Issue 2 - February, 2017
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Welcome to Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.


Formulary Update

The Medicines Clinical Guidelines Team Meeting was held on 10th February 2017. The following agenda items were discussed:

Opioid dependence algorithm

Blood Glucose Testing Strips guideline
Approved. This guideline has been updated to include the Glucomen
Areo 2k Blood Glucose and Ketone Testing meter. This is a cost effective choice for both blood glucose and ketone testing.

Neuropathic Guidelines
Approved, pending minor alteration.

NSAID Guidelines
Approved, pending minor alteration.

treatment (secondary care only)


Endocrine Formulary
Approved. Updated to include recent changes to liothyronine guidance.

Antibiotic eye chapter (secondary care only)

Shared Care

Melatonin for Children.

All guidance will be available at the Medicines Management Website in due course.

Local news

High Strength Insulin – Risk Minimisation Strategy 
Further to the approval of two additional high strength insulins (Humalog Kwikpen 200 units/ml and Tresiba 200 units/ml) at Wirral Drug & Therapeutics Panel in January, the High Strength Insulin – Risk Minimisation Strategy has been updated.  
ScriptSwitch messages have been updated to reflect these changes.
Delayed or Back-up Antibiotic Prescribing 
A Survey Monkey was disseminated to practices about delayed/back-up antibiotic prescribing in December 2016. Thank you to everyone who participated in the survey as your responses have been shared and will be used to reflect on future practice. 
As part of the survey, we asked if practices would agree to participate in a formalised pilot of delayed/back-up antibiotic prescribing.  This would be assessed by using prescribing data from before and after the pilot to see the effect a more formalised approach might have.  Medicines Management would be able to support practices by discussing the best technique for delayed/back-up antibiotic prescribing, providing READ codes, EMIS web searches and resources as necessary.  Undertaking the pilot could form part of a practice’s antibiotic prescribing action plan and should support in reducing any inappropriate antibiotic prescribing.  The outcomes of the pilot could be used for peer and self-reflection. 
Any expressions of interest or requests for further information should be sent to Victoria Vincent at
Emergency Stock Palliative Care Scheme – Reminder 
Wirral CCG commissions twelve community pharmacies to hold an enhanced list of drugs used in palliative care, intended for emergency use. These pharmacies will signpost to other pharmacies if they are unable to make a supply. 
There is information on the Medicines Management Website regarding the Palliative Care Scheme, including the list of Community Pharmacies and the stock list.

Safety Update

Access a copy of February's safety report for more information on all of the safety updates below:
  • SPC Updates:
    • Revised SPC: ZEPATIER® (elbasvir and grazoprevir) film coated tablets
    • Revised SPC: Sustanon® 250, 250mg/ml solution for injection (testosterone propionate, testosterone phenylpropionate, testosterone isocaproate, testosterone decanoate)
    • Revised SPC: APO-go® (apomorphine) products.
  • Newsletter articles:
    • Class 4 Caution in Use: Arava® 10mg film-coated tablets (Leflunomide)
    • Case Study for Shared Learning: Over-ordering of fentanyl patches via repeat prescriptions
    • Drug Alert Class 4, Bayer Plc, Mirena 20 mcg/24 Hours Intrauterine Delivery System. PL 00010/0547
    • Direct-acting antivirals to treat chronic hepatitis C: risk of interaction with vitamin K antagonists and changes in INR.
    • Apremilast (Otezla ▼): risk of suicidal thoughts and behaviour.

Drug Availability

Short Supply / Out of Stock

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.  

Price Changes

This summary document shows the top 10 price changes this month, the top 25 changes this quarter, and the top 100 this year. 
Tell me more about drug tariff price changes. 

Prescribing News

NICE Guidance

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance.
The HIV testing guideline covers how to increase the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, promote awareness of HIV testing and increase opportunities to offer testing to people who may have undiagnosed HIV.
The End of life care for infants, children and young people with life-limiting conditions guideline covers the planning and management of end of life and palliative care for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives. 
The Ticagrelor for preventing atherothrombotic events after myocardial infarction technology appraisal recommends this treatment as an option for preventing atherothrombotic events in adults who had a myocardial infarction and who are at high risk of a further event. Treatment should be stopped when clinically indicated or at a maximum of 3 years. 
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice. 

Clinical Knowledge Summaries 
The following topics have all been reviewed and updated: 
The updated shingles topic has amended recommendations with respect to the choice of drugs for neuropathic pain and also added sections on prevalence, risk factors, and differential diagnosis. There were also minor changes to the prescribing information section on antiviral drugs. The remaining changes for the other topics were minor structural changes. 
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice. 
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.

Victoria Vincent:  0151 541 5390

Copyright © 2017 Midlands & Lancashire Commissioning Support Unit, All rights reserved.

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