Welcome to the February edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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Recommendations
GREY CANNABIS-based products
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of CANNABIS-BASED products for medicinal use.
https://www.panmerseyapc.nhs.uk/media/2062/cannabis.pdf
GREY ERENUMAB pre-filled syringes (Aimovig®▼)
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of ERENUMAB pre-filled syringes (Aimovig®▼) for prophylaxis of migraine.
https://www.panmerseyapc.nhs.uk/media/2134/erenumab.pdf
GREY OSPEMIFENE film-coated tablets (Senshio®▼)
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of OSPEMIFENE film-coated tablets (Senshio®▼) for the treatment of vulvar and vaginal atrophy in post-menopausal women.
https://www.panmerseyapc.nhs.uk/media/2135/ospemifene.pdf
GREY SEMAGLUTIDE solution for injection (Ozempic®▼)
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of SEMAGLUTIDE solution for injection (Ozempic®▼) for Type 2 Diabetes Mellitus.
https://www.panmerseyapc.nhs.uk/media/2136/semaglutide.pdf
Guidelines
Methotrexate for Psoriasis and Dermatological Conditions
The Shared care guideline for methotrexate (oral and subcutaneous) for psoriasis and other dermatological conditions has been updated and approved by Drugs and Therapeutics Panel in January 2019.
Guidelines are available on the Medicines Management Website http://mm.wirral.nhs.uk/
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Over the counter (OTC) medicines in nurseries and schools
In August 2018, NHS Wirral CCG aligned their Self-Care policy to national guidance - this is available at; https://www.wirralccg.nhs.uk/media/5131/final_selfcarepolicyv3aug18.pdf
To support the continued implementation of this policy, NHS Wirral CCG have circulated the following letter to all Wirral nurseries and schools to clarify the current guidance around use of medicines in nurseries and schools.
Current guidance for both schools and nurseries recommends that non-prescription medicines (over the counter medicines) can be administered following written permission by the child’s parent. GPs and other prescribers should not be required to write to confirm that it is appropriate to administer over the counter medicines – parents can provide this consent.
For queries please email abigailcowan@nhs.net
Prescribing ‘Specials’ Medication
‘Specials’ are unlicensed products and have not been assessed by the regulatory authority for safety, quality and efficacy in the same way as licensed products. This means that the quality, bioavailability and consistency can vary even where the same product is prescribed. ‘Specials’ are often considerably more expensive than licensed medicines and may have a short shelf-life.
Pan Mersey guidance advises on a stepped approach when considering the prescribing a ‘special’. Before deciding on whether a ‘special’ is right for your patient, please contact your MLCSU Practice Pharmacist or the MLCSU Medicines Management Team at mlcsu.prescribingadviserswirral@nhs.net
Further information can also be found at:
UKMI document: What are the therapeutic options for patients unable to take solid oral dosage forms? July 2013 provides further detail on the suggested step-wise approach to choosing a suitable formulation and suggestions options for some therapeutic areas.
A specials service to supply unlicensed medicines to children under the joint care of Alder Hey and primary care is also available. For further information please contact the Alder Hey Children’s NHS Foundation Trust Specials Team on 0151 282 4878 or the MLCU Medicines Management Team.
Brexit and Supply of Medicines
The Department of Health and Social Care (DHSC) has been leading contingency planning and work is well advanced across all sectors of the medicines supply chain. The key message for all UK health providers (including hospitals, care homes, GPs and community pharmacies) is that they should not stockpile additional medicines beyond their business as usual stock levels. There is also no need for clinicians to write longer NHS prescriptions and the public should be discouraged from stockpiling.
The latest update from the Chief Pharmaceutical Officer, Dr Keith Ridge, can be found here.
Prescribing For Patients Living or Travelling Abroad
Wirral have adopted the Pan Mersey guidance on:
Prescribing for patients living or travelling abroad or otherwise absent from the UK.
The guidance recommends that prescribers should NOT supply treatment durations in excess of THREE MONTHS for patients who are going to live or travelling abroad or otherwise absent from the UK. Patients should make local arrangements in their country of residence for on-going medical care.
Travel vaccines: Hepatitis B, Japanese encephalitis and meningitis ACWY vaccines should not be prescribed on the NHS solely for the purpose of travel. Some vaccines e.g. cholera, diphtheria/tetanus/polio, hepatitis A and typhoid may still be administered on the NHS exclusively for the purposes of travel, if clinically appropriate, pending any future review.
Other medicines for travel: ‘Just-in case’ medication e.g. anti-diarrhoeals should also not be prescribed on the NHS.
Benzodiazepine Prescribing Guidance
Following a Coroner Regulation 28 report to prevent future deaths in relation to potential risks of suicide associated with benzodiazepine prescribing and withdrawal, Cheshire and Wirral Partnership NHS Foundation Trust have produced a ‘Communications Bulletin – 28/01/19’ to raise awareness.
The key points for prescribers are:
- All patients receiving benzodiazepines for extended periods of time should be reviewed by their prescriber on a regular basis;
- The need to consider the particular risks associated with shorter acting benzodiazepines;
- The existence and continued relevance of guidance from NICE and British Association of Psychopharmacology on prescribing/withdrawal of benzodiazepines. For further information please refer to; https://www.bap.org.uk/pdfs/BAP_Guidelines-Benzodiazepines.pdf
- The need for regular and close monitoring of patients who are gradually withdrawing from benzodiazepines;
Further guidance is also available through the National Institute of Health and Care Excellence (NICE) series of clinical knowledge summaries (CKS). https://cks.nice.org.uk/benzodiazepine-and-z-drug-withdrawal#!scenario
Rescheduling of Pregabalin and Gabapentin as Schedule 3 Controlled Drugs
From 1 April 2019, gabapentin and pregabalin will be reclassified as Schedule 3 controlled drugs under the Misuse of Drugs Regulations 2001, and Class C of the Misuse of Drugs Act 1971. This means that additional prescription requirements as per Controlled Drug Regulations will apply. How these changes will affect you are detailed in the briefing note provided by NHS England.
Although these amendments are not due to come into force until April 2019, EMIS will roll out the upgrades over the following eight weeks to ensure the changes are in place in time for the regulatory amendment.
EMIS has advised us that this communication has already been sent out to practices via the EMIS health news on the homepage RSS feed. Practices that have already received the EMIS upgrade and have been affected by this change should contact their patients and Pharmacies as soon as possible to ensure streamline delivery of their medication. A template letter that you can send to your patients informing them of the change and how it is going to affect them can be found here.
For more information, please contact EMIS Health on 03300 241 270 or informaticshelpdesk@emishealth.com
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Please click here for a summary of safety updates and SPC updates in January.
Tapentadol (Palexia): risk of seizures and reports of serotonin syndrome when co-administered with other medicines
Medicines and Healthcare products Regulatory Agency | 10 January 2019
A safety alert has been issued, advising Seizure (SZ) risk is a recognised adverse reaction for all opioids. However, a recent review of safety data for tapentadol in EU identified need for strengthened advice about this risk. It should be prescribed with care in patients with a history of SZ disorders or epilepsy.
https://www.gov.uk/drug-safety-update/tapentadol-palexia-risk-of-seizures-and-reports-of-serotonin-syndrome-when-co-administered-with-other-medicines
Free Style Libre flash glucose sensor – Use of barrier methods to reduce skin reactions to the sensor adhesive
Medicines and Healthcare products Regulatory Agency | 29 January 2019
Manufactured by Abbott – some users who are experiencing an immune response to the adhesive are applying creams, patches or sprays under their sensor to reduce skin reactions, which may affect device performance.
https://www.cas.mhra.gov.uk/ViewAndAcknowledgment/viewAlert.aspx?AlertID=102829
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NICE Guidance January 2019
There have been two guidelines published in January 2019 by the National Institute for Clinical Excellence which has impact upon primary care.
The renal and ureteric stones guideline has been published. The guideline covers the assessment and management of renal and ureteric stones. The aim of the guideline is to improve the detection, clearance and prevention of stones, helping to reduce pain and anxiety along with improving quality of life.
The cerebral palsy in adults guideline has been published and covers the care and support for adults with the condition. The guideline aims to improve health and wellbeing, promote access to services and support participation and independent living.
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
CKS Updates January 2019
During the month of January 2019, the following Clinical Knowledge Summaries were published or updated:
There have been minor restructures to the topics listed above. The most significant changes have been made to the Depression – antenatal and postnatal topic. A section on prevalence has been added and the management recommendations have been updated in line with NICE. The febrile seizure topic has had assessment and differential diagnosis sections included and the management recommendations have been updated in line with current literature. The two feverish children topics have it’s sections on prevalence and management recommendations updated in line with current literature.
Clinicians can use the updated and new information when reviewing patients.
Useful Resources
Medicines shortages resources - Briefing for prescribers
Please click here for information about medicines supply shortages. The information is aimed at GPs, CCGs and other NHS prescribers
Interim guidance on FMD alerts
The UK False Medicines Directive (FMD) Working Group for Community Pharmacy has published interim guidance for pharmacy teams on dealing with FMD alerts generated when products are scanned. Please click here to view the full guidance
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