Welcome to the May edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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New Medicines
GREY BUDESONIDE orodispersible tablets (Jorveza®▼) for eosinophilic oesophagitis
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of BUDESONIDE orodispersible tablets (Jorveza®▼) for eosinophilic oesophagitis.
https://www.panmerseyapc.nhs.uk/media/2190/budesonide.pdf
GREY DAPAGLIFLOZIN tablets (Forxiga®) in combination with insulin for the treatment of Type 1 Diabetes Mellitus
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DAPAGLIFLOZIN tablets (Forxiga®) in combination with insulin for the treatment of Type 1 Diabetes Mellitus.
https://www.panmerseyapc.nhs.uk/media/2192/dapagliflozin_type1.pdf
GREY FLUOCINOLONE intravitreal implant (Iluvien®)
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of FLUOCINOLONE intravitreal implant (Iluvien®) for non-infectious uveitis.
https://www.panmerseyapc.nhs.uk/media/2191/fluocinolone_uveitis.pdf
GREY MELATONIN prolonged-release tablets (Slenyto®) for the treatment of insomnia in children
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of MELATONIN prolonged-release tablets (Slenyto®) for the treatment of insomnia in children with neurodevelopmental conditions.
https://www.panmerseyapc.nhs.uk/media/2193/melatonin_slenyto.pdf
RED PITOLISANT Tablets (Wakix®▼)
The Pan Mersey Area Prescribing Committee recommends the prescribing of PITOLISANT tablets (Wakix®▼), by specialists working in a regional and national tertiary commissioned sleep service only, for the treatment of Narcolepsy with or without cataplexy in those who are contraindicated or have not tolerated other standard treatments.
https://www.panmerseyapc.nhs.uk/media/2180/pitolisant.pdf
RED SODIUM OXYBATE Oral Solution (Xyrem®)
The Pan Mersey Area Prescribing Committee recommends SODIUM OXYBATE oral solution (Xyrem®) as a treatment option for Narcolepsy with cataplexy in adult patients only when recommended by a consultant in a specialist commissioned sleep service.
https://www.panmerseyapc.nhs.uk/media/2179/sodiumoxybate.pdf
Formulary
BLACK Ascorbic acid tablets
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of ASCORBIC ACID for any indication, other than scurvy.
https://www.panmerseyapc.nhs.uk/media/2173/ascorbicacid.pdf
BLACK Lactase enzyme drops 50,000 units/g (Colief®)
The Pan-Mersey Area Prescribing Committee recommends that Lactase Enzyme Drops 50,000 units/g (Colief®) are not prescribed on the NHS. Patients are advised to purchase Colief® if they wish.
https://www.panmerseyapc.nhs.uk/media/2172/lactase.pdf
RED Drugs used in medically assisted reproduction
Clarification that use of any drug in medically assisted reproduction is designated red, even where the drug has an alternative designation for other indications.
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=7
AMBER INITIATED Aviptadil 25micrograms + phentolamine 2mg intracavernosal injection (Invicorp®)
Additional option to alprostadil in treatment of erectile dysfunction where oral therapy unsuitable.
http://formulary.panmerseyapc.nhs.uk/searchresults.asp?SearchVar=aviptadil
AMBER INITIATED Hydrocortisone granules 0.5mg, 1mg, 2mg and 5mg (Alkindi®)
Licensed formulation for use instead of unlicensed “special”. The unlicensed “special” to be retained for children requiring dose increments of less than 0.5mg.
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=6
GREEN Calcium carbonate 750 mg + colecalciferol 200 units caplets
Additional formulation for patients who cannot swallow/ chew higher dose formulations.
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=9
GREEN Ibuprofen and naproxen oral formulations
The Pan Mersey Area Prescribing Committee recommends the prescribing of IBUPROFEN (low dose) and NAPROXEN (low dose) as the non-steroidal anti-inflammatory drugs (NSAIDs) of choice, if an NSAID is appropriate.
https://www.panmerseyapc.nhs.uk/media/2174/ibuprofennaproxen.pdf
GREEN Preferred choice direct – acting oral anti-coagulant (DOAC)
The Pan Mersey APC recommends, in the absence of a specific clinical reason to select a particular DOAC, that the least costly DOAC is the first line DOAC for patients with non-valvular AF. Currently this is edoxaban.
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=2
Chapter 3 Respiratory system
Routine update and Wirral have now adopted this chapter of the Pan Mersey formulary
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=3
Chapter 12 Ear, nose and oropharynx
Routine update and Wirral have now adopted this chapter of the Pan Mersey formulary.
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=12
Definitions and Criteria for the Categorisation of Medicines in Pan Mersey
Updated to reflect that specialists may be located in specifically commissioned services in community settings, as well as hospitals.
https://www.panmerseyapc.nhs.uk/media/1393/rag_criteria.pdf
Guidelines
AMBER INITIATED Insulin – criteria for transfer of prescribing to primary care
Before requesting that Primary Care take over prescribing of newly initiated insulin the specialist team must be assured that the patient is willing, competent and trained to: administer the insulin (or District Nurse arranged); if and when required amend the dose of the insulin, either with the support of their diabetes HCP or independently.
During this time prior to requesting Primary Care take over prescribing, the specialist team must maintain clinical responsibility, review the patient (either face to face or by telephone) and prescribe the insulin and administration devices for: a minimum of 4 weeks supply; OR a supply length that allows enough time for the patient to be reviewed by the specialist team, whichever of the above is the longer copy of the final review must be sent to the primary care prescriber with the request for transfer of prescribing.’.
http://formulary.panmerseyapc.nhs.uk/chaptersSub.asp?FormularySectionID=6
Asthma guideline in primary care – adults
Updated guideline based on current BTS/SIGN British Asthma guideline in preference to NICE guideline.
https://www.panmerseyapc.nhs.uk/media/2171/asthma_adult.pdf
Paediatric chronic pain guideline
Incorporation of previously agreed restrictions on use of lidocaine plaster into the paediatric chronic pain guideline.
https://www.panmerseyapc.nhs.uk/media/2175/pain_children.pdf
Safety
PARAFFIN-BASED EMOLLIENTS: fire risk
The Pan Mersey Area Prescribing Committee recommends that the risk of fire should be considered when issuing paraffin-based emollient preparations.
https://www.panmerseyapc.nhs.uk/media/2170/emollient_firerisk.pdf
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Current Antimicrobial Guide
This is just a reminder to all Wirral prescribers to use the ‘Pan Mersey Antimicrobial Guide’ which is available at;
http://formulary.panmerseyapc.nhs.uk/chapters.asp - please scroll down and click on ‘Antimicrobial Guide’. This guidance is regularly updated – for quick access please add it to your desktop.
The old paper copies of the Wirral Antimicrobial Guidelines are now out of date – please discard of them.
For any queries please contact abigailcowan@nhs.net from the Medicines Management and Optimisation Team.
TARGET Antibiotic Leaflets – GP Practices
Over this month, the Medicines Optimisation Team will be delivering printed TARGET antibiotic leaflets to all Wirral GP Practices for prescribers to hand out to patients to support the reduction of antibiotic prescribing and antimicrobial resistance. Each practice will be receiving 100 copies of each leaflet.
The leaflets are the most up-to-date versions of;
- Treating Your Infection – Respiratory Tract Infection (RTI)
- Treating Your Infection – Urinary Tract Infection (UTI)
For information - TARGET stands for: Treat Antibiotics Responsibly, Guidance, Education, Tools. The TARGET toolkit helps influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing. It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use, helping to fulfil CPD and revalidation requirements.
Please see the link for further information and electronic (PDF) copies of the leaflets for your records - https://www.rcgp.org.uk/TARGETantibiotics (scroll down the page for leaflets)
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Please click here for a summary of safety updates and SPC updates in March.
Methotrexate: updated recommendations for conception and contraception
BNF eNewsletter | 01 Apr
Manufacturer advises effective contraception during and for at least 6 months after treatment in men and women.
https://www.medicinescomplete.com/#/content/bnf/_680195013#content%2Fbnf%2F_680195013%23pot-conceptionAndContraception
How to minimise the risks of medication errors with rivastigmine patches
Specialist Pharmacy Service | 01 Apr
This updated Q&A aims to raise awareness on the types of medication errors reported with rivastigmine patches, as well as highlighting strategies to improve medication safety on the prescribing and administration of these patches.
https://www.sps.nhs.uk/wp-content/uploads/2017/03/UKMI_QA_rivastigmine-patches_March19_Final.doc
Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April
Medicines and Healthcare Regulatory Agency | 17 Apr
Under the Misuse of Drugs Act 1971, pregabalin and gabapentin are classified as Schedule 3 drugs. Healthcare professionals are advised to evaluate patients for a history of drug abuse before prescribing and observe patients for development of signs of abuse and dependence.
https://www.gov.uk/drug-safety-update/pregabalin-lyrica-gabapentin-neurontin-and-risk-of-abuse-and-dependence-new-scheduling-requirements-from-1-april
Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
Medicines and Healthcare Regulatory Agency | 17 Apr
The Annual Risk Acknowledgement Form for the valproate Pregnancy Prevention Programme has been updated and should be used during annual specialist review of all women and girls of childbearing potential on valproate medicines.
https://www.gov.uk/drug-safety-update/valproate-medicines-and-serious-harms-in-pregnancy-new-annual-risk-acknowledgement-form-and-clinical-guidance-from-professional-bodies-to-support-compliance-with-the-pregnancy-prevention-programme
Yellow fever vaccine (Stamaril) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed and those 60 years and older
Medicines and Healthcare Regulatory Agency | 17 Apr
Following two fatal adverse reactions, yellow fever vaccine must not be given to anyone with a history of thymus dysfunction or who is immunosuppressed. Due to a substantially increased risk in people aged >60 years, a careful risk assessment should be conducted.
https://www.gov.uk/drug-safety-update/yellow-fever-vaccine-stamaril-and-fatal-adverse-reactions-extreme-caution-needed-in-people-who-may-be-immunosuppressed-and-those-60-years-and-older
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NICE Guidance April 2019
There have been three guidelines published in April 2019 by the National Institute for Clinical Excellence which have an impact upon primary care.
The Urinary incontinence and pelvic organ prolapse in women has been published. The guideline covers the assessment and management of urinary incontinence and pelvic organ prolapse in women aged 18 and over. The guideline also covers the complications associated with mesh surgery for these conditions. The guideline now replaces four previous guidance documents.
The Surgical site infections: prevention and treatment guideline has been published. The guideline covers the prevention and treatment of surgical site infections in adults, young people and children who are having a surgical procedure involving a cut through the skin. In order to minimise the risk of infection, the guideline focuses on methods used before, during and after surgery.
The Ectopic pregnancy and miscarriage: diagnosis and initial management guideline has been published. The guideline covers the diagnosis and management of ectopic pregnancy and miscarriage in women with complications, such as pain and bleeding, in early pregnancy (that is, up to 13 weeks completed pregnancy). The guideline aims to improve how early pregnancy loss is diagnosed, and the support women are given, to limit the psychological impact of their loss.
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
CKS Updates April 2019
During the month of April 2019, the following Clinical Knowledge Summaries were published or updated:
All the above topics have undergone reviews and minor restructures. The use of the QRISK3 risk prediction tool has been recommended in the CVD risk assessment and management topic. A new assessment section has been added to the Chronic Kidney disease topic and more information on the management of people with diabetes mellitus and chronic kidney disease has been provided. In addition, the prescribing information section of the topic has also been updated.
Clinicians can use the updated and new information when reviewing patients.
Useful Resources
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