Issue 1 - January 2017
Welcome to the brand new format for Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.


Formulary Update


 Formulary change from alimemazine to promethazine
Alimemazine is currently 3rd line on skin formulary for pruritus or urticaria. The Skin formulary will be changed to include promethazine tablets instead of alimemazine for pruritus or urticaria. 
This will be available at the following link shortly.


AMBER Insulin Degludec 200units/ml
  • Insulin degludec is an ultra-long acting recombinant human insulin analogue.
  • The 100units/ml strength formulation is already on the Wirral formulary for selected patients.
  • The 200units/ml strength will be used in patients with diabetes where the volume of injection is causing a clinical issue e.g. pain or discomfort.
  • The Insulin High Strength Risk Minimisation Strategy should be followed. 
This will be updated following the meeting and is found at the following link.

AMBER Humalog Insulin 200units/ml Kwikpen
  • Humalog (insulin lispro) is short-acting human insulin analogue.  The 100units/ml strength formulation is already on the formulary.
  • The 200units/ml strength will be used in patients with diabetes where the volume of injection is causing a clinical issue e.g. pain or discomfort.
  • The Insulin High Strength Risk Minimisation Strategy should be followed. 
This will be updated following the meeting and is found at the following link.

RED Polyhexamethylene biguanide (PHMB) 0.02% eye drops (unlicensed preparation)
as first line for acanthamoeba keratitis usually in contact lens wearers

RED Levofloxacin 0.5% eye drops
Approved for the following indications:
  1. First line for bacterial keratitis/contact lens associated bacterial keratitis and
  2. As part of the post-operative presumed bacterial endophthalmitis treatment regime

RED Cefuroxime 5% preservative free eye drops (unlicensed preparation)
Approved as second line formulary choice for bacterial keratitis/contact lens associated bacterial keratitis.

RED Natamycin 5% eye drops (unlicensed preparation)
Approved as
 first line for fungal keratitis for lesions confined to the superficial layers of the cornea.

RED Tolvaptan (Jinarc)
Approved as per NICE (TA 358) as an option for treating Autosomal dominant polycystic kidney disease (ADPKD) to slow the progression of cyst development in adults with chronic kidney disease (CKD) stages 2 or 3 and evidence of rapidly progressing disease.

Local news

Liothyronine Joint Wirral Prescribing Guidelines
Joint Wirral guidelines on liothyronine prescribing have recently been produced and were approved at Medicines Clinical Guidelines Team (MCGT) in December. They can be found here.
The cost of liothyronine containing products in Wirral CCG from Aug 15 –July 16 was £238,036.39 for 660 items, compared with levothyroxine (tablets/capsules) at a cost of £601,851.82 for 198,229 items.
Switches from liothyronine to levothyroxine for unstable patients or those patients who have not had an adequate trial of levothyroxine have been agreed, and further detail is available in the guideline. The Medicines Management Team will support prescribers to make any appropriate changes to patients’ medication, where appropriate, over the next few weeks.

Antibiotic ScriptSwitch Messages Updated
Antibiotic ScriptSwitch messages have recently been updated to reflect the changes in the recently updated Wirral Antimicrobial Guidelines and Management of Common Infections in Primary Care.


Safety Update

For more information on the updates listed below, please click here:
  • SPC Updates
  • Safety Articles:
    • Brimonidine gel (Mirvaso®): risk of exacerbation of rosacea
    • Report suspected side effects - MHRA launches social media campaign
    • BNF November/December 2016 updates
    • Patient Safety Alert: Risk of severe harm and death due to withdrawing insulin from pen devices
    • Drug Alert Class 4 Caution In Use; Medreich; Amoxicillin Sugar-Free Suspension 250mg/5l And 125mg/5l; Pl 21880/0124 And Pl 21880/0123
    • Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia
    • Central Alerting System: Influenza Season 2016/17: Use of Antiviral Medicines
    • Cobicistat, ritonavir and co-administration with a steroid: risk of systemic corticosteroid adverse effects
  • Case Studies
    • Alert: Glass shards found in balloon gastrostomy tube balloon ports.

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 full list of Alliance healthcare's out of stock medication can be found here.

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 price changes.

Prescribing News

British Asthma Guideline Update
The British Asthma Guideline jointly published by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network has been updated. Available in a Quick Reference format or as a Full Guideline, the guideline covers diagnosis and management of asthma in adults and children. This update contains minor corrections and changes (apart from change advised to now immediately treat children under 2 years old in hospital settings with acute asthma symptoms).
Action: This guideline is a cornerstone of asthma management. Clinicians who diagnose and treat asthma should be aware of this update and have access to this guideline.

NICE Guidance - November 2016
NICE have published new or updated guidance for the month of November 2016. There are two guidelines and three technology appraisals that impact upon primary care and the full update can be accessed here.
The Hypertension in adults guideline covers identifying and treating primary hypertension in people aged 18 and over. It has been updated to include two MHRA drug safety alerts regarding ACE inhibitor use during pregnancy and breastfeeding.
The Diabetes in children and young people guideline covers the diagnosis and management of type 1 and type 2 diabetes, in children and young people aged under 18. It has been updated to add information on when eye screening should begin and referral for eye screening should happen.

Electronic Repeat Dispensing (
eRD) Awareness Campaign
NHS Digital has developed a series of materials to boost the usage of electronic repeat dispensing (
eRD) as part of a newly launched awareness campaign. The campaign will run from Nov 2016 to March 2017. As part of the campaign to combat the low uptake of eRD, a strategy has been developed to convert up to 80% of repeat prescriptions to electronic repeat dispensing prescriptions. NHS Digital have developed a suite of online support tools summarising activities, toolkits, learning resources and support material that can be accessed by clicking here.

CKS Updates - November 2016
During November 2016, two new Clinical Knowledge Summaries were added for the following:
Pharmacy Quality Payments
As part of the moves to restructure payments under the community pharmacy contract, NHSE is launching a Quality Payment Scheme. This will make £75m available to pharmacies which satisfy a range of criteria. This is the first step towards linking remuneration to quality factors, rather than dispensing volume. Quality encompasses the following dimensions: clinical effectiveness, patient safety and patient experience. For a pharmacy to become eligible for any payment under the Quality Payments Scheme it must first meet four gateway criteria. The payment will then depend on how many of the quality criteria the pharmacy achieves, these include:
  • a requirement to record and learn from incidents and share learning
  • a requirement for pharmacy staff to have undergone safeguarding training
  • patients who have collected over 6 short-acting reliever inhalers without a corticosteroid inhaler in the previous 6 months to be referred to an appropriate healthcare professional.
  • Evidence of increasing use of the summary care record.
Click here for more information.
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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