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Welcome to October's 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 ELTROMBOPAG film-coated tablets (Revolade®) for Acquired Severe Aplastic Anaemia
Routine review of existing black statement. No significant changes as no additional evidence was found to address any of the initial concerns around clinical- and cost-effectiveness. For inclusion on the static list.
GREY FOSTAMATINIB tablets (Tavlesse®▼) for the treatment of chronic immune thrombocytopenia (ITP)
Not recommended until NICE TA published.
GREY OMALIZUMAB solution for injection (Xolair®) for chronic rhinosinusitis with nasal polyps
Not recommended until NICE TA published.
Free of Charge Medicines Schemes
RMOC Free of Charge (FOC) Medicines Scheme Advice
Pan Mersey Free of Charge (FOC) Medicines Scheme - request for approval
The Pan Mersey APC has approved the RMOC FOC Medicines Scheme advice (2020) as local policy.
Requests for approval should be submitted to the commissioner using this separate template.
Formulary and Guidelines
Chronic obstructive pulmonary disease
COPD guideline updated version now based on latest NICE guidelines. Previous version was based on GOLD guideline as previous NICE guidelines were significantly out of date. Emphasis as before on suggested first line options, but actual choice of device can be any on formulary.
Out-of-area Prescribing Requests
Out of area requests (from secondary/tertiary care specialists outside Mersey) - position statement providing guidance to GPs on how to deal with non-formulary requests and requests that treat a drug as a different RAG designation to Mersey position.
Sequential use of biologics
Ankylosing spondylitis pathway
Psoriasis biologics guideline
Psoriatic arthritis pathway
Rheumatoid arthritis pathway
Minor wording changes to guidelines on sequential use of biologics and high cost drugs, intended to remove any ambiguity that the guidelines contradict the RMOC statement on sequential use of these agents. There is no actual change to the substance of each of the guidelines or costs, it is purely to avoid any perceived contradiction to RMOC.
Antimicrobials
Managing common infections in adults
First of two parts covering upper and lower respiratory tract infection, urinary tract infection, meningitis, gastrointestinal and suspected dental infection.
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The Midlands and Lancashire CSU has a dedicated COVID-19 webpage which is updated daily.
Please note that this information is up to date at the time of publication.
The list of resources will be updated as new material becomes available so please check back regularly for updates.
This page groups the resources by subject matter. The same list of resources is also available grouped by the organisation that issued it.
COVID-19 Resources
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Please click here for a full summary of safety updates and SPC updates in September.
Update From The CAS Helpdesk: Changes To MHRA Alerts And Amendments To The Website
17 September 2020
The Medicines and Healthcare products Regulatory Agency (MHRA) is now an accredited issuer of National Patient Safety Alerts. This means there will be some changes to what you receive from CAS as set out in the attached document. There are also some changes to the website and a reminder to organisations to register out of hours email addresses with us if you have them.
Opioids: risk of dependence and addiction
23 September 2020
New recommendations following a review of the risks of dependence and addiction associated with prolonged use of opioid medicines (opioids) for non-cancer pain. Before prescribing opioids, discuss with the patient the risks and features of tolerance, dependence, and addiction, and agree together a treatment strategy and plan for end of treatment.
Transdermal fentanyl patches for non-cancer pain: do not use in opioid-naive patients
23 September 2020
Following a review of the risks associated with use of opioid medicines for non-cancer pain, the Commission on Human Medicines (CHM) has recommended that fentanyl transdermal patches are contraindicated in opioid-naive patients in the UK.
Methotrexate once-weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly dosing
23 September 2020
In autoimmune conditions and some cancer therapies, methotrexate should be taken once a week; however, we continue to receive reports of inadvertent overdose due to more frequent dosing (including daily administration). New measures have been implemented to prompt healthcare professionals to record the day of the week for intake and to remind patients of the dosing schedule and the risks of overdose.
Insulins (all types): risk of cutaneous amyloidosis at injection site
23 September 2020
Cutaneous amyloidosis at the injection site has been reported in patients using insulin and this may affect glycaemic control. Remind patients to rotate injection sites within the same body region.
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NICE Guidelines September 2020
There have been three guidelines, one technology appraisal and one antimicrobial guideline published in September 2020 by the National Institute for Clinical Excellence which has impact upon primary care.
The Low back pain and sciatica in over 16s: assessment and management guideline has been updated and published. The guideline covers the assessment and management of low back pain and has been updated to include several recommendations on the pharmacological management of sciatica. The guideline makes reference to a guideline which is in development, medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management, which is due for publication next year.
The Neuropathic pain in adults: pharmacological management in non-specialist settings guideline has been updated and published. The guideline covers the management of neuropathic pain with pharmacological treatments in adults in non-specialist settings. Evidence on treating sciatica has been reviewed and new recommendations on pharmacological treatments have been added.
The Suspected cancer: recognition and referral guideline has been updated and published. The guideline covers identifying children, young people and adults with symptoms that could be caused by cancer.
The Insect bites and stings: antimicrobial prescribing guideline has been published. An antimicrobial prescribing strategy for insect and spider bites and stings in adults, young people and children has been set out.
The Naldemedine for treating opioid-induced constipation technology appraisal has been published. The appraisal recommends naldemedine within its marketing authorisation, as an option for treating opioid induced constipation in adults who have had laxative treatment.
Clinicians should be aware of these guidelines and implement any necessary changes to their practice.
CKS Updates September 2020
During the month of September 2020, the following Clinical Knowledge Summaries were published or updated:
All the above topics have been reviewed and updated in line with NICE guidance.
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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