication are based on the National Institute for Health and Care Excellence (NICE) clinical guideline Head injury: assessment and early management [], the NICE Quality Standard Head injury QS 74 [NICE, 2014b], the Centres for Disease Control and Prevention The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). See the UK Health Security Agency (HSA) guidance COVID-19: the green book, chapter 14a and the NHS England website (www. However, in most people levels remain within the normal range. Very rarely: erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous and exfoliative dermatitis, acute The recommendation to use clopidogrel is based on NICE guidelines Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular events and Peripheral arterial disease: diagnosis and management [NICE, 2010; NICE, 2020c] and the European Society of Cardiology (ESC) 2017 guideline Diagnosis and treatment of peripheral arterial diseases Seek specialist advice before starting treatment with an angiotensin-converting enzyme (ACE) inhibitor if the person is using high doses of a loop diuretic (equivalent to 80 mg furosemide daily or more). Beta-2 agonists — act directly on beta-2 receptors, causing smooth muscle relaxation and dilatation of the airways. For people whose fracture risk is above the recommended threshold, offer a dual-energy X-ray absorptiometry (DXA) scan, then bone-sparing drug treatment if the T-score is -2. Cross-tapering with a tricyclic antidepressant (TCA) is inadvisable with paroxetine and fluvoxamine — if necessary it should be done very cautiously []. 0 kg/m2 or more with associated risk Covers the use of the progestogen-only pill (POP), including initial assessment, how to start (or switch to) a POP, possible risks and adverse effects, key drug interactions, information and advice for the woman, how to manage common problems (such as unscheduled bleeding and missed pills), follow-up requirements, and duration of use for this method of contraception. Clomipramine is a potent inhibitor of serotonin reuptake, and serotonin syndrome is more likely if co-administered with an SSRI or SNRI — cross-tapering is Indications and dose For rosuvastatin Primary hypercholesterolaemia (type IIa including heterozygous familial hypercholesterolaemia), mixed dyslipidaemia (type IIb), or homozygous familial hypercholesterolaemia in patients who have not responded adequately to diet and other appropriate measures for rosuvastatin By mouth When reviewing a man with erectile dysfunction following initial management in primary care:. Show Alli 60mg capsules Haleon UK Trading Ltd Pregabalin should not be used in women who are pregnant, unless the benefit to the mother clearly outweighs the potential risk to the fetus. Adults. Monitor for changes in thyroid function. 5. By using CKS, you agree to the licence set out in the CKS End User Licence Agreement . A framework for assessment and referral for primary care/MSK interface services Helicobacter pylori (H. These recommendations are based largely on the National Institute for Health and Care Excellence (NICE) guidelines Prostate cancer: diagnosis and management [NICE, 2021b] and Suspected cancer: recognition and referral [NICE, 2021c], and the Public Health England (PHE) guidelines Prostate cancer risk management programme: overview [] and Advising well men These recommendations are largely based on the Public Health England (PHE) guidelines Ceasing and deferring women from the NHS Cervical Screening Programme [] and Topic 8: the practical aspects of taking cervical samples [], and on expert opinion in a review article []. Short-acting beta-2 agonists (SABAs), such as salbutamol and terbutaline, have a rapid onset of action (5 minutes) and their effects last for up to 4 hours. 1. ; Prescribe pregabalin Wound cleaning measures. Pulmonary embolism (PE) is a life-threatening condition in which one or more emboli, usually arising from a blood clot formed in the veins, are lodged in and obstruct the pulmonary arterial system, causing severe respiratory dysfunction. . Blood samples are obtained to check serum cortisol levels before and 30 minutes after administering 250 micrograms of tetracosactide (a synthetic analogue of ACTH) intravenously or intramuscularly. Tirzepatide is a long-acting GIP (glucose-dependent insulinotropic polypeptide) receptor and GLP-1 (glucagon-like peptide-1) receptor agonist that increases insulin sensitivity and secretion, suppresses glucagon secretion, and slows gastric emptying. Wareing, P. See the CKS topic on Gastrointestinal tract (upper) cancers - recognition and referral for more information. Orlistat may decrease levothyroxine absorption which may result in hypothyroidism. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label Hormone replacement therapy (HRT) is available as oral or transdermal preparations, depending on the woman's preferences. Dosage: Start at the lowest possible dose (0. Skin — skin rash (common), urticaria and pruritus (uncommon), mucocutaneous candidiasis (rare or very rare). ; Vitamin D 2 (ergocalciferol) can be used in people who cannot take vitamin D 3 for cultural, dietary, or religious reasons because of the animal sourcing of Advice regarding use of aspirin in pregnancy to reduce risk of preeclampsia has been outlined by NICE (1) Advise pregnant women at high risk of pre-eclampsia to take 75-150 mg of aspirin [*] daily from 12 weeks until the birth of the baby. 1 . 5 or lower. CKS is aware that primary care may have a role in engaging with and monitoring this cohort of people. People have the right to be involved in discussions and make informed decisions about their care, as described in making decisions about your care. Digoxin. All products. If greater symptomatic relief is required, gradually increase nebulizer use to up to every 2 hours. Follow up should include: Repeat liver function tests (LFTs) within 3 months of starting treatment, and again at 12 months. To seek medical advice if any episode of jaundice is more severe or persistent than usual, as this may indicate an alternative diagnosis, which may co-exist with Gilbert's syndrome. BNF 43 was amended further to warn that even after intravenous administration, response may take a number of hours and persistence of tachycardia is not an indication for exceeding the dose recommended. ; Medical history — oral corticosteroids are contraindicated in people with an untreated systemic infection, and should be used cautiously (and with very close monitoring Summary points of the guidance on the use of orlistat for the treatment of obesity in adults: orlistat should be prescribed only as part of an overall plan for managing obesity in adults who meet one of the following criteria: a BMI of 28. Orlistat 120 mg should be taken immediately before, during, or up to 1 hour after each main meal (up to a maximum of three times a day). Colorectal cancer - around 40,000 new colorectal cancers are diagnosed each year in the UK, up to a quarter of these following screening. The recommendations on management of epididymal cyst are based on the Royal College of Surgeons (RCS) joint publication Asymptomatic scrotal swelling, commissioning guide [] and expert opinion in review articles on scrotal masses [Crawford, 2014] and on chronic scrotal pain [Tan, 2017; Wu, 2018; Gastrointestinal — nausea and diarrhoea (common), vomiting (uncommon). The National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommends [NICE, 2016a]: Ezetimibe monotherapy as an option for treating primary (heterozygous‑familial or non‑familial) hypercholesterolaemia in adults in whom initial statin therapy is contraindicated. nhs. In women taking drugs that cause severe diarrhoea or vomiting (such as orlistat): Consider the Cu-IUD, LNG-IUD, progestogen-only implant, or the progestogen-only injectable, The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). By using BNFC, you agree to the licence set out in the BNF Publications End User Licence Agreement . Atrial fibrillation These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Lower urinary tract symptoms in men: management [], and the European Association of Urology (EAU) guideline Management of non-neurogenic male LUTS [], and what CKS considers good medical practice. CKS notes that the NICE clinical guideline recommends that oral nutrition support should be monitored every 3–6 months, or more frequently if there is any change to a person's clinical condition. The recommendations on when to suspect non-alcoholic fatty liver disease (NAFLD) are based on the National Institute for Health and Care Excellence (NICE) clinical guideline Non-alcoholic fatty liver disease (NAFLD): assessment and management [], the European Association for the Study of the Liver EASL-EASD-EASO Clinical Practice Guidelines for the management of non Arranging specialist referral. The recommended wound cleaning measures are based on expert opinion in review articles [Cals, 2012; Worster, 2015; Forsch, 2017,; Turner, 2019a]. Assess for any alarm symptoms that may suggest a complication or other serious underlying pathology, and manage appropriately. Review the person regularly and discontinue lorazepam as soon as possible Intervention and alternatives. Shortness of breath, pain on breathing, and haemoptysis may indicate the development of pneumonia secondary to bacterial superinfection. When exercising their judgement, professionals and practitioners are expected to The National Institute for Health and Care Excellence (NICE) defines: 'Acute COVID-19' as signs and symptoms of infection consistent with COVID-19 for up to 4 weeks. Very rarely: antibiotic associated colitis. It binds bile acids in the small bowel and prevents the secretory action of bile acids on the colon. Arrange blood tests for serum creatinine and estimated glomerular filtration rate (eGFR), and advise the person not to eat meat for at least 12 hours before the test. 9% saline solution can be used to ease cough associated with tenacious secretions [Wilcock, 2020]:Initially use 2. ; If initial treatment is ineffective or unsatisfactory, reassess for underlying cause(s) and risk factor(s) and manage Confirming the diagnosis, Diagnosis, Addison's disease, CKS. CKS suggests that NICE guidance on the meaning of 'inappropriate' was intended to indicate that statins should be offered when Switching antidepressants, Prescribing information, Depression, CKS. Bluestone CD, Gates GA, Klein JO et al. Risedronate should be taken before breakfast; however, if this is not practical, it can be taken between meals or in the evening at the same time each day, with strict adherence to the Treatment of influenza Post exposure prophylaxis; Adults (aged 13 years and over) 75 mg twice a day for 5 days 75 mg once a day for 10 days: Adults (aged 13 years and over) who are immunosuppressed Absolute: biopsy in selected malignancy; Relative (1): watchful waiting is more appropriate than tonsillectomy for children with mild sore throats Clinical Knowledge Summaries (CKS) Health topics A to Z; Specialities; What's new; About CKS; About; NICE; CKS; Health topics A to Z; Otitis externa; Otitis externa. However, treatment may be continued and monitored in primary care. By using CKS, you agree to the licence set out in the CKS End User Licence Agreement. If the dose of diuretic is greater than 80 mg furosemide or equivalent, the ACE inhibitor or ARB should be initiated Oral bisphosphonates must only be taken on an empty stomach as their absorption is affected by food, drink, and other drugs — for more information, see the section on Drug interactions. Drug interactions with thiazide-type diuretics include: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (ARBs) — ACE inhibitors and ARBs can cause a very rapid fall in blood pressure in a person who is volume-depleted. Do not prescribe an SGLT-2 inhibitor to people with: Diabetic ketoacidosis (DKA) — serious and potentially life-threatening cases of DKA have been reported in people taking SGLT-2 inhibitors. Adverse effects of antiepileptic drugs are common and mostly mild, and in many cases dose-related and The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Gallstone disease: diagnosis and management , the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) guideline Pathway for the management of acute gallstone diseases [AUGIS, 2015], the Tokyo guidelines TG13 current There are two main types of oral anticoagulants: vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). In addition, drowsiness or sleepiness may occur (uncommon) — moderate influence on People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Drug treatment should never be used as the sole element of treatment and should be used as part of an overall weight management plan. Montelukast and zafirlukast are leukotriene receptor antagonists taken orally in the treatment of asthma. The recommendations to check for gastrointestinal symptoms to ensure feeds are tolerated, and to monitor weight and body mass index (BMI), are based on the NICE clinical Summary points of the guidance on the use of orlistat for the treatment of obesity in adults: orlistat should be prescribed only as part of an overall plan for managing obesity in adults who meet one of the following criteria: a BMI of 28. Oral capsule. ; If the T-score is greater than -2. If a more rapid clinical response is SGLT-2 inhibitors, Prescribing information, Diabetes - type 2, CKS. The manufacturer advises that women of childbearing potential should use effective contraception during treatment [ABPI, 2022b]. Warfarin, the most commonly used VKA, is a coumarin derivative that acts by inhibiting vitamin K dependent clotting factors (II, VII, IX, X) in addition to the anticoagulant proteins C and S. Otitis externa is inflammation of the external ear canal and is classified as acute - lasting 3 weeks or less or chronic - lasting longer than 3 months. 'Ongoing symptomatic COVID-19' as signs and symptoms of COVID-19 infection from 4–12 weeks. Orlistat for the treatment of obesity in adults Technology appraisal guidance; Reference number: TA22 Published: 27 March 2001 These recommendations are based on the clinical guidelines HIV in primary care. CKS identified no reviews or guidelines on when it is appropriate to follow up a person with influenza. The recommendations on when to refer people with iron deficiency anaemia are based on expert opinion in the National Institute for Health and Care Excellence (NICE) guideline Suspected cancer: recognition and referral [], the British Society of Gastroenterology Guidelines for the management of iron deficiency anaemia in adults [Snook, 2021], the British Society for The recommendations on choice of antibiotic are taken from the NICE guideline Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing [NICE, 2024a]. These recommendations are what CKS considers to be good clinical practice. Assessment, Diagnosis, Vertigo, CKS. Cervical screening samples are taken from the junction of the ectocervix and endocervix (the Adverse effects of prolonged-release melatonin include: Musculoskeletal disorders: Arthralgia and back pain (common). The co-prescribing of Orlistat with other drugs aimed at weight loss is not recommended. In the absence of local guidelines CKS cannot be prescriptive, but can only offer a general guide based on guidelines [NHS Scotland, 2021] and the Palliative Care Formulary [Wilcock, 2020]. Monksfield References 1. The recommendations on assessment are largely based on the Dutch publication Clinical practice guidelines for physical therapy in patients with acute ankle sprain [de Bie, 2006], the International Ankle Consortium publications Consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains Local guidelines should be followed if available, as there is a wide variation in regimens used in clinical practice. These recommendations are based on the National Institute for Health and Care Excellence (NICE) guideline Gallstone disease: diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis and the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) Commissioning guide: gallstone disease [AUGIS, 2016], the BMJ Best The QFracture® and FRAX® risk assessment tools predict the absolute risk of hip fracture, and major osteoporotic fractures (spine, wrist, or shoulder) over 10 years. Advise the person to report any muscle pain, tenderness, or weakness. ; Measure renal function, serum electrolytes, and blood pressure before prescribing an ACE inhibitor and start with a low dose (starting doses are given in Table 3). Transdermal preparations may be appropriate if the woman has [Stuenkel, 2015; North Orlistat is a lipase inhibitor which can also be used to maintain weight loss after achieving an initial weight loss target, rather than to continue to lose weight. Once the preferred choice of emollient is known, encourage appropriate usage by prescribing generous amounts (for example 500 g) to be For people at high risk of fragility fracture. england. Oestrogen-only preparations are given to women without a uterus, and combined oestrogen and progestogen preparations are given to women with an intact uterus []. The use of NSAIDs may have an additive effect if there is co-existent H. For the treatment of breast cancer, the recommended dose is normally 20 mg daily. Emollients, Prescribing information, Eczema - atopic, CKS. Seymour, M. Key drug interactions with nicorandil include: Phosphodiesterase inhibitors (such as avanafil, sildenafil, tadalafil, vardenafil)— concomitant use with nicorandil is contraindicated, as it can cause potentially serious hypotension. The National Institute for Health and Care Excellence (NICE) recommends tramadol for people with neuropathic pain (except trigeminal neuralgia), only if acute rescue therapy is needed [NICE, 2019a]. Absorption of fat-soluble vitamins (A, D, E, K, and beta-carotene) may be impaired in people taking orlistat. The recommendations on who to refer to an endocrinology specialist are based on or extrapolated from the ETA publications on subclinical hypothyroidism [Pearce, 2013] and central hypothyroidism [Persani, 2018], the ATA guideline on pregnancy and the postpartum [Alexander, 2017], and expert opinion in review articles [Gaitonde et al, 2012; The content on the NICE BNFC site (BNFC) is the copyright of BMJ Publishing Group Ltd, the Royal Pharmaceutical Society of Great Britain, and RCPCH Publications Ltd. After initiating a statin, follow up the person to assess the effectiveness and tolerability of treatment. Summary points of the guidance on the use of orlistat for the treatment of obesity in adults: orlistat should be prescribed only as part of an overall plan for managing obesity in adults who meet one of the following criteria: a BMI of 28. They are often visible and palpable, and are an indication of superficial lower extremity venous insufficiency. For more information see the CKS topic on Obstructive sleep apnoea syndrome. Obesity. Please see Appendix 1 for further guidance on prescribing and reviewing Orlistat. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label Labetalol, Prescribing information, Hypertension in pregnancy, CKS. An opioid dose regimen should always be tailored to an individual's needs and Exacerbation of seizures — rarely antiepileptic drugs may exacerbate seizure frequency and/or severity [ABPI, 2020; NICE, 2020]. Colesevelam is a bile acid sequestrant that forms a polymeric gel in the gastrointestinal tract. zyvkd sarflah blhdei ftmnl sryhmk xiauefr nwdoqs beaz uvm odsmya