Issue 17 - July 2018
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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 CSU.


Formulary Update

RED GUSELKUMAB solution for injection (Tremfya®▼) for Plaque Psoriasis 
The Pan Mersey Area Prescribing Committee recommends the prescribing of GUSELKUMAB solution for injection (Tremfya®▼) in specialist settings only, for treating plaque psoriasis in accordance with NICE TA521. 

AMBER INITIATED  TAPENTADOL prolonged release tablets  (Palexia® SR)
The Pan Mersey Area Prescribing Committee recommends TAPENTADOL prolonged release tablets (Palexia® SR) for severe chronic pain in adults only when initiated by chronic pain specialists or palliative care specialists. 

AMBER RECOMMENDED  Elasticated Viscose Stockinette (‘Viscose’) Garments (CliniFast®, Comfifast Easywrap®, Skinnies Viscose®, Tubifast 2-way stretch®)
The Pan Mersey Area Prescribing Committee recommends the prescribing of Elasticated Viscose Stockinette (‘Viscose’) Garments following specialist recommendation for skin conditions. 

GREY EVOLOCUMAB solution for injection (Repatha®▼)  for the reduction of cardiovascular risk in patients with established atherosclerotic cardiovascular disease 
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing EVOLOCUMAB solution for injection (Repatha®▼) for the reduction of cardiovascular risk in patients with established atherosclerotic cardiovascular disease. 

GREY FERRIC MALTOL hard capsules (Feraccru®▼)  for iron deficiency in adults 
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of FERRIC MALTOL hard capsules (Feraccru®). 

GREY LOXAPINE inhalation powder (Adasuve®▼) 
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of LOXAPINE inhalation powder (Adasuve®▼) for mild-to-moderate agitation in adult patients with schizophrenia or bipolar disorder. 

GREY OSPEMIFENE film-coated tablets (Senshio®▼) 
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of OSPEMIFENE film-coated tablets (Senshio®▼) for the treatment of vulvar and vaginal atrophy in post-menopausal women. 

COPD inhaled therapy 

Sequential use of biological agents in the management of Psoriasis in adults 


Ear, Nose and Throat infections

Eye infections


Methotrexate, Safe Prescribing and Dispensing
The Pan Mersey Area Prescribing Committee recommends: 
  • All specialities, including haematology, should prescribe the methotrexate dose in multiples of 2.5mg tablets and the total dose in milligrams must also be included. For example, “Three 2.5mg tablets (7.5 milligrams)” 
  • Methotrexate 10mg tablets MUST NOT be prescribed or supplied. 
  • Prescription and the dispensing label must clearly show the dose in milligram and the number of tablets to be taken and the frequency as “ONCE a week on the same day each week”. 
  • Prescribing of methotrexate with co-trimoxazole or trimethoprim is an ABSOLUTE CONTRAINDICATION and MUST NOT occur under any circumstances*. This contraindication applies to people that have recently taken methotrexate. 

Safety Update

Please click here for a summary of  safety updates and SPC updates

European CHMP endorses measures to reduce risk of liver injury with ulipristal acetate (Esmya)
European Medicines Agency | 04 June 2018
New measures have been placed to highlight contraindications in liver problems. It is advised to do liver tests before, during and after stopping treatment. There should be a patient card detailing liver monitoring and to contact GP if symptomatic. Additionally, use of more than one treatment course is restricted to women not eligible for surgery.

Can small volume intramuscular injections be given to patients taking oral anticoagulants?
Specialist Pharmacy Service | 12 June 2018
Q+A notes most of published studies relate to IM influenza vaccination in patients on older anticoagulants. Data are limited, and some findings are contradictory. There is very little published information about the risks of adverse effects with DOACs and IM injections.

What factors need to be considered when dosing patients with renal impairment?
Specialist Pharmacy Service | 18 June 2018
This article discusses the pharmacokinetic and pharmacodynamic factors that affect dosing in renal impairment.

Resources to support safer modification of food and drink
Central Alerting System | 27 June 2018
This alert has been released to highlight the variation in the terminology used to describe the thickness of modified food for patients with dysphagia.


Prescribing News

NICE Guidance June 2018

There has been one guideline and one technology appraisal published in June 2018 by the National Institute for Clinical Excellence.

The new dementia guideline which covers diagnosing and managing dementia (including Alzheimer’s disease) has replaced the previous guideline from 2006. The guideline provides recommendations on the training of staff and aims to help carers to support people living with dementia.

The donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease technology appraisal has had the recommendation in section 1.3 replaced by the dementia guideline as listed above.

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

CKS Updates June 2018

During the month of June 2018, the following Clinical Knowledge Summaries were updated:  New topics were published for: There have been substantial changes to some of the topics listed above.  Notably, the fungal skin infection – foot, has had complications and differential diagnosis notes added to the diagnosis section. The prescribing information section has been updated and the management recommendations have been updated in line with current literature. Clinicians can use the updated and new information when reviewing patients.

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 issues update for primary care July 2018
New issues

Imigran (sumatriptan) injection 

There is currently a manufacturing issue affecting supplies of GSK’s branded sumatriptan injection, Imigran. Limited supplies of both Imigran injection initiation packs and Imigran injection refill packs are currently available, but it is estimated that supplies will be exhausted by mid-August 2018 and resupply is not expected until Q4 2018/2019 (January-March 2019).

Generic supplies of sumatriptan injection in both initiation and refill packs are available from Sun Pharma/Ranbaxy – this product is ‘sumatriptan 6mg/0.5 ml solution for injection’ and Sun Pharma/Ranbaxy have confirmed that they are able to support the additional demand during this time.
Priadel liquid 
There is a current shortage of Priadel Liquid (lithium citrate liquid), due to a recent batch failure. Stocks are insufficient to meet the UK demand. The situation will be temporary and it is hoped to be resolved by mid August 2018. Some community pharmacies may have a small stock remaining of the Priadel liquid.
Please see the following guidance on switching patients to alternative products which has been produced by UKMI.
Ongoing Issues:

Drug tariff price Changes

This summary document shows the top 10 price changes this month, the top 25 changes compared to three months ago, and the top 50 since last year. 
Tell me more about drug tariff price changes.
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

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