Issue 50 - November 2021
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Welcome to November's edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.


Formulary Update

New Medicines

RED LANREOTIDE solution for injection (Somatuline Autogel®) for the treatment of angioectasia
Lanreotide is a tariff-excluded PbRE drug and will be used off-label for GI bleeding due to angioectasia which cannot be managed by endoscopic treatment. It should only be used after all appropriate investigations have been undertaken and all other treatment options have been exhausted.

BLACK EVOLOCUMAB injection (Repatha SureClick®) for reduction of cardiovascular risk in adults with established atherosclerotic cardiovascular disease
Routine review of black statement at expiry, to be added to the static list. There is no new evidence to warrant a change in RAG status from black. No significant changes have been made, minor revisions include cost of statins and removal of dosage adjustments in renal impairment as per SPC.

GREEN Inclisiran injection (Leqvio®▼) for primary hypercholesterolaemia or mixed dyslipidaemia
Green statement in line with NICE TA733 that recommends inclisiran as an option for treating hypercholesterolaemia or mixed dyslipidaemia as an adjunct to diet in adults only if certain criteria are met and it is provided according to the commercial arrangement.

GREY DAPAGLIFLOZIN tablets (Forxiga®) for treating chronic kidney disease
Not recommended until NICE TA published.

GREY EMPAGLIFLOZIN tablets (Jardiance®) for treating chronic heart failure with reduced ejection fraction
Not recommended until NICE TA published

GREY ESTRADIOL 1mg / PROGESTERONE 100mg capsules (Bijuve®) for oestrogen deficiency symptoms in postmenopausal women
Not recommended. This will be reviewed if a formal application for use is received and prioritised for in-year review.

GREY RELUGOLIX 40mg / ESTRADIOL 1mg/ NORETHISTERONE 0.5mg tablets (Ryeqo®▼)  for uterine fibroids
Not recommended until NICE TA published.

GREY ROXADUSTAT tablets (Evrenzo®▼) for treatment of anaemia associated with chronic kidney disease
Not recommended until NICE TA published.

GREY TIRBANIBULIN ointment (Klisyri ®▼) for the treatment of actinic keratosis
Not recommended. This will be reviewed if a formal application for use is received and prioritised for in-year review.

GREY TRALOKINUMAB solution for injection (Adtralza® ) for treating atopic dermatitis
Not recommended until NICE TA published.

GREY UPADACITINIB prolonged-release tablets (RINVOQ® ) for treating atopic dermatitis
Not recommended until NICE TA published.

Formulary & Guidelines

Opioids and gabapentinoids for chronic pain in adults

Routine review which includes recommendations in NICE NG193 (Chronic pain, primary and secondary in over 16s), a recent Drug Safety update reporting respiratory depression with pregabalin and a link to the Pan Mersey safety guidance, Opioids: considerations for safe and effective prescribing in chronic pain.


METHOTREXATE: safe prescribing and dispensing

Routine review. The document was comprehensively re-written, but the core safety messages remain unchanged.


Safety Update

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

Emerade 300 microgram and 500 microgram adrenaline auto-injectors: re-supply to
market - important safety information

Following satisfactory implementation of corrective actions, MHRA has agreed 300 and 500 microgram strengths of Emerade adrenaline autoinjectors can be re-supplied to market in Oct 2021. Emerade 150 microgram auto-injectors will not be returning to market at this time.

Prescribing News

NICE Guidance October 2021

There is one guideline and one technology appraisal published in October 2021 by the National Institute for Clinical Excellence which has impact upon primary care.
Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia technology appraisal has been published. This treatment is recommended as an option for treating primary hypercholesterolaemia or mixed dyslipidaemia as an adjunct to diet in adults only if:
  • there is a history of any of the following cardiovascular events:
    • acute coronary syndrome (such as myocardial infarction or unstable angina needing hospital admission)
    • coronary or other arterial revascularisation procedures
    • coronary heart disease
    • ischaemic stroke or
    • peripheral arterial disease, and
  • low-density lipoprotein cholesterol (LDL-C) concentrations are persistently 2.6 mmol/l or more, despite maximum tolerated lipid-lowering therapy, that is:
    • maximum tolerated statins with or without other lipid-lowering therapies or,
    • other lipid-lowering therapies when statins are not tolerated or are contraindicated, and
  • the company provides inclisiran according to the commercial arrangement.
It would be expected that treatment would be commenced and supervised by a clinician with a special interest however there is a unique funding arrangement in place that includes a new section in the Drug Tariff (DT) that will encourage use in primary care.

The looked-after children and young people guideline has been published. The guideline aims to help these children and young people reach their full potential and have the same opportunities as their peers.
Clinicians should be aware of this guideline and implement any necessary changes to their practice. 

CKS October 2021

During the month of October 2021, the following Clinical Knowledge Summaries were published or updated:  
All the above topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Candida – female genital topic has been updated to remove the terms ‘uncomplicated’ and ‘complicated’ as they are not recommended in the BASHH national guideline. The Immunizations - seasonal influenza topic has been updated to include the recommendation that children aged over 2 years with a history of severe anaphylaxis to egg who have previously required intensive care management in hospital can be offered the egg-free cell-based quadrivalent influenza vaccine (QIVc) as an alternative to referral to a specialist for immunisation in hospital.  The Tiredness/fatigue in adult’s topic has been updated with new recommendations on blood tests, referral timescales and the range of supportive measures to consider in primary care.
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 monthly drug availability update 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 October.

The role of locum GPs in antibiotic prescribing and stewardship: a mixed-methods study

Nineteen telephone interviews with locums in England found they prescribed antibiotics more often than other GPs and nurse prescribers for cough, sore throat, asthma exacerbations and acute bronchitis (4% higher on absolute scale). Themes linked to this difference were explored.

Administration of benzylpenicillin injection prior to transfer to secondary care in suspected bacterial meningitis or meningococcal septicaemia: PGD template
This PGD template for local adaptation has been produced with support from NICE, NHSE, RCGP and PHE. SPS have provided a PGD implementation advice webpage to assist organisations.

Sodium content of cold and flu preparations and painkillers

This article provides details of sodium content (SC) of preparations used for management of cold, flu & pain. It lists SC at both individual dose & maximum dose levels, along with associated limitations of the list. It can be used to help find similar formulations with lower SC.

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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