Welcome to the January edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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New Medicines
RED PENTOSAN POLYSULFATE SODIUM capsules (Elmiron®) for treating bladder pain syndrome
The Pan Mersey Area Prescribing Committee recommends the prescribing of PENTOSAN POLYSULFATE SODIUM capsules (Elmiron®), by specialists only, for treating bladder pain syndrome in accordance with NICE TA610.
GREY BUPRENORPHINE prolonged-release injection (Buvidal®) for the treatment of opioid dependence
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of BUPRENORPHINE prolonged-release injection (Buvidal®) for the treatment of opioid dependence.
GREY DUPILUMAB solution for injection (Dupixient®▼) for chronic rhinosinusitis
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DUPILUMAB solution for injection (Dupixient®▼) for the treatment of chronic rhinosinusitis.
GREEN DOXYLAMINE/PYRIDOXINE gastro-resistant tablets (Xonvea®) for the treatment of nausea and vomiting of pregnancy
The Pan Mersey Area Prescribing Committee recommends the prescribing of DOXYLAMINE/PYRIDOXINE gastro-resistant tablets (Xonvea®), as an option for the treatment of nausea and vomiting of pregnancy
GREEN RIVAROXABAN 2.5mg tablets (Xarelto®▼) for the prevention of atherothrombotic events
The Pan Mersey Area Prescribing Committee recommends the prescribing of RIVAROXABAN 2.5mg tablets (Xarelto®▼) plus aspirin, for the prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischaemic events, in accordance with NICE TA607.
Formulary and Guidelines
BLACK Rituximab for refractory focal segmental glomerulosclerosis
This condition is commissioned by NHS England, but it does not commission rituximab.
RED Cinacalcet for primary hyperparathyroidism
This is commissioned by NHS England.
RED Biological agents for psoriasis without prior treatment with PUVA
Biological agents may be prescribed without prior treatment with PUVA if PUVA treatment is difficult for logistical reasons e.g. travel, distance, time off work or immobility.
AMBER RETAINED BRONCHIECTASIS (non-cystic fibrosis), nebulised antibiotics
The Pan Mersey Area Prescribing Committee recommends the prescribing of nebulised colistimethate (Colomycin®), gentamicin or tobramycin for adult non- cystic fibrosis bronchiectasis patient.
AMBER RETAINED Anti-androgens to prevent tumour flare
Confirmation of a Red RAG rating for cyproterone or bicalutamide for the prevention of tumour flare in treatment for prostate cancer when a course of a gonadorelin analogue is initiated. To remain Amber Retained if the GnRH analogue is restarted after a 3 month or more gap in prescribing.
Shared Care
AMBER RETAINED Apomorphine prescribing support information
Routine review of the existing document. A GP letter is now included.
AMBER RETAINED Amiodarone prescribing support information
New information to reflect the guidance from NHS England. A change in RAG rating for Amber Initiated to Amber Retained alongside the need for an annual specialist review.
AMBER RETAINED Gonadorelin analogues prescribing support information
Minor update to clarify that one dose has been administered in secondary care.
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November
Please click here for a summary of safety updates and SPC updates in November.
Coroner writes to NICE over lack of prescribing guidance for amitriptyline and oxycodone
A coroner’s letter, following the death of a patient who was prescribed amitriptyline and oxycodone, has criticised the BNF for its lack of guidance on co-prescribing this combination, and highlights the need for both caution and monitoring.
Dangers of selective NSAID prescribing in Quality and Outcomes Framework
Letter warns that while coxibs are less likely to cause GI bleeds, they are prothrombotic and thus carry higher risk of CV events. Patients who might require NSAIDs may also be at risk of both GI bleeds and CVD (e.g. frail, elderly, multimorbidity, polypharmacy, smokers).
December
Please click here for a summary of safety updates and SPC updates in December.
Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
Domperidone is no longer licensed for use in children younger than 12 years or those weighing less than 35 kg. Results from a placebo-controlled study in children younger than 12 years with acute gastroenteritis did not show any difference in efficacy at relieving nausea and vomiting compared with placebo.
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NICE Guidance November 2019
There has been six guidelines and one technology appraisal published in November 2019 by the National Institute for Clinical Excellence which has impact upon primary care.
The Fever in under 5s: assessment and initial management guideline has been published. The topic covers the assessment and early management of fever in children under 5 with no obvious cause. This aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.
The Diverticular disease: diagnosis and management guideline has been published. The guideline covers the diagnosis and management of diverticular disease in people aged 18 years and over. The topic aims to improve diagnosis and help people get timely information and advice, including advice about symptoms and when to seek help.
The Familial breast cancer guideline has been updated and published. The guideline covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer. The updated guideline has revised the recommendations on topics that should be discussed with a person before deciding on whether to have annual mammographic surveillance and includes links to patient decisions aids.
The Multiple sclerosis in adults: management guideline has been updated and published. The guideline covers diagnosing and managing multiple sclerosis in people aged 18 and over. This update replaces the recommendation on using Sativex (THC:CBD spray) to treat spasticity in people with multiple sclerosis with a cross reference to recommendations on THC:CBD spray in the NICE guideline on cannabis-based medicinal products.
The Epilepsies: diagnosis and management guideline has been updated and published. The guideline covers diagnosing, treating and managing epilepsy and seizures in children, young people and adults in primary and secondary care. The footnotes have been amended to reflect a change in law with pregabalin and gabapentin now being classed as controlled drugs.
The Pentosan polysulfate sodium for treating bladder pain syndrome technology appraisal has been published. This treatment is being recommended as an option for treating bladder pain syndrome with glomerulations or Hunner’s lesions in adults with urinary urgency and frequency, and moderate to severe pain, only if:
- their condition has not responded to an adequate trial of standard oral treatments
- it is not offered in combination with bladder instillations
- any previous treatment with bladder instillations was not stopped because of lack of response
- it is used in secondary care and
- the company provides pentosan polysulfate sodium according to the commercial arrangement.
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
NICE Guidance December 2019
There has been two guidelines and two technology appraisals published in December 2019 by the National Institute for Clinical Excellence which has impact upon primary care.
The Acute kidney injury: prevention, detection and management guideline has been published. The topic covers the preventing, detecting and managing acute kidney injury in children, young people and adults. The topic aims to improve early recognition and treatment and reduce risk of complications in people with acute kidney injury, by improving assessment and detection by non-specialists and specifying when people should be referred to specialist services.
The Menopause: diagnosis and management guideline has been updated and published. The guideline covers the diagnosis and management of menopause, including in women who have premature ovarian insufficiency. The guideline has been updated with the MHRA safety alert information regarding the risks of breast cancer and the guideline aims to improve the consistency of support and information provided to women in menopause.
The Cannabidiol with clobazam for treating seizures associated with Dravet syndrome technology appraisal has been published. The technology appraisal recommends this treatment as an option for treating seizures associated with Dravet syndrome in people aged 2 years and older, only if:
- the frequency of convulsive seizures is checked every 6 months, and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment
- the company provides cannabidiol according to the commercial arrangement
The Cannabidiol with clobazam for treating seizures associated with Lennox-Gastaut syndrome technology appraisal has been published. The technology appraisal recommends this treatment as an option for treating seizures associated with Lennox-Gastaut syndrome in people aged 2 years and older, only if:
- the frequency of drop seizures is checked every 6 months, and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment
- the company provides cannabidiol according to the commercial arrangement
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
CKS Updates November 2019
During the month of November 2019, the following Clinical Knowledge Summaries were published or updated:
The Depression in children topic has been updated in line with current NICE guidance. The Styes (hordeola) topic and the Teething topic have both had significant changes to its layout. A new assessment section has been added to the Styes (hordeola) topic. The other topics have undergone review and minor restructures.
Clinicians can use the updated and new information when reviewing patients.
The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog.
This section has been adapted from www.prescriber.org.uk
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