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Welcome to April's edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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The Midlands and Lancashire CSU has a dedicated COVID-19 webpage which is updated daily.
Chloroquine and Hydroxychloroquine
Recent media reports have suggested that chloroquine can protect patients from coronavirus or treat COVID-19, the illness caused by a coronavirus. The MHRA has clarified this and states:
1) Chloroquine and hydroxychloroquine are not licensed to treat COVID-19 related symptoms or prevent infection
2) No conclusions have been reached from the ongoing clinical trials to test chloroquine and hydroxychloroquine as an agent in the treatment of COVID-19 or to prevent COVID-19 infection
3) MHRA advises that until clear, definitive evidence that these treatments are safe and effective for use in COVID-19, they should only be used for this purpose within a clinical trial.
Ibuprofen
The Commission of Human Medicines (CHM)Expert Working Group on coronavirus (COVID-19) has concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and susceptibility to contracting COVID-19 or the worsening of its symptoms.
Patients can take paracetamol or ibuprofen when self-medicating for symptoms of COVID-19, such as fever and headache, and should follow NHS advice if they have any questions or if symptoms get worse.
Other COVID-19 Resources
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Abridged during the COVID-19 pandemic
SGLT2 inhibitors: monitor ketones in blood during treatment interruption for surgical procedures or acute serious medical illness
18 March 2020
SGLT2 inhibitor treatment should be interrupted in patients who are hospitalised for major surgical procedures or acute serious medical illnesses and ketone levels measured, preferably in blood rather than urine.
Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression
18 March 2020
Benzodiazepines and opioids can both cause respiratory depression, which can be fatal if not recognised in time. Only prescribe together if there is no alternative and closely monitor patients for signs of respiratory depression.
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NICE Rapid Guidelines
NICE has published a number of COVID-19 rapid guidelines, including:
- Managing symptoms (including at the end of life) in the community
- Managing suspected or confirmed pneumonia in adults in the community
- Rheumatological autoimmune, inflammatory and metabolic bone disorders
- Severe asthma.
Electronic Repeat Dispensing (eRD)
Practices are encouraged to consider putting all suitable patients on electronic Repeat Dispensing (eRD) as soon as possible. This will reduce the need for patients to present at the practice and pharmacy and will reduce the longer-term administrative burden on the practice associated with processing repeat prescriptions.
How does eRD work?
- eRD allows the prescriber to authorise and issue a batch of repeatable prescriptions for up to 12 months with just one digital signature.
- eRD stores all issues of the eRD prescriptions securely on the NHS Spine and automatically downloads them to the patient's nominated community pharmacy at intervals set by the prescriber.
- patients are required to give their consent for repeat dispensing. This can be verbal and formal written consent is not required.
- eRD allows the cancellation at item or whole prescription level, which will cancel all subsequent issues on the Spine.
- PRN or 'when required' medication can be prescribed using eRD (it's advised that PRN items are set up as a separate eRD batch as they may have a different interval to the patient's other eRD batches). The prescriber can set the specified intervals based on the patient's usage history to predict the number of uses/doses. If the patient runs out, the subsequent issue can be downloaded in advance - based on clinical assessment by the dispenser. This may mean an extra prescription is needed to ensure the patient has enough medication to last until their next review. Some prescribing systems have a variable prescription type, which helps with this.
More information about eRD, including identifying suitable patients and online training, can be found here.
Useful Resources
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