Issue 6 - June 2017
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Welcome to the June edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.


Formulary Update


BLACK ELTROMBOPAG film-coated tablets (Revolade®) for Acquired Severe Aplastic Anaemia (SAA)
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of ELTROMBOPAG tablets (Revolade®) for Acquired Severe Aplastic Anaemia (SAA). Tell me more about eltrombopag.

RED IXEKIZUMAB solution for injection (Taltz®▼) for Plaque Psoriasis

The Pan Mersey Area Prescribing Committee recommends the prescribing of IXEKIZUMAB solution for injection (Taltz®▼) in specialist settings only, for treating plaque psoriasis in accordance with NICE TA442. Tell me more about ixekizumab.

RED RITUXIMAB infusion in Rheumatoid Arthritis (RA)

The Pan Mersey Area Prescribing Committee recommends the prescribing of rituximab infusion for rheumatoid arthritis in accordance with NICE TA195 and in accordance with the Mersey Rheumatoid Arthritis Biologics Pathway. Treatment should be initiated and supervised by a rheumatologist. Tell me more about rituximab.

RED USTEKINUMAB injection (Stelara®) for Psoriatic Arthritis

The Pan Mersey Area Prescribing Committee recommends the prescribing of USTEKINUMAB injection (Stelara®) for active psoriatic arthritis in accordance with NICE TA340. Tell me more about ustekinumab.

AMBER OPICAPONE capsules (Ongentys®▼)

The Pan Mersey Area Prescribing Committee recommends the prescribing of OPICAPONE (Ongentys®▼) following specialist recommendation as add-on therapy in adult patients with Parkinson’s disease. Tell me more about opicapone.

AMBER RIVAROXABAN 2.5mg tablets (Xarelto®▼) for Acute Coronary Syndrome

The Pan Mersey Area Prescribing Committee recommends the prescribing of Rivaroxaban 2.5mg tablets (Xarelto®▼) following specialist initiation for preventing adverse outcomes after acute management of acute coronary syndrome in accordance with NICE TA335. Tell me more about rivaroxaban.

AMBER SAFINAMIDE tablets (Xadago®▼)

The Pan Mersey Area Prescribing Committee recommends the prescribing of SAFINAMIDE (Xadago®▼) following specialist recommendation in the management of mid to late stage Parkinson’s disease. Tell me more about safinamide.

GREY ELUXADOLINE film-coated tablets (Truberzi®▼)

The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of ELUXADOLINE film-coated tablets (Truberzi®▼) for the treatment of irritable bowel syndrome with diarrhoea (IBS-D). Tell me more about eluxadoline.

GREY TOFACITINIB film-coated tablets (Xeljanz®▼) 

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



ENSURING SAFETY WHEN USING FENTANYL AND BUPRENORPHINE PATCHES Tell me more about safe use of transdermal opioid patches

Safety Update

For more information on all the safety and SPC updates listed below, please click here:
Educational Risk Minimisation Materials for Clexane (enoxaparin sodium)  "Dear Healthcare Professional” letter notes that enoxaparin is expressed both in international units (IU) of anti-Xa activity and in milligrams (mg)
Educational Risk Minimisation Materials for Levetiracetam 100mg/ml oral solution ‘Dear Healthcare Professional’ letter covers overdose due to medication errors and how to reduce risk
Finasteride: rare reports of depression and suicidal thoughts 
Accu-Chek® Insight insulin pumps – updated information for battery management 
Class 2 Medicines Recall: Sodium Cromoglicate 2% w/v 13.5 mL Eye Drops.- FDC International Ltd is recalling the batches listed as a precautionary measure
Medical Device Alert: All LIFEPAK 1000 automatic external defibrillators (AEDs) - risk of device shutting down unexpectedly during patient treatment and possible failure to deliver therapy 
Trimethoprim and Methotrexate: never co-prescribe The BNF states that there is an increased risk of haematological toxicity when methotrexate is given with trimethoprim (also with co-trimoxazole).

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®
Click here for the full list of Alliance healthcare's out of stock medication

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. 

Product discontinuations

Discontinuation of Protelos (strontium ranelate) 2g granules for oral suspension

Servier will cease production and distribution of strontium ranelate at the end of August 2017. This worldwide and strategic decision has been taken for commercial reasons. A memo which can be accessed at the following link  discusses alternative treatment options and signposts relevant NICE guidance

Drug availability issues

Quetiapine immediate release

There are currently problems affecting the availability of immediate release quetiapine (25mg and 200mg) although the supply problems may extend to affect the other strengths. We understand that the issue is likely to be relatively short term and supplies should return to normal by early July 2017.

The BNF advises that patients can be switched from immediate-release to modified-release tablets at an equivalent daily dose; to maintain clinical response, dose titration may be required.

Olanzapine tablets

There are currently problems affecting the supplies of generic versions of olanzapine tablets (standard and orodispersible). There are issues affecting the supplies of the Accord brand of olanzapine 5mg tablets until July 2017. Accord’s range of orodispersible tablets is currently unaffected.
The Teva range of olanzapine 5mg, 7.5mg, 10mg and 20mg standard tablets are likely to be affected until September 2017.The orodispersible 5mg, 15mg and 10mg are likely to be in short supply until the end of June 2017.
Availability of the products appears to be variable and prescribers are advised to consider the use of orodispersible or branded versions of olanzapine on a short term basis if issues arise.

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

National Institute of Health and Care Excellence (NICE) New or Updated guidance for May 2017.

The Type 2 diabetes in adults guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels and identifying and managing long-term complications. It has been updated to include sodium–glucose cotransporter 2 (SGLT-2) inhibitors in the section on drug treatment and the algorithm for blood glucose lowering therapy has been also updated to include these treatment options. 

The Eating disorders: recognition and treatment guideline covers the assessment, treatment, monitoring and inpatient care for children, young people and adults with eating disorders. It aims to improve the care people receive by detailing the most effective treatments for anorexia nervosa, binge eating disorder and bulimia nervosa. The guideline includes recommendations on identifying eating disorders.

Clinical Knowledge Summaries Updates for April 2017

The following topics were all reviewed: 
The topics have undergone minor restructures. The most significant change is to the Parvovirus B19 infection topic which has been renamed from slapped cheek syndrome.
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

Copyright © 2017 Midlands & Lancashire Commissioning Support Unit, All rights reserved.

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