Bath emollients among further prescribing restrictions issued by NHS England

Following the restrictions issued last year on prescribing of 35 'low-priority' treatments, NHS England has identified seven more items that should not routinely be prescribed in primary care. They are:

• Aliskiren
• Amiodarone
• Bath and shower preparations for dry and pruritic skin conditions
• Dronedarone
• Minocycline for acne
• Needles for pre-filled and reusable insulin pens
• Silk garments

Emollient bath additives were shown in the randomised controlled BATHE trial to have no clinical benefit in childhood eczema, and NHS England has ruled that this finding can be extrapolated to adults in the absence of other good-quality evidence. 'Leave-on' emollients remain the mainstay of treatment for eczema and can be used as soap substitutes if necessary.

Insulin pen needles that cost more than £5 per 100 needles should not be initiated for any diabetes patient in primary care. A 4mm needle is considered to be the safest option for adults and children regardless of age, gender and BMI, as shorter needles help to prevent intramuscular injection of insulin. For patients currently using longer needles (8mm or 12mm), it is advisable to change to a shorter needle after discussion with a healthcare professional.

Minocycline is not recommended for use in acne as it is associated with an increased risk of adverse effects such as drug-induced lupus, skin pigmentation and hepatitis. Aliskiren, amiodarone and dronedarone are not recommended by NICE for routine prescribing.

NHS England estimates that implementation of the new restrictions could save up to £22.4 million.