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Issue 44 - April 2021
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Welcome to April's edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.

Contents

Formulary Update

New medicines
 
NICE recommends baricitinib as an option for treating moderate to severe atopic dermatitis in adultsPBR excluded high cost drug, for specialist use only.  
NICE recommends filgotinib as an option for treating active moderate to severe RA in adultsPBR excluded high cost drug, for specialist use only.  
NICE recommends dapagliflozin as an option for treating symptomatic chronic heart failure with reduced ejection fraction in adults. Prescribing and monitoring of dapagliflozin must be retained by the heart failure specialist until the patient’s heart failure regimen and, for diabetic patients, their diabetes regimen, are considered stable. The specialist can then request that the GP continues prescribing. 
Not recommended until NICE TA published. 
Not recommended until NICE TA published. 
Not recommended until NICE TA published. 
Not recommended until NICE TA published


Formulary and Guidelines
Addition of subcutaneous formulation to formulary in addition to intravenous formulation. No significant cost impact. 
Addition of subcutaneous formulation to formulary in addition to intravenous formulation. No significant cost impact. 
Statement updated to include Freestyle Libre 2 upgraded version of flash glucose monitoring sensors. Cost identical to original Freestyle Libre sensors 
NHSE Accelerated Access Collaborative document - Pan Mersey endorsement of the document and addition of link to the document from the APC website.  
NHSE Accelerated Access Collaborative document - Pan Mersey endorsement of the document and addition of link to the document from the APC website.  


Shared Care
 
Additional bullet point to be added to the Primary Care Responsibilities section in Appendix 1 of the shared care frameworks 

COVID-19

The Midlands and Lancashire CSU has a dedicated COVID-19 webpage.

The list of resources will be updated as new material becomes available so please check back regularly for updates.

Please note that the information is up to date at the time of publication.



COVID-19 Resources

Safety Update

Please click here for a full summary of safety updates and SPC updates in March.

Guidance on issuing the Steroid Emergency Card
02 March 2021
The Society for Endocrinology, Specialist Pharmacy Service (SPS) and the British Association of Dermatology has produced more detailed guidance for use by primary and secondary care providers as necessary to implement the National Patient Safety Alert in a more consistent way.


How to minimise the risks of medication errors with rivastigmine patches
31 March 2021
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.

Prescribing News

NICE Guidelines March 2021

There have been four guidelines published in March 2021 by the National Institute for Clinical Excellence which has impact upon primary care.

The Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing has been published. The guideline sets out an antimicrobial prescribing strategy for secondary bacterial infection of eczema and covers infection of other common skin conditions. The guideline aims to optimise antibiotic use and reduce antibiotic resistance.

The Atopic eczema in under 12s: diagnosis and management guideline has been updated and published. The update links to the new guideline covering management of secondary bacterial infection of eczema.

The Asthma: diagnosis, monitoring and chronic asthma management guideline has been updated and published. The guideline aims to improve the accuracy of diagnosis, help people to control their asthma and reduce risk of asthma attacks.
 
The Cannabis-based medicinal products guideline has been updated and published. The update clarified recommendations for the use of unlicensed cannabis-based medicinal products for severe treatment-resistant epilepsy.
 
Clinicians should be aware of this guideline and implement any necessary changes to their practice. 


CKS Updates March 2021

During the month of March 2021, the following Clinical Knowledge Summaries were published or updated: The Platelets – abnormal counts and cancer topic is new. All of the other above topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Contraception -progestogen only methods topics have had references to retired QOF indicators removed and have been updated in line with the Faculty of Sexual and Reproductive Healthcare (FSRH) guidance. section for the Itch – widespread topic. The Itch- widespread topic has been updated to recommend the use of non-sedating oral histamines first line unless there is a history of troublesome nocturnal itch and as a result new sections on cetirizine, loratadine and fexofenadine have been added to the prescribing information section.

Clinicians should be aware of these guidelines and implement any necessary changes to their practice. 

The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog at www.prescriber.org.uk

Drug Availability

Products in Short Supply and Product Discontinuations

The following links provide prescribers with up to date information on commonly prescribed products which are currently in short supply from the manufacturers.
 

The information held on these lists is not exhaustive. Availability can vary geographically and also between wholesalers. Up-to-date information should be sought from manufacturers, local community pharmacies and suppliers.


Supply Issue Update for Primary and Secondary Care

Registered users can access the monthly drug availability update for primary and secondary care produced by the Department for Health and Social Care (DHSC), on the Specialist Pharmacy Service (SPS) website. 

Please note you must be registered with SPS, with the relevant permissions, and logged in to view this page. Click on ‘sign in’ in the top right hand.

Drug Tariff Price Changes

Drug tariff price changes are summarised as the top 10 price reductions and top 10 price increases since last month, the top 25 increases and decreases compared to three months ago, and the top 50 changes since last year. 

Drug tariff price changes in March 

Antimicrobial Update

Please click here for a full summary of antimicrobial related guidelines and SPC updates in March.
Please note that the information in this newsletter is correct at the time of publication.
Clinicians should always refer to the most up to date information.

Contacts
Kieron Donlon: kieron.donlon1@nhs.net - 0151 296 7076


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