Copy
Issue 28 - September 2019
Email not displaying correctly? View it in your browser.
Welcome to the September edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team at Midlands and Lancashire CSU.

Contents

Formulary Update

New medicines

BLACK OESTROGENS, CONJUGATED and BAZEDOXIFENE ACETATE tablets (Duavive®)
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.

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 & febuxostat) and uricosuric agents (benzbromarone) or for whom these drugs are contraindicated.

BLACK THYROID extracts, desiccated  (e.g. Armour Thyroid®) for the management of hypothyroidism
The Pan Mersey Area Prescribing Committee does not recommend the prescribing of Desiccated Thyroid Extracts (e.g. Armour Thyroid®), for the management of hypothyroidism.

GREY FREMANEZUMAB pre-filled syringe for injection (Ajovy®▼) for prophylaxis of migraine
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of FREMANEZUMAB pre-filled syringe for injection (Ajovy®▼) for prophylaxis of migraine.

GREY GALCANEZUMAB solution for injection (Emgality®▼) for prophylaxis of migraine
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of GALCANEZUMAB solution for injection (Emgality®▼) for prophylaxis of migraine.

GREY MELATONIN tablets 3 mg and oral solution 1 mg/ml for jet-lag
The Pan Mersey Area Prescribing Committee does not currently recommend the prescribing of MELATONIN tablets 3 mg and oral solution 1 mg/ml for jet-lag.

AMBER RECOMMENDED ROFLUMILAST (Daxas®▼) for COPD
The Pan Mersey Area Prescribing Committee recommends the prescribing of ROFLUMILAST tablets (Daxas®▼) following specialist recommendation as an add-on to bronchodilator therapy, for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis (in accordance with NICE TA461).

AMBER RECOMMENDED OPICAPONE capsules (Ongentys®▼) for Parkinson's Disease
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.

AMBER RECOMMENDED SAFINAMIDE tablets (Xadago®▼) for Parkinson's Disease
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.



Formulary

RED Pethidine for pain
Addition of pethidine injection 50mg and 100mg to the formulary to reflect use in secondary care. N.B. Pethidine tablets have been removed from the formulary (previously Green). Very low use in primary care so existing patients would be reviewed on an individual basis.

AMBER INITIATED FLASH GLUCOSE MONITOR (FreeStyle Libre®)
The Pan Mersey Area Prescribing Committee recommends the prescribing on the NHS of flash glucose monitor sensors (FreeStyle Libre®) only within the criteria outlined below.

AMBER RECOMMENDED Food thickeners for dysphagia
Addition of Nutilis Clear® and Swalloweze Clear® as first line thickeners for dysphagia in adults, following recommendation by speech and language therapist or other appropriate specialist.



Guidelines

Multi-compartment Compliance Aids (Blister packs) FAQs for prescribers
Pan Mersey guidance for prescribers



Safety

SUMMARY CARE RECORD: minimising harm from missing data
The Pan Mersey Area Prescribing Committee recommends that ALL clinicians have a responsibility in ensuring that Drugs Prescribed Elsewhere are updated in the patients’ electronic medical records in order to ensure the accuracy of the Summary Care Record.

Safety Updates

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

Reminder: citalopram and escitalopram - QT interval prolongation 
MHRA | December 2011 
Citalopram and escitalopram may have an additive effect to other drugs that prolong the QT interval. Coadministration of citalopram and escitalopram with medicines that prolong the QT interval is therefore contraindicated. Experience shared by NHS St Helens CCG highlighted the contraindication between citalopram and formoterol which itself may induce prolongation of the QTc interval.

Emerade 500 Microgram and 300 Microgram Adrenaline Auto-Injector Devices manufactured by Bausch & Lomb UK 
Central Alerting System | 01 August 2019 
Emerade 500 microgram and 300 microgram devices manufactured by Bausch & Lomb UK will be experiencing a short-term disruption in supply. Emerade 500 microgram is out of stock until the 28 August 2019. Emerade 300 microgram has limited supplies remaining but will be out of stock from early-mid August with further supplies expected by 30 September 2019. The alert also provides a management plan for organisations to follow in managing stock.

Elmiron (pentosan polysulfate sodium): risk of pigmentary maculopathy 
Consilient Health Ltd | 19 August 2019 
Letter advises that rare cases of pigmentary maculopathy (PM) have been reported, especially after long term use. During treatment patients should have regular eye examination for early detection of PM and seek medical advice in case of visual changes.

Naltrexone/bupropion (Mysimba): risk of adverse reactions that could affect ability to drive 
Medicines and Healthcare products Regulatory Agency | 19 August 2019 
People on Mysimba may commonly experience dizziness/somnolence, and may rarely experience loss of consciousness/seizure, especially, at beginning of treatment/during dose titration. If these ADRs occur, they should be advised not to drive/operate machinery until they have resolved.

Can miconazole oral gel be used by patients taking a statin? 
Specialist Pharmacy Service | 27 August 2019 
Cardiovascular system disorders | Infection and infectious diseases
This updated Medicines Q&A explores the evidence for the interaction between miconazole oral gel and statins.


Hormone replacement therapy (HRT) and increased risk of breast cancer 
Medicines and Healthcare products Regulatory Agency | 30 August 2019 
Further information on the known increased risk of breast cancer with HRT and its persistence after stopping. New data has confirmed the risk of breast cancer is increased during use of all types of HRT, except vaginal estrogens, and has also shown an excess risk of breast cancer persists for longer after stopping HRT than previously thought. Prescribers of HRT are advised to discuss the updated total risk with women using HRT at their next routine appointment

Prescribing News

NICE Guidance August & September 2019
 
Six guidelines and one technology appraisal that impact upon primary care have been published in July & August 2019 by the National Institute for Clinical Excellence.  
 
The Suspected neurological conditions guideline has been updated. It covers the initial assessment of symptoms and signs that might indicate a neurological condition.
 
The Long-acting reversible contraception guideline has been updated. It aims to increase the use of long-acting reversible contraception by improving the information given to women about their contraceptive choices.  
 
The Neuropathic pain in adults: pharmacological management in non-specialist settings guideline has been updated. It covers managing neuropathic pain with pharmacological treatments in adults in non-specialist settings.
 
The Motor neurone disease: assessment and management guideline has been updated. It covers assessing and managing motor neurone disease (MND).  
 
The Hypertension in adults: diagnosis and management guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. This guideline updates and replaces NICE guideline CG127. It also updates and replaces the section on blood pressure management in the NICE guideline on type 2 diabetes in adults (NG28). 
 
The Type 2 diabetes in adults: management guideline has been updated. It covers the care and management of type 2 diabetes in adults (aged 18 and over).  
 
The Dapagliflozin with insulin for treating type 1 diabetes technology appraisal has been published. Dapagliflozin with insulin is recommended as an option for treating type 1 diabetes in adults under specific criteria.  
 
 
 
CKS Updates August & September 2019

During the months of July & August 2019, the following Clinical Knowledge Summaries were updated: 

The Autism in adults, Cerebral palsy and Sepsis topics are new. The Neutropenic sepsis has been updated in line with current evidence and new sections have been added on Specialist assessment and Follow-up. The Cholesteatoma and Gallstones topics have undergone reviews and minor restructures 
 
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 Issues Update for Primary and Secondary Care: September 2019 
 
This report has been produced by the Department of Health and Social Care (DHSC) Medicine Supply Team. We aim to update this report monthly to provide an update on current primary and secondary care medicine supply issues that we are working on. This information is confidential to the NHS; please do not upload to websites in the public domain. Please do share with relevant colleagues and networks.
 
Where it has been stated ‘a clinical memo from UKMI will be published on the SPS website’, this will be found at the following URL:
https://www.sps.nhs.uk/category/shortages-discontinuations-and-expiries/ 

Please click here for all the information provided week commencing 9th September 2019

Drug Tariff Changes

This summary document shows the top 10 price changes since last 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 for August
 

Antimicrobial Updates

Please click here for a full summary of antimicrobial related guidelines and SPC updates in August and September.
 
National Institute for Health and Care Excellence
 
Public Health England
 
British Journal of General Practice
 
National Institute for Health and Care Excellence
 
E Clinical Medicine
 
Public Health England
 
British Medical Journal
 
Drug and Therapeutics Bulletin

 
Summary of Product Characteristics updates
 
SPC updated to include data collected from a large observational study which did not indicate an increased risk for developing herpes zoster after concomitant administration with Zostavax (varicella-zoster virus live) vaccine.
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.donlon1@nhs.net


Copyright © 2018 Midlands & Lancashire Commissioning Support Unit, All rights reserved.

Our mailing address is:
MLCSU.Tablets@nhs.net


unsubscribe from this list | update your preferences
Email Marketing Powered by Mailchimp