Issue 12 - February 2018
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Welcome to the February edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire Commissioning Support Unit.


Formulary Update


BLACK COLLAGENASE CLOSTRIDIUM HISTOLYTICUM injection (Xiapex®) for Peyronie's disease 
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of COLLAGENASE CLOSTRIDIUM HISTOLYTICUM injection (Xiapex®) for Peyronie's disease.

BLACK DOXAZOSIN modified release (M/R) tablets (All Brands)
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of DOXAZOSIN modified release (M/R) tablets (All Brands)

BLACK LIRAGLUTIDE (Saxenda®▼) for weight management
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of LIRAGLUTIDE (Saxenda®▼) 6mg/ml solution for subcutaneous injection for weight management.

BLACK NALTREXONE/BUPROPION prolonged-release tablets (Mysimba®▼) 
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of NALTREXONE-BUPROPION 8 mg/90 mg prolonged-release tablets (Mysimba®▼) for managing overweight and obesity in accordance with NICE TA494.

RED GOLIMUMAB INJECTION (Simponi®) in non-radiographic axial spondyloarthritis
The Pan Mersey Area Prescribing Committee recommends the prescribing of golimumab injection (Simponi®), by specialists only, for non-radiographic axial spondyloarthritis in accordance with NICE TA497.

AMBER IVABRADINE (Procoralan®) for the treatment of chronic heart failure 
Ivabradine has been approved by NICE (TA 267)1 as an option for treating chronic heart failure following specialist initiation in patients with chronic, stable heart failure (NYHA class II-IV), left ventricular systolic dysfunction (LVEF 35% or less) and who are in sinus rhythm with a heart rate of 75 beats per minute or more.

GREEN NALOXEGOL Tablets (Moventig®▼) 
The Pan Mersey Area Prescribing Committee recommends the prescribing of NALOXEGOL Tablets (Moventig®▼) as an option for treating opioid induced constipation in adults in accordance with NICE TA345 (22nd July 2015).

The Pan Mersey Area Prescribing Committee recommends the prescribing of ROSUVASTATIN TABLETS tablets ONLY where no other statin is suitable.


Ankylosing spondyliltis and non-radiographic axial spondyloarthritis
Issued: January 2018 Review: January 2021

Constipation, chronic, management of adult patients in primary care

Issued: January 2018 | Review: January 2021

Gout, management of, British Society for Rheumatology Guideline
Issued: July 2017

Prescribing for patients living or travelling abroad or otherwise absent from the UK
Pan Mersey Area Prescribing Committee recommends that prescribers should NOT supply treatment durations in excess of THREE MONTHS for patients who are going to live or travelling abroad or otherwise absent from the UK. Patients should make local arrangements in their country of residence for on-going medical care.

Sequential use of biological agents in the management of Psoriasis in adults
Issued: January 2018 | Review: January 2021

Prescribing support

Atypical antipsychotics
Issued: January 2018 Review: January 2021
Prescribing support information
Request for discharge
Request for prescribing

Issued: January 2018 | Review: January 2021
Prescribing support information
GP letter

Nitrazepam for the treatment of epilepsy in children
Issued: January 2018 | Review: January 2021

Antimicrobial guide

Gastrointestinal infections

Respiratory tract infections

Safety Update

For more information on the updates listed below, please click here.

Drug interactions with senna or salbutamol increasing the risk of torsade de pointes
Specialist Pharmacy Service| 05 Feb 2018
This memo for prescribers and pharmacy staff has been produced in response to questions from primary care prescribers and pharmacists concerned about seemingly innocuous drug combinations flagged up on prescribing systems.

Sodium valproate prescribing data
NHS Business Services Authority | Jan 2018
This report aims to identify the number of female patients of child bearing age that have received prescriptions for sodium valproate. This data will be produced every 6 months to contribute to the monitoring of effectiveness of actions to ensure safe and appropriate use of sodium valproate.

Changes to Ribena to reduce sugar levels
Royal Pharmaceutical Society | 07 Feb 2018
Lucozade Ribena Suntory are reducing the sugar content of Ribena Blackcurrant (Ready To Drink and squash by approximately 55%). Pharmacists should be aware of this change as Ribena Blackcurrant is sometimes used by people with diabetes to help manage their blood sugar levels.

Esmya (Ulipristal Acetate) For Uterine Fibroids: Monitor Liver Function In Current And Recent Users; Do Not Initiate Treatment In New Users Or Those Between Treatment Courses
Central Alerting System | 09 Feb 2018
This letter is to inform you of temporary safety measures for the medicine Esmya (ulipristal acetate) indicated for pre-operative and intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age.The emergency contraceptive ellaOne also contains ulipristal acetate (single-dose, 30mg). No cases of serious liver injury have been reported with ellaOne and there are no concerns with this medicine at this time.

Fencino (fentanyl) patches
Ethypharm | 01 Feb 2018
This letter highlights the potential presence of crystals on some patches. They are embedded in the matrix, do not break off by themselves and there is no evidence that the crystals cause skin irritation and there are no patient safety concerns.

PRAC recommends new measures to avoid valproate exposure in pregnancy
European Medicines Agency | 09 Feb 2018
PRAC recommend a new pregnancy prevention programme. They also recommend inclusion of a visual warning about the risks in pregnancy on the packaging, as well as a patient reminder card for pharmacists to discuss with the patient at the time of dispensing.

PRAC recommends updating measures for pregnancy prevention during retinoid use
European Medicines Agency | 09 Feb 2018
PRAC has now updated and harmonised the pregnancy prevention programme for these medicines across the EU.

SPC Updates here

Case Study for Shared Learning

Electronic Prescription Service (EPS) Incident

Following a home visit, a GP sent a prescription for amoxicillin 500mg to a community pharmacy via EPS for a patient. The EPS token was sent to print but it was not clear if it was printed and no label was created. Hence the PMR did not show the visual alert for delivery. There was no record of a verbal request from the GP, patient or patients family requesting the antibiotics for urgent delivery, hence medication was not dispensed or supplied.
The patient collapsed five days later and was rushed to hospital. The patient sadly passed away due to sepsis three days later. The pharmacy superintendent has shared details of the incident across organisations to make them aware of learning from this incident. The learning point for this is “EPS system does not allow urgent prescriptions to be highlighted to the receiving pharmacy when sent from a GP system” (not dependent on the PMR supplier the pharmacy uses) and “A phone call is required for urgent prescriptions to the pharmacy team”. NHS Digital are currently reviewing the options available to support the identification of clinically urgent prescriptions.

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 issues update for primary care February 2018

New Issues

Menadiol tablets

Alliance, the sole supplier is likely to be out of stock from mid-January until October 2018. They will be supplying an unlicensed special however this will not be available until the end of February 2018 and there will be a gap of approximately a month before supplies of the special will be available. The special is the same formulation as the licensed product. Please find an information sheet which was drawn up about the special product.

UKMI have drafted a shortages memo, which will provide advice on alternatives, this is available on the SPS website:

The suppliers of the alternatives are aware of Alliance’s issue and they are working to ensure they maintain supplies during this time. Suggested alternatives are listed below but decisions will need to be taken by specialities locally as to the most appropriate product for their patients:

Licensed alternatives identified:
  • Phytomenadione 2 mg/0.2 ml (Konakion MM Paediatric)
  • Phytomenadione 10mg/1ml (Konakion MM)
  • Phytomenadione 1mg capsule (Neokay)

Unlicensed alternatives identified:
  • Phytomenadione 10mg tablet (from Denmark, brand name Menadion)
  • Phytomenadione oral drops 20mg/1ml (from Germany, brand name KA-VIT®).
  • DEKAs® multivitamin and mineral dietary supplements

Soltel CFC-free inhaler 25mcg

The brand Soltel CFC - free inhaler is used as an alternative in some localities to generic salmeterol 25mcg pMDI. Kent Pharmaceuticals have confirmed that their product, Soltel, will be out of stock until 4th March 2018 due to a delay with the manufacturers who are waiting on the patient information leaflet. There is no residual stock at any of the wholesalers.


Hydrocortisone injection:
Concordia will be out of stock of hydrocortisone sodium phosphate injection 100mg/ml (formerly marketed as Efcortesol) until some point in 2018. Solu-Cortef (hydrocortisone sodium succinate) 100mg, manufactured by Pfizer, is considered an acceptable alternative during this time. Solu-Cortef is currently available and Pfizer are aware of the supply issues with Concordia’s hydrocortisone injection.

There are differences in the formulation and administration between these two products, the following guidance provides further information about the administration of Solu-Cortef:
Additional information on the use of Solu-Cortef injection can also be found on these sites:

Acetazolamide MR:

Concordia have advised that supplies of Diamox MR will not be available until Mid-March 2018. Teva have advised that supplies of Eytazox Cap 250mg M/R will not be available until Mid-March 2018. In the interim immediate release acetazolamide 250mg tables are available from both Teva and Concordia.

Lacidipine 2mg and 4mg:

Due to a combination of manufacturing and regulatory issues, there are currently some supply issues with the generic version of this product. Manufacturers GSK have good supplies of the brand, Motens in both 2mg and 4mg strength.

Tranexamic acid:

There are ongoing supply issues due to difficulty in obtaining the raw materials. Supplies of both the generic and branded preparations are limited. UKMI have provided the following shortage memo which advises on alternatives


Menveo (meningitis ACWY):

GSK will be out of stock from the end of January and the date when supplies will resume has not yet been confirmed. Pfizer have confirmed they are able to support increased demand with their product Nimenrix.

For updates on other vaccine supply position, please refer to PHE’s Vaccine Update Bulletin 


Typhoid vaccine:
  • GSK has been out of stock of Typherix (Typhoid) Hepatyrix (combined Hepatitis A and Typhoid vaccine) since May 2017. They have now issued a public statement to confirm they will be discontinuing both vaccines globally.
  • Sanofi Pasteur: Typhim is available to order without restrictions.
  • PaxVax: Vivotif is available.

Cardene SR (nicardipine) (Astellas):
  • Cardene SR is being discontinued in January 2018. Nicardipine immediate release remains available and a number of other therapeutic alternatives.

Isotrex (isotretinoin) gel (GSK):
  • GSK discontinued Isotrex gel in February 2017 but have informed us that it is now out of stock. Alternative products remain available.

Izinova (sodium sulfate, anhydrous, magnesium sulfate heptahydrate & potassium sulfate) concentrate for oral solution (Ipsen):
  • Izinova is being discontinued at the end December 2017 due to problems with a third-party manufacturer. Therapeutic alternatives remain available.

Daklinza (daclatasvir) 90mg tablets (BMS):
  • BMS is discontinuing Daklinza (daclatasvir) 90mg tablets from the EU market in December 2017 as part of a portfolio rationalisation process. The company has confirmed that the 30mg & 60mg presentations will remain available. Daklinza is indicated for the treatment of chronic Hepatitis C and the recommended dose is 60mg (alternate dosage regimens can be managed by the remaining strengths).

Fosamax (alendronic acid) 10mg tablets (MSD):
  • MSD plans to discontinue Fosamax (alendronic acid) 10mg tablets with immediate effect from the UK market as part of a portfolio rationalisation process. Fosamax Once Weekly and generic alendronic acid 10mg tablets remain available.

Nizatidine 150mg capsules (Flynn):
  • Flynn plans to discontinue Nizatidine 150mg capsules with immediate effect from the UK market. Generic Nizatidine 150mg capsules remain available from other suppliers.

Drug tariff 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 that impact upon primary care.

New NICE guideline on Age-related macular degeneration covers new recommendations on the classification, risk factors as well as management and monitoring of the condition. The guidelines also include criteria for referral in primary care. The objective is to improve the promptness of diagnosis and prevent loss of sight in patients.

Action: Clinicians should be aware of this new guidance and implement any necessary changes to practice.

CKS Updates

There are no CKS Updates for January 2018
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.

Kieron Donlon: - 0151 296 7076

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

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