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Welcome to September'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
RED AVATROMBOPAG tablets (Doptelet®▼) for treating severe thrombocytopenia in adults with chronic liver disease having planned invasive procedures
The Pan Mersey Area Prescribing Committee recommends the prescribing of AVATROMBOPAG tablets (Doptelet®▼), by specialists only, for treating severe thrombocytopenia in adults with chronic liver disease having planned invasive procedures in accordance with NICE TA626.
RED FREMANEZUMAB injection (Ajovy®▼) for prophylaxis of migraine
The Pan Mersey Area Prescribing Committee recommends the prescribing of FREMANEZUMAB injection (Ajovy®▼), by specialists only, for prevention of migraine in accordance with NICE TA631.
RED USTEKINUMAB solution for injection (Stelara®) for ulcerative colitis
The Pan Mersey Area Prescribing Committee recommends the prescribing of USTEKINUMAB solution for injection (Stelara®), by specialists only, for moderately to severely active ulcerative colitis in accordance with NICE TA633.
GREY BROLUCIZUMAB solution for injection (Beovu®▼) for neovascular (wet) age-related macular degeneration
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of BROLUCIZUMAB solution for injection (Beovu®▼) for neovascular (wet) age-related macular degeneration.
GREY DIENOGEST tablets (Zalkya®▼) for endometriosis
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of DIENOGEST tablets (Zalkya®▼) for endometriosis.
GREY IXEKIZUMAB solution for injection (Taltz®▼) for axial spondyloarthritis
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of IXEKIZUMAB solution for injection (Taltz®▼) for axial spondyloarthritis.
GREY ROMOSOZUMAB solution for injection (EVENITY®▼) for severe osteoporosis in postmenopausal women
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of ROMOSOZUMAB solution for injection (EVENITY®▼) for treatment of severe osteoporosis in postmenopausal women.
GREY SECUKINUMAB solution for injection (Cosentyx®) for non-radiographic axial spondyloarthritis
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of SECUKINUMAB solution for injection (Cosentyx®) for non-radiographic axial spondyloarthritis.
Formulary and guidelines
RED Inflammatory bowel disease guidelines
Guidelines for the use of high cost drugs. Minor update to include ustekinumab for ulcerative colitis in accordance with NICE TA 633.
Adult Asthma Guidelines
Update in line with the British Thoracic Society guidelines.
Sunscreen guideline
Routine review with minor updates. Moved to the static list.
AMBER Sterimar RAG rating
When recommended by an ENT consultant for patients with chronic rhinosinusitis after first-line options, including self-care have been tried. Remains RED for post-operative use.
Headache pathway
Update to existing primary care headache pathway produced by The Walton Centre. The majority of the amendments are in migraine prophylaxis advice section, with a few minor wording amendments throughout the document.
Shared Care
AMBER INITIATED Denosumab prescribing support information
Routine review with minor amendments and the addition of a template letter.
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The Midlands and Lancashire CSU has a dedicated COVID-19 webpage which is updated daily.
Please note that this information is up to date at the time of publication.
The list of resources will be updated as new material becomes available so please check back regularly for updates.
This page groups the resources by subject matter. The same list of resources is also available grouped by the organisation that issued it.
COVID-19 Resources
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Please click here for a full summary of safety updates and SPC updates in July and August.
Safe use of emollient skin creams to treat dry skin conditions
03 August 2020
Dried-on emollients, transferred from skin onto clothing, bedding and bandages, have been shown to make fabric more flammable. The resulting fire may result in serious injury or death, therefore the MHRA is warning for anyone using emollients to avoid any naked flame/smoking.
Steroid Emergency Card To Support Early Recognition And Treatment Of Adrenal Crisis In Adults
10 August 2020
The alert asks providers to ensure all eligible patients are issued with a Steroid Emergency Card; and to put processes in place to check if a patient has a Steroid Emergency Card ahead of any emergency treatment, elective surgery, or other invasive procedures.
NPSA Rapid Response Report: Preventing fatalities from medication loading doses. A UKMI risk assessment tool to support local implementation
17 August 2020
This updated document, which supports the NPSA rapid response report on preventing fatalities from medication loading doses, provides a comprehensive list of medications for which a loading dose is given in routine clinical practice.
Lithium Carbonate (Priadel) 200mg And 400mg Modified Release Tablets - Supply Disruption
21 August 2020
Priadel® (lithium carbonate) 200mg and 400mg modified-release tablets are being discontinued in the UK and remaining supplies of both strengths are expected to be exhausted by April 2021. This alert contains advice on the management of impacted patients.
Isotretinoin (Roaccutane▼): reminder of important risks and precautions
26 August 2020
We remind healthcare professionals that isotretinoin should only be used for severe forms of acne resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy. Prescription of isotretinoin should be supervised by specialist dermatologists with a full understanding of the potential risks and monitoring requirements.
Click here for full summary.
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NICE Guidelines July 2020
There has been two COVID-19 rapid guidelines and one medtech innovation briefing published in July 2020 by the National Institute for Clinical Excellence which has impact upon primary care.
The COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders guideline has been updated and published. The guideline aims to maximise the safety of children and adults with rheumatological autoimmune, inflammatory and metabolic bone disorders during the COVID-19 pandemic. This update highlights the possible risk of adrenal crisis for patients on long-term corticosteroids.
The COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services guideline has been published. The guideline aims to help healthcare professionals deliver efficient planned care while minimising the risk of COVID-19 in the context of increasing or decreasing local prevalence. The guideline also aims to help patients make decisions about their planned care. It includes recommendations on social distancing and hand hygiene measures prior to planned care.
The Prontosan for acute and chronic wounds medtech innovation briefing has been published. The innovation briefing notes that the intended place in therapy would be as an alternative to saline or water to cleanse wounds during dressing changes. The available evidence indicates that Prontosan is likely to be better than saline for treating acute and chronic wounds, but it is noted that the studies were of short duration and there could be significant resource implications depending on product type and quantity used.
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
NICE Guidelines August 2020
There has been one guideline and one COVID-19 rapid guideline published in August 2020 by the National Institute for Clinical Excellence which has impact upon primary care.
The Surgical site infections: prevention and treatment guideline has been updated and published. The guideline covers the prevention and treatment of surgical site infections in adults, young people and children who are having a surgical procedure. The update also links to new guidance on perioperative care.
The COVID-19 rapid guideline: children and young people who are immunocompromised guideline has been updated and published. The guideline aims to maximise the safety of children and young people who are immunocompromised during the COVID-19 pandemic. It also aims to protect staff from infection and enable services to make the best use of NHS resources.
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
CKS Updates July 2020
During the month of July 2020, the following Clinical Knowledge Summaries were published or updated:
The Vitiligo topic has undergone a major restructure and recommendations have been updated in line with current evidence. The topic has now moved in line with the CKS layout and the prescribing information section directs readers to the CKS topic Corticosteroids – topical (skin), nose and eyes.
Clinicians can use the updated and new information when reviewing patients.
CKS Updates August 2020
During the month of August 2020, the following Clinical Knowledge Summaries were published or updated:
Analgesia - mild-to-moderate pain
Appendicitis
Constipation in children
HIV infection and AIDS
Meningitis - bacterial meningitis and meningococcal disease
Restless legs syndrome
All the above topics have been reviewed and have undergone minor restructuring. The diagnosis section of the Appendicitis topic has been significantly restructured. The HIV infection and AIDS topic has also been updated to include information on the use of pre-exposure prophylaxis.
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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