This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through new and updated guidelines published in December 2023 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only.  I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.   There is a podcast version of this and other videos that you can access here:  Primary Care guidelines podcast:   ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines ·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK ·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here:  The Practical GP YouTube Channel:  https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk The Full NICE News bulletin for December 2023 can be found here: ·      https://www.nice.org.uk/guidance/published?from=2023-12-01&to=2023-12-30&ndt=Guidance&ndt=Quality+standard  The links to the update guidance covered can be found here: Bipolar disorder: assessment and management: ·      https://www.nice.org.uk/guidance/cg185 Empagliflozin for treating chronic kidney disease: ·      https://www.nice.org.uk/guidance/ta942 Cardiovascular disease: risk assessment and reduction, including lipid modification: ·      https://www.nice.org.uk/guidance/ng238   Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]  Music provided by Audio Library Plus  Watch: https://youtu.be/aBGk6aJM3IU  Free Download / Stream: https://alplus.io/halfway-through    Transcript Hello and welcome, I am Fernando, a GP in the UK. Today, we are looking at the NICE updates published in December 2023, focusing on what is relevant in Primary Care only. We will be covering: valproate toxicity, empagliflozin for CKD, and cardiovascular risk reduction.   The episode is fairly short so let’s jump into it. The first clinical area refers to the use of valproate in the bipolar disorder guideline, in line with new MHRA guidance published in November 2023. And perhaps we should remember that the previous MHRA advice stated that valproate must not be used in women and girls of childbearing potential unless other options are unsuitable and a pregnancy prevention programme is in place. But the new safety advice is much stricter and states that valproate must not be started in people (either male or female) younger than 55 years, unless 2 specialists independently consider that there is no other treatment, or that the reproductive risks do not apply. So, let’s have a look at this in a bit more detail. We know that valproate must not be used in pregnancy as well as in any female of child bearing age unless there is a Pregnancy Prevention Programme in place, which involves an annual review and the requirement for highly effective methods of contraception (such as a hormonal intrauterine device). This is because of the risks of malformations and developmental problems. Valproate is a known teratogenic drug, resulting in both physical birth defects and neurodevelopmental harm including lower intellectual abilities, poor language skills and memory problems. Although the risk of structural malformations is greatest in the first trimester, the risk of neurodevelopmental harm is thought to be present throughout, and therefore valproate is never safe