Issue 4 - April 2017
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Welcome to the April edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.


Formulary Update


RED  APREMILAST film coated tablets (Otezla®▼) for treating psoriatic arthritis
The Pan Mersey Area Prescribing Committee recommends the prescribing of APREMILAST film coated tablets (Otezla®▼) in specialist settings only, for treating active psoriatic arthritis in accordance with NICE TA433. Tell me more about apremilast.

GREY   BARICITINIB film-coated tablets (Olumiant®▼)
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of BARICITINIB film-coated tablets (Olumiant®▼) for the treatment of rheumatoid arthritis. Tell me more about baricitinib.

GREY LIRAGLUTIDE 6 mg/mL solution for injection (Saxenda®▼) for weight management.
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of LIRAGLUTIDE 6 mg/mL solution for injection (Saxenda®▼) for weight management. Tell me more about liraglutide.

GREEN IVERMECTIN 10mg/g cream (Soolantra®▼) 
The Pan Mersey Area Prescribing Committee recommends the prescribing of IVERMECTIN 10mg/g cream (Soolantra®▼) for second line topical treatment of moderate to severe papulopustular rosacea in adult patients. Tell me more about ivermectin.


Avoidance of Clostridium difficile infection

Clostridium difficile infection (CDI) is a leading cause of iatrogenic diarrhoea. Patients most at risk from CDI are the elderly, immunosuppressed and those with co-morbidities. Tell me more about Clostridium difficile.

Specialist Infant Formula Feeds in Lactose Intolerance and Cow's Milk Protein Allergy

This guidance covers all infants; including those who breastfeed, who are formula-fed or those who do a combination of both. Tell me more about infant formula.

SUNSCREENS - prescribing on the NHS  

The Pan Mersey Area Prescribing Committee recommends that sunscreens must only be prescribed on the NHS for patients who fit the ACBS prescribing criteria. Tell me more about sunscreens.

Prescribing Support Information

Degarelix (Firmagon®) 

This medicine has been categorised as Amber Patient Retained by the Pan-Mersey Area Prescribing Committee. Tell me more about degarelix and the GP letter.

Gonadorelin analogues

These medicines have been categorised as Amber Patient Retained for the indications in this document by the Pan-Mersey Area Prescribing Committee. They have been categorised as Red for infertility and hypersexuality. Tell me more about gonadorelin analogues and the GP letter.


Safety Update

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

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.

Please find a full list of drug product availability provided by Scriptswitch
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. 

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

NHS Prescription Charges to go up from April 2017

The Department of Health announced in March that the price for an NHS prescription in England will increase by 20p to £8.60 for each medicine or appliance dispensed, with effect from the 1st April 2017.

The prices for 3 and 12 month pre-payment certificates are frozen and have remained the same at £29.10 and £104 respectively. For anyone requiring more than 3 items in 3 months or more than 12 in a year these certificates can provide significant savings.

Other NHS charges such as for dental work, wigs and fabric supports are also being increased in line with inflation.

NICE updates for March 2017.

The Stroke and transient ischaemic attack in over 16s clinical guideline has been updated to give a definition of aspirin intolerance, rather than a link to a definition. The guideline covers interventions in the acute stage of a stroke or transient ischaemic attack (TIA). It offers the best clinical advice on the diagnosis and acute management of stroke and TIA in the 48 hours after onset of symptoms, although some interventions of up to 2 weeks are covered as well.

The Familial breast cancer clinical guideline has been updated after a review of the evidence for chemo-prevention for women with no personal history of breast cancer. The guideline covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer. It aims to improve the long-term health of these families by describing strategies to reduce the risk of and promote early detection of breast cancer (including genetic testing and mammography). It also includes advice on treatments (tamoxifen, raloxifene) and surgery (mastectomy).

Clinical Knowledge Summaries were updated in March 2017. The following topics were reviewed:
The topics have undergone minor restructures. The most significant change is that all people presenting with suspected TIA within the last week should be referred urgently (to be seen within 24 hours) to a stroke physician without risk stratification.
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
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Copyright © 2017 Midlands & Lancashire Commissioning Support Unit, All rights reserved.


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