Issue 54 - April 2022
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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

New Medicines

BLACK  SOLRIAMFETOL HYDROCHLORIDE tablets (Sunosi®▼) for treating excessive daytime sleepiness caused by obstructive sleep apnoea 
Solriamfetol is not recommended for treating excessive daytime sleepiness caused by obstructive sleep apnoea.

RED FREMANEZUMAB injection (Ajovy®▼) for prevention of migraine  
This updates and replaces NICE TA631, which only recommended fremanezumab for use in chronic migraine. The existing Pan Mersey APC red statement in line with TA631 will be superseded by this statement. Existing CCG approvals have not been carried over. This is a PbRE (tariff-excluded) high-cost drug and is specialist only.

GREY ESKETAMINE nasal spray solution (Spravato®▼) for treatment-resistant depression  
This grey statement expired in February 2022 and the NICE TA publication date remains TBC. The expiry date of the grey statement is extended by 12 months to allow additional time for the NICE TA to be published.

GREY TOFACITINIB film-coated tablets (XELJANZ®▼) for ankylosing spondylitis  
Not recommended until NICE TA is published.

GREEN DAPAGLIFLOZIN tablets (Forxiga ®) for treating chronic kidney disease  
A green RAG rating was assigned by NMSG as it was agreed that this cohort of patients would not be under the care of a renal specialist at this stage of CKD and an amber RAG rating would create a barrier to accessing treatment.

GREEN DOXYLAMINE/PYRIDOXINE gastro-resistant tablets (Xonvea®) for the treatment of nausea and vomiting during pregnancy  
Routine review and added to the static list. No significant changes to the document and minor updates have been made in line with NICE NG201 and the SPC. Costs have been updated.

Formulary and Guidelines

AMBER RETAINED  Apomorphine injection (Dacepton® brand)
Dacepton® brand was added to the formulary in addition to the Apo-Go® brand. Ease of use of infusion device and lower cost benefits.

Shared Care
PURPLE  Disease-modifying antirheumatic drugs
Routine review that incorporated the latest safety guidance, changes in the summaries of product characteristics, the RMOC shared care frameworks and other guidance.
PURPLE Lithium shared care framework
Routine review that incorporated parts of the RMOC lithium shared care protocol and the latest NICE guidance where appropriate.


SUMMARY CARE RECORD: minimising harm from missing data
Routine review. Updated to advise that records for temporary patients will not update to the SCR and a recommendation to ensure patients are aware that ‘medication prescribed elsewhere’ will be shared on the SCR unless they have opted out.

Safety Update

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

Potential Contamination Of Alimentum And Elecare Infant Formula Food Products
04 March 2022

The recall notice provides product details and specific batch codes which may have possible contamination with Salmonella Newport and Cronobacter sakazakii. They must not be used, patients supplied these products should be contacted and products should be returned to a pharmacy.

Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision
15 March 2022

Amiodarone has been associated with serious and potentially life-threatening side effects, particularly of the lung, liver, and thyroid gland. We remind healthcare professionals that patients should be supervised and reviewed regularly during treatment.

Metformin in pregnancy: study shows no safety concerns 
15 March 2022

A large study has shown no safety issues of concern relating to the use of metformin during pregnancy. The licence for metformin now reflects that it can be considered for use during pregnancy and the periconceptional phase as an addition or an alternative to insulin, if clinically needed. This is consistent with current clinical guidance.


Prescribing News

NICE Guidance March 2022

There are five guidelines and two technology appraisals published in March 2022 by the National Institute for Clinical Excellence which has an impact on primary care.

The Mental wellbeing at work guideline has been published. The guideline aims to promote a supportive and inclusive work environment, including training and support for managers and helping people who have or are at risk of poor mental health.

The Disabled children and young people up to 25 with severe complex needs guideline has been published. It aims to encourage education, health and social care services to work together and provide more coordinated support to children and young people, and their families and carers.

The Integrated health and social care for people experiencing homelessness guideline has been published. It aims to improve access to and engagement with health and social care and ensure care is coordinated across different services.

Hypertension in adults: diagnosis and management guideline has been updated. The update includes new recommendations on blood pressure targets and antihypertensive drug treatment for people with cardiovascular disease.

The Otitis media (acute): antimicrobial prescribing guideline has been updated. The update adds a new recommendation on ear drops containing an anaesthetic and an analgesic because a licensed preparation is now available in the UK.

The Empagliflozin for treating chronic heart failure with reduced ejection fraction technology appraisal has been published. This treatment is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction in adults, only if it is used as an add-on to optimised standard care with:
  • an angiotensin-converting enzyme (ACE) inhibitor or angiotensin 2 receptor blocker (ARB), with a beta blocker and, if tolerated, a mineralocorticoid receptor antagonist (MRA), or
  • sacubitril/valsartan with a beta blocker and, if tolerated, an MRA
The Dapagliflozin for treating chronic kidney disease technology appraisal has been published. This treatment is recommended as an option for treating chronic kidney disease (CKD) in adults. It is recommended only if:
It is an add-on to optimised standard care including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated, and
  • People have an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73 m2 to 75 ml/min/1.73 m2 at the start of treatment and: ◦have type 2 diabetes or
  • Have a urine albumin-to-creatinine ratio (uACR) of 22.6 mg/mmol or more
Clinicians should be aware of this guideline and implement any necessary changes to their practice. 

CKS March 2022

During the month of March 2022, the following Clinical Knowledge Summaries were published or updated: The Rehabilitation after traumatic injury topic is new. All the remaining topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Breastfeeding problems topic contains updated to the management of suspected ductal infection section. The Cervical cancer and HPV has been updated in line with current evidence. The Molluscum contagiosum topic contains a new section on risk factors in background information.

Clinicians can use the updated and new information when reviewing patients.
The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog 
This section has been adapted from

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 Medicines Supply Tool, which provides monthly drug availability updates 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. 

Antimicrobial Update

Please see below for the antimicrobial related guidelines and click here to find SPC updates in March.

Non-antibiotic treatment of acute urinary tract infection in primary care: a qualitative study

In this qualitative study involving 26 women it was shown that in certain situations (eg mild symptoms) postponement of antibiotic treatment by up to 3 days would be acceptable, especially if offered an interim non-antibiotic option with perceived therapeutic potential.

Factors predicting amoxicillin prescribing in primary care among children: a cohort study

Cohort study (n=2,493, Bradford, 2007-2013) found during first year of life, socio-economic status (OR 1.4, 95% CI 1.0-1.9) & ethnic background (Pakistani, 1.4; 1.1-1.9) strongly linked to amoxicillin prescribing and respiratory tract infection consultations during childhood.

The Association between Vitamin D and Incident Herpes Zoster: A UK Biobank Study

Analysis (n= 177,572, mean follow-up time of 10.1 years) found no link between vitamin D status, supplementation or prescription with incident herpes zoster and thus no evidence to support vitamin D supplementation as a preventative strategy.

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:

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