Wirral NHS CCG Newsletter 2018

Issue 16 - June 2018

Email not displaying correctly? View it in your browser.

Recommendations

BLACK ULIPRISTAL 5mg tablets (Esmya®) for uterine fibroids

Monitor liver function in current and recent users; do not initiate treatment in new users or those between treatment courses.

GREEN Direct Oral Anticoagulants (DOACs) (previously known as NOACs) in Non Valvular Atrial Fibrillation: a multiple prescribing statement for Apixaban, Dabigatran, Edoxaban and Rivaroxaban

DOACs are recommended as treatment options for the prevention of stroke and systemic emboli in non-valvular atrial fibrillation where an oral anticoagulant is indicated. Wirral have adopted the Pan Mersey statement.

AMBER RECOMMENDED VisuXL eye drops (sodium hyaluronate 0.1%, co-enzyme Q10 0.1%, Vit E TPGS 0.5%).

Additional option for severe dry eye symptoms in ocular surface disease, including Sjogren’s syndrome and chronic keratitis. Only on recommendation of ophthalmologist.

RED BRODALUMAB solution for injection (Kyntheum®▼)

The Pan Mersey Area Prescribing Committee recommends the prescribing of BRODALUMAB solution for injection (Kyntheum®▼), by specialists only, for treating plaque psoriasis in accordance with NICE TA511.

Guidance on Prescribing in Primary Care following a Private Consultation

Issued: April 2018 | Review: April 2021

Safety

ADRENALINE auto-injectors: uncertainty over drug delivery

Advice for healthcare professionals:

Ensure the patient or carer, or both are trained and understand optimal use of their adrenaline auto injector device.

Advise the patient or carer or both to carry two adrenaline auto injectors at all times.
Select a device that has a needle size appropriate to the individual patient.

http://www.panmerseyapc.nhs.uk/safety/documents/S18.pdf

These documents can all be accessed through the Wirral Medicines Management Website

NICE Guidance May 2018

There have been no guidelines published in May 2018 by the National Institute for Clinical Excellence.

CKS Updates May 2018

During the month of May 2018, the following Clinical Knowledge Summaries were updated:

·       Acne vulgaris
·       Acute kidney injury
·       Conduct disorders in children and young people
·       Ectopic pregnancy
·       Fungal skin infection – scalp
·       Infertility
·       Smoking cessation

There have been substantial changes to some of the topics listed above. Notably, the Fungal skin infection – scalp topic, has had complications and prognosis notes added to the background information and a differential diagnosis note has been added to the diagnosis section. For the Smoking cessation topic, recommendations regarding e-cigarettes have been added. Additionally, there is now advice added on smoking cessation in adults and pregnant women. Clinicians can use this updated information when reviewing their current clinical practice when reviewing patients.

Products in short supply and product discontinuations

The following links provide prescribers with up to date information on commonly prescribed products which are currently in short supply from the manufacturers.

The information held on these lists is not exhaustive. Availability can vary geographically and also between wholesalers. Up-to-date information should be sought from manufacturers, local community pharmacies and suppliers.

Supply issues update for primary care June 2018

New issues

Diamorphine injection

Last month, The Department of Health and Social Care (DHSC) first wrote about a manufacturing issue with one of the suppliers of diamorphine 5mg and 10mg injection.
DHSC and NHSE have since been working with Accord and their supplier in Germany and the manufacture of diamorphine 5mg and 10mg injection will soon resume with an anticipated resupply date of beginning of September 2018. DHSC and NHSE have also been working with the remaining supplier, Wockhardt, to support the supply issue. Wockhardt have been able to increase their production of diamorphine 5mg and 10mg but are unable to support the entire market in July and August.
A management plan has been developed to manage the supply issue during July and August 2018:

Management plan from 1st July 2018:

Primary care and drug misuse centres will be able to continue to order diamorphine in line with historical demand.
Secondary care will have access to restricted supplies of diamorphine

Recommended Local Action- Primary care and drug misuse centres

Although you will be able to access diamorphine as per historical demand, prescribers are encouraged to be aware of the supply issues and reduce prescribing where appropriate.
Please order responsibly during this time, in line with historical demand and do not stock pile to avoid lengthening the stock out period.
In the case that diamorphine cannot be accessed, please refer to the clinical guidance issued by UKMI which provides more information on suggested alternatives to diamorphine: The first-choice is morphine which is given in detail in this link. If you require clinical guidance locally – please liaise with secondary care prescribing partners in substance misuse services or pain specialist services.
Further information which you may wish to review include the Patient Safety Alert on high dose morphine and diamorphine
Additional information for patients can be accessed here

Distribution Arrangements (From 1st July)

Diamorphine 5mg and 10mg will only be available to order from Alliance. No minimum surcharges will be levied
Morphine 10mg injection (Martindale) available to order from AAH only.
Diamorphine 30mg injection (Wockhardt), diamorphine 100mg (Accord) and diamorphine 500mg (Accord and Wockhardt) – usual wholesalers.

For further information on ordering processes please contact:
Alliance - Phone Number: 0330 1000 448 (customerservice@alliance-healthcare.co.uk)
AAH - Phone Number: 0344 561 8899

Diazepam 5mg/ml Emulsion for injection (Diazemuls)

Accord, the sole supplier of diazepam emulsion for injection, will be out of stock of this product until mid-August 2018 due to an issue with the raw material. UKMI have prepared the following advice on alternatives, which can be found here

This suggests the following products as possible alternatives and contact has been made with all the suppliers to make them aware of the issue:
o   Ativan (lorazepam 4mg/ml)- Pfizer in stock
o   Buccolam (Midazolam buccal)- Shire are in stock of all strengths
o   Diazepam rectal tubes- see information below

Diazepam Rectal tubes

Wockhardt, the sole supplier of diazepam 2.5mg rectal tubes is currently out of stock until July. Wockhardt are also out of stock of the 5mg and 10mg. Diazepam 5mg and 10mg rectal tubes continue to be available from Accord and Desitin.

Colestyramine (Questran)

There are currently manufacturing issues affecting the colestyramine products, Questran Powder for Oral suspension 4g and Questran light. Supplies of both are expected to be depleted from early June. Further supplies of Questran light are currently expected in early July and by the end of July for the other formulation.

Advice from UKMi on suitable alternatives can be found here

Phenobarbital injection

Martindale are the sole supplier of phenobarbital injection and they are currently out of stock of the 30mg and 60mg presentations. This issue is due to regulatory changes with the British Pharmacopoeia monograph for phenobarbital. Work has been undertaken with both Martindale and the MHRA to resolve this issue and a batch of 200mg has been released. Supplies should now be available via AAH.

The timescales for further supplies of the remaining strengths are not yet confirmed but work is continuing towards making these available as soon as possible.

UKMI have prepared the following shortages memo, which has now been published on the SPS website . This provides advice on possible alternatives and they have also provided information on using the 200mg product in place of the lower strengths if needed.

Adalat LA20

Bayer are out of stock of Adalat LA 20 tablets. Estimated resupply date Mid July 2018. Other brands of Nifedipine in a 20mg modified/prolonged release formation remain available including;

Adipine (Chiesi)
Coracten (UCB)
Nifedipress (Dexcel)
Tensipine (Genus)

Ongoing Issues:

For advice on ongoing issues please click here

This summary document shows the top 10 price changes this month, the top 25 changes this quarter, and the top 100 this year.

Tell me more about drug tariff price changes .

Please note that the information in this newsletter is correct at the time of publication.
Clinicians should always refer to the most up to date information.

Contacts

Victoria Vincent: victoriavincent@nhs.net 0151 541 5390

Contents

Formulary Update

Safety Update

Prescribing News

Drug Availability

Drug tariff price Changes