Welcome to the May edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.
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New Medicines
BLACK PITOLISANT HYDROCHLORIDE film-coated tablets (Ozawade®) for excessive daytime sleepiness caused by obstructive sleep apnoea
Pitolisant is not recommended for treating excessive daytime sleepiness caused by obstructive sleep apnoea.
AMBER RECOMMENDED EMPAGLIFLOZIN tablets (Jardiance®) for symptomatic chronic heart failure with reduced ejection fraction
Empagliflozin is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction in adults, only if specific criteria are met and it is started on the advice of a heart failure specialist. This is the second SGLT2 inhibitor to be recommended by NICE for this indication.
GREY OZANIMOD capsules (Zeposia®▼) for ulcerative colitis
Not recommended until NICE TA published.
Formulary and Guidelines
RED Biologic agents for juvenile idiopathic arthritis
Current guideline updated to include addition of anakinra and tofacitinib in line with NICE Technology Appraisals 685 and 735.
RED Biologic agents for inflammatory monoarthritis or oligoarthritis (and pathway)
Addition of secukinumab and ustekinumab as options to current statement and pathway. These are not covered by NICE TA's and have been requested by Mersey rheumatologists.
RED High-cost drugs pathway – rheumatoid arthritis
Current pathway updated to include NICE Technology Appraisals 744 and 751 (use of upadacitinib, adalimumab, etanercept and infliximab in moderate severity rheumatoid arthritis).
AMBER RECOMMENDED Pancreatin
Change of RAG designation from amber initiated to amber recommended. On initiation each patient discusses treatment with a specialist nurse or consultant and is advised on how to titrate the dose according to stool consistency and dietary intake. Dose titration is not required by GP.
AMBER RECOMMENDED Testosterone gel for testosterone deficiency in women
Guideline for use of testosterone gel for testosterone deficiency in women providing background information and process whereby specialist assesses patients (including optimising other HRT) and then requests primary care to commence prescribing. There is no biochemical / plasma level monitoring required. Use of testosterone gel in women is an off-label indication. Any local community gynaecology services would be included in the definition of specialist for recommendation purposes.
GREEN Blood glucose meters
Withdrawal of current Pan Mersey Blood Glucose And Ketone Meters And Testing Strips guideline. Blood glucose meters with testing strips costing less than £10 per 50 strips (less than £10 per 10 ketone strips) to be listed in the formulary for reference. When the guideline was originally published not all available meters met International Organisation for Standardisation (ISO) 15197.2013, and a significant proportion used strips costing more than £10 per 50 strips. All meters are now required to meet the ISO standard and availability of those using strips costing less than £10 per 50 strips has increased.
GREEN Atectura Breezhaler
Addition to the formulary for the treatment of asthma. Similar cost to the already agreed formulary alternatives and this is a low carbon inhaler which will be included in the new asthma guidelines.
GREEN Enerzair Breezhaler
Addition to the formulary for the treatment of asthma. This is the second triple therapy combination inhaler. Similar cost to the already agreed formulary alternative (Trimbow) with a lower carbon footprint and it will be included in the new asthma guidelines.
Shared Care
RED Penicillamine
Change of RAG rating from Purple to Red for safety reasons due to the rarity of prescribing and withdrawal of the shared care framework.
AMBER RECOMMENDED Dementia prescribing support information
Change of RAG rating from Amber initiated to Amber recommended in accordance with NICE NG97 which says treatment should only be started on the advice of a specialist and the first prescription may be made in primary care.
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Please click here for a full summary of safety updates and SPC updates in April.
Inadvertent Oral Administration Of Potassium Permanganate
05 April 2022
These concentrated forms of potassium permanganate resemble oral tablet or drink & if ingested are highly toxic. Alert asks secondary & primary care providers to take action to assess if use can be reduced; to ensure safer prescribing & labelling, & to ensure it is stored safely.
Urgent public health message - Hepatitis: increase in acute cases of unknown aetiology in children
08 April 2022
Urgent public health message to all GP practices and paediatric services regarding an increase in acute hepatitis cases of unknown aetiology in children. Contains information on symptoms, testing and referral
Pregabalin (Lyrica): findings of safety study on risks during pregnancy
20 April 2022
A new study has suggested pregabalin may slightly increase the risk of major congenital malformations if used in pregnancy. Patients should continue to use effective contraception during treatment and avoid use in pregnancy unless clearly necessary.
Unintentional overdose of morphine sulfate oral solution
28 April 2022
Report aims to help improve safe use of oral morphine sulfate solution. The reference event concerned 89-year old patient who took an accidental and fatal overdose after mistaking manufacturer’s text on bottle for the dose and not noticing dispensing label affixed to outer box.
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NICE Guidance April 2022
There are two guidelines published in April 2022 by the National Institute for Clinical Excellence which has impact upon primary care.
The Epilepsies in children, young people and adult’s guideline has been published. The guideline aims to improve diagnosis and treatment for different seizure types and epilepsy syndromes and reduce the risks for people with epilepsy.
The Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adult’s guideline has been published. It covers general principles for prescribing and managing withdrawal from opioids, benzodiazepines, gabapentinoids, Z‑drugs and antidepressants in primary and secondary care.
Clinicians should be aware of this guideline and implement any necessary changes to their practice.
CKS April 2022
During the month of April 2022, 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 Headache-tension-type topic has been updated to reflect recommendations on management in primary care. The QIPP section on nonsteroidal anti-inflammatory drugs (NSAIDs) has been removed. The Trigeminal neuralgia topic has been updated with the addition of a differential diagnosis section, minor changes based on drug literature and an update to the supporting evidence for the topic.
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 www.prescriber.org.uk
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