Uncommon Clause Samples

Uncommon. Anaemia; anxiety; electrolyte imbalance; hyperlipidaemia; taste altered; thrombocytopenia Agranulocytosis; eosinophilia; hepatic disorders; infection; pancreatitis; pancytopenia; respiratory disorders; sepsis; severe cutaneous adverse reactions (SCARs); vasculitis Cutaneous lupus erythematosus; hypouricaemia; pulmonary hypertension; renal failure For a comprehensive list of interactions see the BNF or product SPC. Leflunomide has an extremely long half-life and interactions may occur even after leflunomide has been discontinued. Leflunomide may inhibit the metabolism of warfarin, phenytoin and tolbutamide. The effect of leflunomide is decreased by cholestyramine. This should be avoided unless this effect is desired. This drug should not be prescribed during pregnancy or while breastfeeding. It is important that women of childbearing potential do not start leflunomide until pregnancy has been excluded. Effective contraception essential during treatment and for at least 2 years after treatment in women and at least 3 months after treatment in men (plasma concentration monitoring required; waiting time before conception may be reduced with washout procedure—consult product literature). If there is a delay in onset of menstruation or other reason to suspect pregnancy then the patient much notify their primary care prescriber and consultant as soon as possible. If the patient wants to conceive then blood metabolite levels need to be checked and a wash out organised as specified in product literature if necessary.

Uncommon. Alopecia; depression; dyspnoea; myalgia; photosensitivity reaction; thrombocytopenia • Agranulocytosis; bone marrow disorders; cardiac inflammation; hepatitis; neutropenia; pancreatitis; peripheral neuropathy; renal impairment; respiratory disorders • Angioedema; eosinophilia; haemolytic anaemia; nephritis tubulointerstitial; oligozoospermia (reversible); ulcerative colitis aggravated For a comprehensive list of interactions see the BNF or product SPC. Patients receiving hypoglycemic agents and sulfasalazine should be closely monitored. Azathiopurine and sulfasalazine should not be co-prescribed. Reduced absorption of digoxin occurred with co-administration. Sulfasalazine can be prescribed in pregnant or breastfeeding patients. In these instances, prescribing should remain with the consultant. In breastfeeding children small amounts of sulfasalazine are secreted in breastmilk. Patients should avoid breastfeeding while taking this medicine. Consultants should identify patients requiring immunisation in line with JCVI recommendations. Once administered the primary care prescriber will provide written confirmation that the vaccine has been administered then treatment will be commenced. Annual flu vaccines are recommended. Check patient has had ONE DOSE of pneumococcal vaccine. Additional doses are not routinely recommended. Low levels of immunosuppression are not absolute contraindication to the use of live vaccines, these should be discussed with a specialist on a case by case basis. All patients which are immunosuppressed due to a conventional DMARD should be encouraged to receive a COVID-19 vaccine, regardless of treatment regimen or underlying diagnosis. The benefits of the COVID-19 vaccination outweigh the risks and by having the vaccine, they reduce the risk of developing severe complications due to COVID-19. Some may have a sub-optimal response. If there is any uncertainty regarding advice to give patients please contact the Rheumatology team at RJAH on the contact details below. The Joint Committee of Vaccination and Immunisation (JCVI) hasn't advised a vaccine preference for any specific population, advising that all give very high protection against severe disease and have good safety profiles. This information on COVID-19 vaccinations is under constant review. The latest updated information can be found in The Green book. At Initiation Test Frequency Monitored and acted on by FBC Full Blood Count including differential • 2 weekly for 6 weeks • THEN...

Uncommon. Aggression, cold extremities, emotional lability, hostility, hypoaesthesia, menstrual disturbances, muscle spasms, pruritus, psychosis, QT-interval prolongation, suicidal ideation, syncope and tics. ▇▇▇▇▇▇▇’s phenomenon and seizures. Angle-closure glaucoma and hepatic disorders For other adverse effects refer to current Summary of Product Characteristics (SPC): ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇.▇▇ or British National Formulary for Children (BNFC), available at ▇▇▇.▇▇▇.▇▇▇ Refer to current Summary of Product Characteristics (SPC): ▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇.▇▇ or British National Formulary for Children (BNFC), available at ▇▇▇.▇▇▇.▇▇▇ Dear doctor, Patient (Insert patient’s name) Identifier (CHI/address) I have received your request for shared care of this patient who has been advised to continue (Atomoxetine). I have read the Atomoxetine Shared Care Agreement. Please circle a response A) I am willing to prescribe Atomoxetine and adhere to the terms in this Shared Care Agreement.