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Issue 53 - March 2022
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Welcome to the March edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.

Contents

Formulary Update

Recommendations

RED Arachis hypogaea L. (Palforzia®▼) for treating peanut allergy in children and young people 
NICE recommends Palforzia as an option for treating peanut allergy in children aged 4 to 17. It can be continued in people who turn 18 while on treatment and should be used with a peanut-avoidant diet. fficacy data are currently available for up to 24 months of treatment. NICE does not specify treatment duration but estimates that 87% of children are expected to have discontinued treatment after 24 months based on trial data. 
A short number of sentences extracted from the recommendation.


RED UPADACITINIB prolonged-release tablets (RINVOQ®▼) for psoriatic arthritis  
NICE recommends upadacitinib, alone or with methotrexate, as an option for treating active psoriatic arthritis in adults whose disease has not responded well enough to DMARDs or who cannot tolerate them.  


GREY FILGOTINIB tablets(Jyseleca®▼) for ulcerative colitis  
 Not recommended until NICE TA published. 


GREY ICOSAPENT ETHYL capsules (Vazkepa®▼) for reducing the risk of cardiovascular events 
Not recommended until NICE TA published. 

GREY MEPOLIZUMAB injection (Nucala®) for chronic rhinosinusitis with nasal polyps 
Not recommended until NICE TA published. 


GREEN RIVAROXABAN 2.5mg tablets (Xarelto®▼) for the prevention of atherothrombotic events  
Routine review of green statement at expiry, to be added to the static list. There is no new evidence to warrant a change in RAG status from green. No significant changes have been made, minor revisions include costs and updates in line with the SPC.  


Formulary and Guidelines

RED Psoriasis in adults, sequential use of biologic agents 
Addition of bimekizumab to guideline in line with recent NICE TA723, as Class 3: IL 17 agent.  

GREEN Bevespi Aerosphere inhaler 
Addition to the formulary for the treatment of COPD. Similar cost to the already agreed formulary alternatives and this is a metered dose inhaler that will be helpful for patients who need to use a spacer device. 

GREEN Trixeo Aerosphere inhaler 
Addition to the formulary for the treatment of COPD. This is the third triple therapy combination inhaler. Similar cost to the already agreed formulary alternatives and an alternative metered dose inhaler with a slightly lower carbon footprint than Trimbow. 

GREEN Trimbow inhaler 

The license for Trimbow has been extended to include asthma. This is the addition of the asthma indication to the formulary and it is the first triple therapy inhaler to be added to the formulary for this indication. It is a metred dose inhaler that will be helpful for patients who need to use a spacer device. 


Safety

DEXAMETHASONE injection – different injection strengths 
Routine review to STATIC at expiry date. Minor updates. Base dose equivalence table update to include 3.3 mg and 4 mg dose equivalence.  
 

Safety Update

Please click here or a full summary of safety updates and SPC updates in February
 

Weight-based medication errors in children

03 February 2022

Investigation was launched following errors in the prescription, dispensing and administration processes leading to a 4-year old child receiving 10 times the intended dose of anticoagulant on five separate occasions over three days, resulting in a non-fatal bleed on brain.

 

Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions

15 February 2022

MHRA advise clinicians to carefully consider benefits & risks before prescribing systemic azithromycin or other macrolides to patients on hydroxychloroquine or chloroquine. An observational study has shown co-administration is associated with increased cardiovascular mortality.

 

Unintentional overdose of paracetamol in adults with low bodyweight

24 February 2022

Adult inpatients with low bodyweight (less than 50kg) and the risk of liver toxicity from oral paracetamol is the focus of this investigation, which speciifically focuses on the dose prescribed and the processes for ensuring weight is accurately recorded.

 

Prescribing News

NICE Guidance February 2022


There is one guideline published in February 2022 by the National Institute for Clinical Excellence which has impact upon primary care.

The Type 2 diabetes in adults: management guideline has been updated. This update reviewed the evidence on drug treatment and the new recommendation places SGLT2 inhibitors earlier in the drug treatment pathway for patients with atherosclerotic cardiovascular disease and heart failure. It is specifically recommended to offer an SGLT2 inhibitor with proven cardiovascular benefit in addition to metformin to such patients. It is also recommended to consider this intervention in patients at high risk of CVD characterised as a QRISK2 ≥ 10%. In patients who do not meet either of these criteria, SGLT2 inhibitors remains a second line treatment option along with DPP‑4 inhibitors, pioglitazone and sulfonylureas.  

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



CKS February 2022

During the month of February 2022, the following Clinical Knowledge Summaries were published or updated:  
The Faecal incontinence in adults topic is new. All the remaining topics have been reviewed and updated in line with NICE guidance with minor layout changes. The Prostate cancer topic has been updated to include amended recommendations risk stratification and age-specific prostate-specific antigen (PSA) thresholds for referral. The Scrotal pain and swelling topic update reflect recommendations on assessment and management and a prescribing information section has been added that includes antibiotic treatment options for suspected acute epididymo-orchitis.

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


 

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 Medicines Supply Tool, which provides monthly drug availability updates 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 Price 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. 

Antimicrobial Update

Please see below for the antimicrobial related guidelines and click here to find SPC updates in February.

Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions

MHRA advise clinicians to carefully consider benefits & risks before prescribing systemic azithromycin or other macrolides to patients on hydroxychloroquine or chloroquine. An observational study has shown co-administration is associated with increased cardiovascular mortality.


DTB Select: Awareness of long-term nitrofurantoin adverse effects

Summary and context are provided for a study of long-term nitrofurantoin prescribing practices which found that most prescribers did not monitor for the possible liver or pulmonary adverse events as per recommendations in product SPCs

 
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.

Contacts
Kieron Donlon: kieron.donlon1@nhs.net


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