Issue 7 - July 2017
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Welcome to the July edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire Commissioning Support Unit.


Formulary Update


The Pan Mersey Area Prescribing Committee does not recommend the prescribing of CONJUGATED OESTROGENS and BAZEDOXIFENE 0.45mg/20mg modified release tablets (Duavive®)for the treatment of oestrogen deficiency in postmenopausal women with a uterus. Tell me more about Duavive

BLACK RASBURICASE powder and solvent for concentrate for solution for infusion (Fasturtec®▼)for severe, refractory, tophaceous gout 
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of Rasburicase powder and solvent for concentrate for solution for infusion (Fasturtec®▼)for the "off label" treatment of severe, refractory, tophaceous gout resistant to xanthine oxidase inhibitors (allopurinol and febuxostat)and uricosuric agents (benzbromarone)or for whom these drugs are contraindicated. Tell me more about Rasburicase

The Pan Mersey Area Prescribing Committee does not recommend the prescribing of DESICCATED THYROID EXTRACTS, e.g. Armour Thyroid, in the management of hypothyroidism. Tell me more about thyroid extracts

RED CERTOLIZUMAB PEGOL and SECUKINUMAB (Cimzia® and Cosentyx®▼ in Psoriatic Arthritis) 
The Pan Mersey Area Prescribing Committee recommends the prescribing of CERTOLIZUMAB PEGOL (Cimzia®)and SECUKINUMAB (Cosentyx®▼), by specialists only, for psoriatic arthritis in accordance with NICE TA445. Tell me more about certolizumab and secukinumab

GREY INSULIN GLARGINE + LIXISENATIDE solution for injection (Suliqua®▼)
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of INSULIN GLARGINE + LIXISENATIDE solution for injection (Suliqua®▼)for the treatment of type 2 diabetes mellitus. Tell me more about glargine + lixisenatide

GREEN CALCIPOTRIOL and BETAMETHASONE cutaneous foam (Enstilar®) 
The Pan Mersey Area Prescribing Committee recommends the prescribing of CALCIPOTRIOL 50 micrograms and BETAMETHASONE 500 micrograms per 1 gram cutaneous foam (Enstilar®)for psoriasis vulgaris in adults. Tell me more about Enstilar


Dry eye symptoms, non-specialist management
Issued: June 2017 | Review: June 2020 Tell me more about dry eyes

Malnutrition, managing adults in the community
Issued: June 2017 | Review: June 2020 Tell me more about malnutrition


Biological agents pathway for Psoriatic Arthritis and Peripheral Spondyloarthropathy
Issued: June 2017 | Review: June 2020 Tell me more about the biologics pathway

Biological agents policy for Psoriatic Arthritis
Issued: June 2017 | Review: June 2020 Tell me more about the biologics policy

Safety Update

For more information on the updates listed below, please click here:

Brimonidine gel (Mirvaso®): risk of systemic cardiovascular effects
Warn patients not to apply brimonidine gel to irritated or damaged skin, including after laser therapy to the skin.

Denosumab (Prolia®, Xgeva®▼): 
The possibility of osteonecrosis of the external auditory canal should be considered in patients receiving denosumab who present with ear symptoms including chronic ear infections or in those with suspected cholesteatoma.

e-cigarettes and refill containers (e-liquids):
Members of the public and healthcare professionals can use the Yellow Card Scheme website to report any suspected side effects or safety concerns with e-cigarettes and the e-liquids used for vaping.

Influenza Season 2016/17: 
Prescribers working in primary care and community pharmacists should no longer prescribe or supply antiviral medicines for the prophylaxis and treatment of influenza on an FP10 prescription form.

Risk minimisation materials: Physician prescribing checklist for Mysimba® (8mg naltrexone /90mg bupropion) prolonged-release tablets;
This checklist ensures the appropriate contraindications and special warnings/precautions are considered when prescribing Mysimba prolonged-release tablets. 

Risk management materials for Valdoxan® (agomelatine) – liver function monitoring and drug interactions.
New guidance for healthcare professionals has been provided for monitoring liver function in patients before and during treatment with Valdoxan. 

Educational Risk Minimisation Materials: Prescribers’ Administration Guide for Qutenza® (capsaicin)
Covers warnings and precautions for use, practice precautions, briefing the patient, correct application of patch, managing treatment-associated discomfort, and patient follow-up. 

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 out of stock 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. 

Clexane® 20 mg shortage 28th July - 14th August

Sanofi have contacted the NHSE Commercial Medicines Unit to inform them that, Clexane® 20mg will be out of stock sooner than was expected. AAH will be out of stock from Friday 21st July. Hospital Trusts will be directed to Phoenix who have sufficient stock of the 20mg to fill orders until Friday 28th July but then they too will be out of stock. Clexane 20mg will then remain out of stock at all wholesalers until  Monday 14th August. Sanofi have protected a small amount of 20mg stock in line with historical demand for use in primary care. This stock can be ordered in the normal way by community pharmacists from Phoenix.
Tell me more about Clexane® shortage.

Permanent discontinuation of supply of MODECATE ® (fluphenazine decanoate) injection by end of 2018

Sanofi, the manufacturer of fluphenazine decanoate (Modecate®) injection has written to healthcare professionals advising that this product will be discontinued by the end of 2018. Production of both strengths of the injection (25mg/ml and 100mg/ml) will cease by mid-2018, and the product is expected to remain available in the UK up until the end of 2018 (assuming that the rate of use does not change significantly at that time).

This is due to unpredictable supplies of the active ingredient from the single global manufacturer as the reason for this decision and  is not due to any safety concerns.
For further information, 

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 June 2017.

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of June 2017. This month there are two guidelines that impact upon primary care.

The Head injury clinical guideline has been updated to cross-reference other NICE guidelines and an outdated research recommendation was deleted. The guideline covers the assessment and early management of head injury in children, young people and adults.

The Spondyloarthritis in over 16s guideline has been updated to clarify the advice on what imaging should be done. The guideline covers diagnosing and managing spondyloarthritis that is suspected or confirmed in adults who are 16 years or older.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

Clinical Knowledge Summaries Updates for June 2017

During June 2017 Clinical Knowledge Summaries were updated for the following topics:

New Medicines Features - Emis Web

Emis Web has recently been updated with some useful new features regarding medicines:- for further information click here
  • One-off Issue of a medicine 
  • Variable Use repeat medicines 
  • Over the Counter medicines 
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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