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New medicines
RED ANDEXANET ALFA infusion (Ondexxya®▼) for reversing anticoagulation from apixaban or rivaroxaban
Andexanet alfa is recommended for anticoagulant reversal in adults taking apixaban or rivaroxaban and only for those experiencing life threatening or uncontrolled bleeding where the bleed is in the gastrointestinal tract.
GREEN BEMPEDOIC ACID tablets (Nilemdo®▼) and BEMPEDOIC ACID-EZETIMIBE tablets (Nustendi®▼) for primary hypercholesterolaemia or mixed dyslipidaemia: a multiple prescribing statement
Bempedoic acid is only recommended when given in combination with ezetimibe, either as separate tablets or a fixed-dose combination.
Formulary and guidelines
RED Inflammatory Bowel Disease High Cost Drugs Treatment Pathway for Adults
Minor update to include the use of infliximab for acute exacerbations of ulcerative colitis. This is in the additional information box on page 3. Methotrexate and polymeric diets have been added to the top box in the Crohn’s disease pathway.
AMBER INITIATED Direct Oral Anticoagulants(DOACs) for the treatment and prevention of Deep Vein thrombosis and/or pulmonary embolism
Full review of the existing statement which follows NICE NG158 (Venous thromboembolic diseases: diagnosis, management and thrombophilia testing), published in March 2020. NICE say these new recommendations are expected to lead to increased use of DOACs, particularly apixaban and rivaroxaban, but this guidance will result in savings for the NHS.
AMBER RECOMMENDED AZITHROMYCIN tablets for prevention of exacerbations of COPD and bronchiectasis in selected high-risk patients
Routine review of the existing statement which is now based on the British Thoracic Society Guideline for Long Term Macrolide Use, published in April 2020. Some dosing and supporting evidence have been updated and a new GP letter was developed.
Shared care
AMBER RETAINED Amiodarone prescribing support information
Routine review of the existing prescribing support information and a new GP letter. 6monthly U&E monitoring as recommended in the NICE CKS on atrial fibrillation was added.
AMBER RETAINED Hydroxychloroquine prescribing support information
Routine review of the existing prescribing support information incorporating additional guidance from the Royal College of Ophthalmology guidelines published in 2020. The GP letter has also been adapted to reflect the updated guidance.
Safety
CLOZAPINE: reducing the risk of harm
New document, originally in response to an MHRA update on the risk of constipation, broadened to accommodate prescribing advice issued to GPs from specialist mental health trusts. Advice is intended to support best practice to reduce the risk of or mitigate the harms from clozapine use.
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