Indication for orlistat nice cks. If a more rapid clinical response is .
Indication for orlistat nice cks 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. 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. Dosage: Start at the lowest possible dose (0. 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). 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. Skin — skin rash (common), urticaria and pruritus (uncommon), mucocutaneous candidiasis (rare or very rare). 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. History and examination. 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). 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. The National Institute for Health and Care Excellence (NICE) recommend pharmacological treatment (i. 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. Lack of sleep. This may occur within 1 month of starting treatment, or dose increases, and is reversible upon discontinuation or dose decrease []. 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. 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. 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. Monitor for changes in thyroid function. 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. 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. 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. 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. Assess for any alarm symptoms that may suggest a complication or other serious underlying pathology, and manage appropriately. ; 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. Moghul, L. Our expert clinical advisers commend the ‘alternative regimen’ for digoxin infusion in the BNF, because it is simple, safe and more practical. Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. Drug treatment should never be used as the sole element of treatment and should be used as part of an overall weight management plan. Colorectal cancer - around 40,000 new colorectal cancers are diagnosed each year in the UK, up to a quarter of these following screening. 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. 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. 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. 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 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) . For the adrenocorticotrophic hormone (ACTH) stimulation (Synacthen ®) test (in secondary care):. Last revised in May 2024. For a list of medicinal forms of colecalciferol, see the British National Formulary (BNF) section on Colecalciferol. Monksfield References 1. The use of NSAIDs may have an additive effect if there is co-existent H. 1. Hepatitis B vaccine, Prescribing information, Hepatitis B, CKS. Montelukast and zafirlukast are leukotriene receptor antagonists taken orally in the treatment of asthma. Colesevelam is a bile acid sequestrant that forms a polymeric gel in the gastrointestinal tract. 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]. 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]. 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. 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. 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 []. pylori infection, further increasing the risk of peptic ulceration and bleeding. Consider issuing a steroid treatment card [] to:People using prolonged high doses of inhaled corticosteroids. 1. 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. The maximum dose in 24 hours should not exceed 2 mg [Healthcare Improvement Scotland, 2014]. 1 . ; 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. Emollients are typically under-prescribed and under-used. 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. Before initiating a statin, perform baseline blood tests to ensure that lipid-modification treatment is appropriate. Emollients, Prescribing information, Eczema - atopic, CKS. 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]. People have the right to be involved in discussions and make informed decisions about their care, as described in making decisions about your care. 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. Doses to be taken in the evening. See the UK Health Security Agency (HSA) guidance COVID-19: the green book, chapter 14a and the NHS England website (www. Follow up should include: Repeat liver function tests (LFTs) within 3 months of starting treatment, and again at 12 months. 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. For more information see the CKS topic on Heart failure - chronic. 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. 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. 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. 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. 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). The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. If a more rapid clinical response is SGLT-2 inhibitors, Prescribing information, Diabetes - type 2, CKS. 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). H. The co-prescribing of Orlistat with other drugs aimed at weight loss is not recommended. 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. Beta-2 agonists — act directly on beta-2 receptors, causing smooth muscle relaxation and dilatation of the airways. If the eGFR is less than 60 mL/min/1. View orlistat information, including dose, uses, side-effects, pregnancy, breast feeding, contra-indications and drug action. See the CKS topic on Insomnia for more information on management strategies. Advise the person to report any muscle pain, tenderness, or weakness. 5 mL to 5 mL four times a day as needed and before physiotherapy [Twycross, 2016]. Warfarin has been used for decades as an anticoagulant. 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]. See the section on Management for more information. Review the person regularly and discontinue lorazepam as soon as possible Intervention and alternatives. CKS is aware that primary care may have a role in engaging with and monitoring this cohort of people. See the CKS topic on Gastrointestinal tract (upper) cancers - recognition and referral for more information. 9% saline solution can be used to ease cough associated with tenacious secretions [Wilcock, 2020]:Initially use 2. 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. If initial treatment is effective, reinforce lifestyle modification advice and arrange review depending on clinical judgement. 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. 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). Both NICE and the EAU Fluconazole inhibits the metabolism of drugs metabolized by the cytochrome P450 enzymes CYP2C9 (potently), CYP3A4 (moderately), and CYP2C19. Adults. 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]. ; If the T-score is greater than -2. 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. 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. Obesity. NICE; CKS; Health topics A to Z; Gastrointestinal tract (lower) cancers - recognition and referral; Gastrointestinal tract (lower) cancers - recognition and referral. england. 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. Shortness of breath, pain on breathing, and haemoptysis may indicate the development of pneumonia secondary to bacterial superinfection. However, in most people levels remain within the normal range. 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). Orlistat can help you to lose weight if you are overweight. 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:. 1 Recommendations . By using CKS, you agree to the licence set out in the CKS End User Licence Agreement . ; Soluble guanylate cyclase stimulators (such as riociguat) — concomitant use with nicorandil is contraindicated, as it can lead to serious hypotension. 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]. 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]. nhs. For detailed prescribing information on amitriptyline, see the CKS topic on Depression. Wareing, P. Very rarely: antibiotic associated colitis. Fast titration (usually suitable for otherwise healthy younger adults). 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. By using CKS, you agree to the licence set out in the CKS End User Licence Agreement. 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. Last revised in October 2024. 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. Digoxin. Oestrogen-only preparations are given to women without a uterus, and combined oestrogen and progestogen preparations are given to women with an intact uterus []. 73 m 2, repeat the test within 2 weeks to exclude causes of acute Assessment, Diagnosis, Sprains and strains, CKS. 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. Please see Appendix 1 for further guidance on prescribing and reviewing Orlistat. 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). 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. 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. If a diagnosis of chronic kidney disease (CKD) is suspected, arrange initial investigations in primary care. 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. 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). 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). 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. This results in suboptimal treatment of dry skin and eczema, and may increase the occurrence of flares [NICE, 2007a]. Nearly a third of the fat that you eat is blocked by orlistat. The manufacturer advises that women of childbearing potential should use effective contraception during treatment [ABPI, 2022b]. 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. Immunological evaluation may be warranted in children with recurrent episodes of AOM leading to mastoiditis Authors: E. 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. The information below is up-to-date at the time of publication of this CKS topic. 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). Oral capsule. 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. 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). 5. 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. 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. Assessment, Diagnosis, Vertigo, CKS. 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. 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. These recommendations are what CKS considers to be good clinical practice. All products. Warner, G. This may result in a higher and/or prolonged action of these drugs, including adverse effects. Particular care should be taken with antiepileptics, antiretrovirals, oral contraceptives, and drugs that have a narrow therapeutic index. 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. ; 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. 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. Heart failure. The recommended wound cleaning measures are based on expert opinion in review articles [Cals, 2012; Worster, 2015; Forsch, 2017,; Turner, 2019a]. Dose adjustment may be necessary depending on side-effects. Doses vary depending on the person's age, response to treatment and the preparation prescribed. Orlistat may decrease levothyroxine absorption which may result in hypothyroidism. Collin, K. 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). 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). 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. 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). 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). Advise people to have a diet that is rich in fruit and vegetables and consider the use of a multivitamin supplement. e Orlistat) as an option for the management of obesity for people who have not 1. They are often visible and palpable, and are an indication of superficial lower extremity venous insufficiency. Absorption of fat-soluble vitamins (A, D, E, K, and beta-carotene) may be impaired in people taking orlistat. 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. ; 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. Seymour, M. 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. 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. 5–1 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 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. 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. 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]. 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. CKS identified no reviews or guidelines on when it is appropriate to follow up a person with influenza. 5 or lower. 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). 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). 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. 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. By using BNFC, you agree to the licence set out in the BNF Publications End User Licence Agreement . After initiating a statin, follow up the person to assess the effectiveness and tolerability of treatment. . 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. Create a free account. ; 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). 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]. Covers the management of an epididymal cyst or spermatocele. Baseline prothrombin measurements should be taken before starting treatment with warfarin. It binds bile acids in the small bowel and prevents the secretory action of bile acids on the colon. 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. For more information see the CKS topic on Obesity. 'Ongoing symptomatic COVID-19' as signs and symptoms of COVID-19 infection from 4–12 weeks. 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. No additional benefit, in terms of delayed recurrence or improved survival, has been demonstrated with higher doses. Definitions NICE; CKS; Health topics A to Z; Atrial fibrillation; Prescribing information; Digoxin; Atrial fibrillation: Digoxin. Nervous system disorders: headache (common), dizziness, lethargy (uncommon), syncope, memory disturbance, restless legs syndrome, and poor quality sleep (rare). 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. 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. Note: for detailed prescribing information on inhaled corticosteroids, see the CKS topic on Corticosteroids - inhaled. 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). Refer people who are overweight or obese to a weight management service if appropriate. The typical induction dose of warfarin is 10 mg daily for 2 days, but this should be tailored to individual requirements. For the treatment of breast cancer, the recommended dose is normally 20 mg daily. For further information on This guidance has been replaced by NICE guideline CG43. The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care). ; Prescribe pregabalin Wound cleaning measures. 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. If greater symptomatic relief is required, gradually increase nebulizer use to up to every 2 hours. Vitamin D 3 (colecalciferol) is the vitamin D preparation of choice for treatment of vitamin D deficiency []. 1 Generic principles of 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. Bulk-forming laxatives (containing soluble fibre) act by retaining fluid within the stool and increasing faecal mass, stimulating peristalsis; also have stool-softening properties. 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. Aciclovir is generally well tolerated. 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. 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. Last revised in August 2023. Cross-tapering with a tricyclic antidepressant (TCA) is inadvisable with paroxetine and fluvoxamine — if necessary it should be done very cautiously []. This treatment summary topic describes obesity. A framework for assessment and referral for primary care/MSK interface services Helicobacter pylori (H. However, treatment may be continued and monitored in primary care. For more information see the CKS topic on Obstructive sleep apnoea syndrome. cezab pjycwxv wjxzr mutjx zerttpfe tkcz wyke hlpzni aysug osvyxc