Issue 42 - February 2021
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Welcome to February's edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.


Formulary Update

New medicines
Galcanezumab is the second biologic agent to be recommended by NICE for preventing migraine. PBR excluded high cost drug, for specialist use only. It is an alternative treatment option in the pathway, alongside fremanezumab 
Upadacitinib is another oral biologic treatment option, recommended by NICE for treating severe rheumatoid arthritis. PBR excluded high cost drug, for specialist use only.  
Saxenda is recommended by NICE for managing overweight and obesity for adults who meet specific weight criteria and have a high risk of cardiovascular disease. It needs to be prescribed in secondary care by a specialist MDT tier 3 weight management service in order to be able to access the PAS discount.  
Not recommended until NICE TA published. 
Not recommended until NICE TA published. 
Not recommended until NICE TA published. 

Formulary and guidelines
Addition of people with diabetes and a learning disability who use insulin to treat their diabetes to the statement, in line with NHSE recommendation. 
Addition of naldemedine for opioid-induced constipation to current guideline as per NICE TA651. 

Shared care
Routine review with minor updates plus updated GP letter. 
Routine review with minor updates plus updated GP letter. 
Updated monitoring guidance to clarify that this applies to the risk of arrythmia and not cardiac function in general. 


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

Safety Update

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

SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery
07 January 2021
Data from observational studies suggest use of SSRI/SNRI antidepressants during month before delivery may result in small increased risk of postpartum haemorrhage. Prescribers should consider this risk vs. benefits of antidepressants for patient’s mental health during this time.

Use of medicines in pregnancy and breastfeeding
13 January 2021
This guidance signposts patients, healthcare professionals and developers of new medicines to advice and resources on medicines in pregnancy and breastfeeding and is supported by Safer Medicines in Pregnancy and Breastfeeding Consortium.

Valproate use by women and girls
13 January 2021
New versions of the patient card, patient booklet, and healthcare professionals booklet (dated November 2020) are now available.

Prescribing News

NICE Guidelines January 2021

There is one evidence summary published in January 2021 by the National Institute for Clinical Excellence which has impact upon primary care.

The Antimicrobial prescribing: delafloxacin for acute bacterial skin and skin structure infections evidence summary has been published. The evidence summary sets out delafloxacin as an option for adults needing hospital treatment for severe acute bacterial skin and skin structure infections (ABSSSI), primarily cellulitis or erysipelas, abscesses and wound infections, when standard oral and intravenous treatments are not suitable.

Clinicians should be aware of this guideline and implement any necessary changes to their practice. 

CKS Updates January 2021

During the month of January 2021, the following Clinical Knowledge Summaries were published or updated: The Mental health in students topic is new. All the other above topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Anticoagulation - oral topic has been updated to include a section on monitoring people taking anticoagulants during the COVID-19 pandemic in line with MHRA recommendations.

Clinicians should be aware of these guidelines and implement any necessary changes to their practice. 

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 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.

Drug tariff price changes for February


Antimicrobial Update

Please see below for a full summary of antimicrobial related guidelines and SPC updates in January.
Burden of enteral supplement interactions with common antimicrobial agents: a single-centre observational analysis  
This case series (4067 prescriptions for ciprofloxacin, levofloxacin or doxycycline) found 810 (19.3%) had an interacting enteral therapy (calcium or iron salt) administered within 2 hours of the antimicrobial, which may impair oral bioavailability and limit treatment efficacy.  

UK study concluded that a practice with 10.4% higher antibiotic prescribing was associated with 5.7% lower rate of infection-related admissions with largest associations in hospital admissions for lower respiratory tract infection (16.1%) and urinary tract infection (14.7%).  
Review (6 studies; n=557) found a non-significant trend of benefit of methenamine hippurate vs antibiotics over 12 months (RR 0.65, 95%CI 0.4-1.07, I2=49%); vs controls over 6/12 months (0.56; 0.13-2.35; 93%) and vs any antibiotic for abacteruria (0.80; 0.62-1.03; 23%).  
This new PGD template supports the immediate administration of a single dose of benzylpenicillin injection prior to transfer to secondary care in suspected bacterial meningitis or meningococcal septicaemia. 
The PGD templates for oseltamivir for pre and post exposure prophylaxis of non H7N9 and H5N8 avian influenza and for post exposure prophylaxis of avian influenza H5N8 and H7N9 have been updated.   
This DRAFT guideline sets out an antimicrobial prescribing strategy for Clostridioides difficile infection in adults, young people and children aged 72 hours and over in both community and hospital settings. It aims to optimise antibiotic use and reduce antibiotic resistance.  

Summary of Product Characteristics updates
SPC highlights warnings of increased risk of ototoxicity with aminoglycosides administered to pts with mitochondrial mutations, particularly the m.1555A>G mutation, including cases where aminoglycoside levels were within recommended range. The incidence of this effect is unknown.  
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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