GPs can prescribe anti-alcohol drug for first time, says NICE

GPs should prescribe the drug nalmefene to help high-risk drinkers reduce their alcohol intake, NICE guidance has recommended.

Alcohol: NICE guidance overhauled (Photo: JH Lancy)
Alcohol: NICE guidance overhauled (Photo: JH Lancy)

Guidance released on Wednesday, states that the drug should only be prescribed ‘in conjunction with continuous psychosocial support’ which focuses on reducing alcohol consumption. It is the first time GPs have been able to prescribe a drug to combat alcohol misuse.

GPs and other clinicians should only consider the treatment in patients who continue to have a high drinking risk level two weeks after their initial assessment.

WHO guidelines define a high drinking risk level as daily alcohol consumption greater than 60g for men (7.5 units) and 40g for women (5 units).

Dr Andrew Green, chairman of the GPC’s clinical and prescribing subcommittee, cautioned that GPs should not feel pressurised into prescribing the drug to patients.

Nalmefene treatment is suited for adult patients with mild alcohol dependence and a high drinking risk level. Patients with physical withdrawal symptoms and those that require immediate detoxification should be referred.

GPs not obliged to prescribe

The drug, marketed as Selincro and manufactured by Lundbeck, is an opioid receptor modulator.

It comes in the form of 18mg tablets, which should be taken ‘as-needed’ one to two hours before a time of day when patients believe they may be at risk of drinking, with a maximum dose of one per day. It works by reducing their urge to drink.

During trials, nalmefene plus psychosocial support was found to reduce total alcohol consumption by 1.8 units per day compared to psychosocial support alone.

Dr Green said: ‘There is the world of difference between NICE recommending a treatment and GPs having an obligation to provide it. The key point here is that it is to be used "alongside psychosocial support" and not "instead of".

‘Commissioners will need to consider how they fund this new activity and how they can ensure it is safely and effectively delivered, probably some will choose shared care arrangements. Until this happens GPs should not feel pressurised into prescribing drugs with which they are unfamiliar or unresourced.’

Professor Carole Longson, NICE health technology evaluation centre director, said: ‘Those who could be prescribed nalmefene have already taken the first big steps by visiting their doctor, engaging with support services and taking part in therapy programmes.

'We are pleased to be able to recommend the use of namelfene to support people further in their efforts to fight alcohol dependence. When used alongside psychosocial support nalmefene is clinically and cost effective for the NHS compared with psychosocial support alone.’

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