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Welcome to January's 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 ABROCITINIB tablets (Cibinqo®▼) for atopic dermatitis
Not recommended until NICE TA published.
GREY MOMETASONE / OLOPATADINE nasal spray (Ryaltris®) for allergic rhinitis
Not recommended. This will be reviewed if a formal application for use is received and prioritised for in-year review.
RED UPADACITINIB prolonged-release tablets (RINVOQ®▼) for treating moderate rheumatoid arthritis
Red statement in line with NICE TA744 that recommends upadacitinib as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with 2 or more conventional disease modifying antirheumatic drugs, only if disease is moderate (a disease activity score [DAS28] of 3.2 to 5.1) and the company provides upadacitinib according to the commercial arrangement.
RED ANDEXANET ALFA infusion (OndexKxya®▼) for reversing anticoagulation from apixaban, edoxaban or rivaroxaban
Update to the existing red statement for use of andexanet alfa for anticoagulant reversal for apixaban and rivaroxaban in accordance with NICE TA697 to include off-label use as anticoagulant reversal for edoxaban (using the same criteria as NICE TA697).
AMBER DAPAGLIFLOZIN tablets(Forxiga ®) for symptomatic chronic heart failure with reduced ejection fraction
Updated document, change in RAG rating to amber recommended.
Formulary and Guidelines
RED Risankizumab 150 mg pen and 150 mg pre-filled syringe - psoriasis, psoriatic arthritis
Replaces 75 mg x 2 pre-filled syringe, being discontinued. Confidential NHS Patient Access Scheme (PAS) price per dose remains unchanged.
RED Tofacitinib 11mg m/r tablets (once daily formulation) - rheumatoid arthritis, psoriatic arthritis
Additional to tofacitinib 5mg twice daily formulation. Confidential NHS Patient Access Scheme (PAS) daily cost same as for the 5mg tablets.
GREEN Exenatide 2mg BCise pen prolonged-release injectable suspension – type 2 diabetes
Replaces exenatide 2 mg powder and solvent prolonged-release suspension for injection in pre-filled pen, which is discontinued. Price is unchanged.
Guidelines for Managing Malnutrition in Adults in the Community
Addition of clarification to Appendix 4 of guideline that contact with free online “direct to patient sample service” from manufacturers can only be made by health care professionals.
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Please click here for a full summary of safety updates and SPC updates in November.
16 November 2021
Emerade 300 and 500 microgram adrenaline auto-injectors have been re-supplied to the market following the implementation of corrective actions – patients and their caregivers should be provided with training and advice specific to their prescribed adrenaline auto-injector. Follow the advice in the Summary of Product Characteristics for dosing considerations and continue to reiterate to patients the importance of carrying 2 in-date adrenaline auto-injectors with them at all times.
Please click here for a full summary of safety updates and SPC updates in December.
10 December 2021
We remind healthcare professionals that elderly patients are at an increased risk of adverse neurological and cardiac effects when being treated with haloperidol for delirium. The lowest possible dose of haloperidol should be used for the shortest possible time, and cardiac and extrapyramidal adverse effects should be closely monitored.
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NICE Guidance November & December 2021
There are four guidelines and one COVID-19 rapid guideline published in November 2021 by the National Institute for Clinical Excellence which has an impact upon primary care.
The Heart valve disease presenting in adults: investigation and management guideline has been published. It covers the investigation and management of heart valve disease presenting in adults.
The Acute heart failure: diagnosis and management guideline has been updated. Recommendations on valvular surgery and percutaneous intervention have been withdrawn and replaced by the new guideline above.
Type 2 diabetes in adults: management guideline has been updated. The update reviewed the evidence and made new recommendations for SGLT2 inhibitors for adults with type 2 diabetes and chronic kidney disease.
The Chronic kidney disease: assessment and management guideline has been updated. The guidance on SGLT2 inhibitors for adults with type 2 diabetes and chronic kidney disease has been updated and links to the Type 2 diabetes in adults guideline.
The COVID-19 rapid guideline: managing the long-term effects of COVID-19 guideline has been updated. The update makes new recommendations and updates existing recommendations in several areas including identification, planning care, multidisciplinary rehabilitation, and follow-up. The list of common symptoms was also updated, emphasising that these may be different for children.
There are three guidelines and two technology appraisals published in December 2021 by the National Institute for Clinical Excellence which has an impact upon primary care.
The Headaches in Over 12s: diagnosis and management guideline has been updated. The update changed the strength of the recommendations on metoclopramide or prochlorperazine for acute migraine from ‘offer to ‘consider’, to reflect the balance of benefits and risks of these treatments.
The Suspected cancer: recognition and referral guideline has been updated. This update reviewed the evidence on fixed and age-adjusted thresholds for prostate-specific antigen testing and updated the recommendations on referral for suspected prostate cancer.
The Pelvic floor dysfunction: prevention and non-surgical management guideline has been published. The guideline covers the prevention, assessment and non-surgical management of pelvic floor dysfunction in women aged 12 and over.
The Mexiletine for treating the symptoms of myotonia in non-dystrophic myotonic disorders technology appraisal has been published. This treatment is recommended, within its marketing authorisation, as an option for treating the symptoms of myotonia in adults with non-dystrophic myotonic disorders.
The Liraglutide for managing obesity in people aged 12 to 17 years technology appraisal has been terminated due to the manufacturer not providing an evidence submission.
Clinicians should be aware of this guideline and implement any necessary changes to their practice.
CKS November 2021
During the month of November 2021, the following Clinical Knowledge Summaries were published or updated:
All the above topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Otitis externa topic has removed information on oral flucloxacillin, and clarithromycin as oral antibiotics are not routinely needed in primary care for the management of uncomplicated acute otitis externa. The Stroke and TIA topic has removed a recommendation that suspected Transient Ischaemic Attack (TIA) taking anticoagulants should not be given an immediate dose of aspirin 300mg. This intervention is likely to carry a low risk of causing or aggravating bleeding and aspirin can now be given.
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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