NICE guidelines update

13th January 2011 by Louise Hudman

I  will be publishing a short summary of a new guideline every week or two.

Constipation (women) – PrucaloprideTechnical Appraisal

This guidance advises the use of prucalopride in ‘laxative refractory chronic constipation’ after at least 2 drugs have been tried at maximum dose for at least 6m. It’s expensive. Review the woman at 4/52. If it’s not worked by then, it’s unlikely to work at all.

Vascular Disease, clopidogrel and dipyridamoleTechnical Appraisal

This guideline increases the indications for which generic clopidogrel can be used first line. As the price has come down, so it’s cost-effectiveness has increased. Aspirin isn’t mentioned as an alternative 1st line choice, but this is implied.

  • Ischaemic stroke: 1st line – clopidogrel or aspirin, 2nd line – MR dipyridamole + aspirin, 3rd line – MR dipyridamole alone
  • Peripheral vascular disease or ‘multivascular disease’: clopidogrel or aspirin
  • TIA: 1st line – MR dipyridamole + aspirin (the 2 yr time limit has been removed, so this should be continued indefinitely), 2nd line – MR dypridamole alone

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