March 2025

Drug changes and additions

Hydrofilm Plus dressings have been renamed to Cosmopor Transparent.

See here for the formulary entry.

Offmate adhesive remover spray has been renamed to Offmore.

See here for the formulary entry.

Dexamethasone 1mg tablets have been added to the Devon Formulary as a blue (second line) option.

See here for the formulary entry.

Acetazolamide 250mg modified-release capsules have been discontinued and removed from the Devon Formulary.

Magnesium trisilicate oral suspension has been discontinued and removed from the Devon Formulary.

NICE Technology Appraisals (TAs)

NICE TA1027: Tebentafusp solution for infusion vials have been added to the Devon Formulary as a red (hospital only) option for treating advanced uveal melanoma (in line with the technology appraisal guidance).

See here for the formulary entry.

Formulary Interface Group (FIG) Governance

The Devon Formulary Interface Group (FIG) Annual Report (1^st April 2023 to 31^st March 2024) has been published.

See here for an account of the activity and governance processes of the NHS Devon FIG.

February 2025

Drug changes and additions

Oseltamivir 30mg, 45mg, 75mg capsules and 6mg/ml oral suspension sugar free and zanamivir 5mg inhalation powder blisters with device for the treatment and post-exposure prophylaxis of influenza have been reclassified as green (first line). The drug entries have been updated with dosing and additional information, and links to UKHSA resources have been added.

The DHSC provides annual notification, usually through the CMO, of the start and end of the season when influenza is circulating in the community. GPs may prescribe antivirals for the treatment of influenza during this time period. 

Antiviral treatment outside of the flu season, and prophylaxis (at any time), is provided through a commissioned service and should not be routinely prescribed by GPs.

See here for the formulary entry.

Ivermectin 3mg oral tablets have been added as a blue (second line) option for the treatment of scabies if topical therapy is contraindicated or unsuitable.

See here for the formulary entry.

Co-trimoxazole tablets and oral suspension have been added as blue (second line) options for the prophylaxis and treatment of human and animal bites for those aged 12 years and above.

Co-trimoxazole solution for infusion ampoules have been added as a red (hospital only) option.

See here for the formulary entry.

Dienogest 2mg tablets have been added as an amber (specialist input) option for use in the management of endometriosis when initial hormonal therapy (for example, the combined oral contraceptive pill or a progestogen) is ineffective or not tolerated or contraindicated.

Treatment with dienogest may be started in primary care on the advice of a specialist.

See here for the formulary entry.

Ferric maltol 30mg hard capsules have been added to the formulary as an amber (specialist input) option for the treatment of iron deficiency anaemia (IDA) in patients with inflammatory bowel disease (IBD) in whom two standard oral iron preparations have been ineffective or not tolerated.

Gastroenterology specialists will prescribe the first 4-weeks of treatment and assess haematological response. If an adequate haematological response is observed following 4-weeks of treatment, primary care may be asked to continue prescribing for a further 12-weeks.

See here for the formulary entry.

Fluticasone propionate and azelastine hydrochloride nasal spray (50micrograms / 137micrograms) has been added to the formulary as an amber (specialist input) option for moderate to severe symptoms of allergic rhinitis in adults and children aged ≥12 years, following failure of combination therapy (antihistamine and nasal corticosteroid) which has been optimised by a secondary care allergy specialist (adult immunology services or specialists in paediatric allergy management).

Initiation of treatment by other specialist services is not supported.

Allergy specialists will prescribe and assess treatment response; if the product results in a sustained reduction in symptoms primary care may be asked to continue prescribing.

See here for the formulary entry.

The formulary recommendations and supporting guidance for thickened fluids have been updated in consultation with local Speech and Language Therapists (SLT) and dieticians. Thickened fluids are one of several dysphagia management tools, and should be considered only after comprehensive assessment by SLT.

All thickened fluids (including thickeners, pre-thickened drinks, and semi-solid desserts) are now classified
as amber (specialist input), however, it is accepted that GPs may occasionally initiate thickened fluids for individual patients without the need for SLT assessment, i.e. end-of-life care or infants/babies with reflux.

• Instant Carobel powder has been added as clear gum-based option for patients from birth to 3 years.
• Thixo-D Original powder has been added as starch-based option for children aged 1 year and over.

For patients already using thickened fluids without SLT involvement, there is no need to seek retrospective specialist input; if the patient’s clinical requirements have changed, and/or it is thought that thickened fluids may no longer be required, GPs can seek advice from / refer to SLT.

See here for the formulary guidance.

The formulary continence chapter product recommendations have been reviewed with Bladder and Bowel Care and Urology Specialists from the three acute NHS Trusts across Devon, to create cohesive Devon-wide continence care recommendations.

See here for Chapter 18: Continence care.

Formulary guidance

Human and animal bites

Updates include:

• Antibiotic course durations have been reduced to 3 days for prophylaxis and 5 days for treatment
• Advice to seek specialist advice for those who are pregnant
• Prophylaxis and treatment recommendations for those under 18 years of age have been added, these include:
  • Co-amoxiclav as a green (first line) option
  • Doxycycline plus metronidazole as a blue (second line) option for those aged 12 years and above
  • Co-trimoxazole as a blue (second line) option for those aged 12 years and above
• Updated advice on when to offer antibiotic prophylaxis
• Reassessment and referral advice.

See here for the formulary guidance.

Management of scabies

Updates include:

• definition and transmission of scabies
• single case / contact / closed setting management
• hygiene and prevention advice
• addition of ivermectin 3mg oral tablets
• follow up and post-treatment advice.

See here for the formulary guidance.

NICE Technology Appraisals (TAs)

NICE TA1015: Teclistamab solution for injection vials have been added to the Devon Formulary as a red (hospital only) option for treating relapsed and refractory multiple myeloma after 3 or more treatments (in line with the technology appraisal guidance).

See here for the formulary entry.

NICE TA1016: Elafibranor tablets have been added to the Devon Formulary as a red (hospital only) option for previously treated primary biliary cholangitis (in line with the technology appraisal guidance).

See here for the formulary entry.

NICE TA1023: Elranatamab solution for injection vials have been added to the Devon Formulary as a red (hospital only) option for treating relapsed and refractory multiple myeloma after 3 or more treatments (in line with the technology appraisal guidance).

See here for the formulary entry.

NICE TA1026: Tirzepatide solution for injection pre-filled disposable devices have been added to the Devon Formulary section ‘4.5 Drugs used in the treatment of obesity’ as a red (hospital only) option for use in the specialist weight management services for the purposes of weight management in line with NICE TA1026.

Implementation of TA1026 is determined by NICE and NHS England (see here). The national plan for the future is for a phased delivery to patient cohorts in other settings, including primary care-based services, based on NHS England prioritisation criteria.

Until further communication, use of tirzepatide for weight management purposes remains with the specialist weight management service. The formulary entry and traffic light classification for tirzepatide for weight management will be reviewed in the future when more information is available.

See here for the formulary entry for tirzepatide for weight management.

Note: Tirzepatide remains blue (second line) for use in type 2 diabetes in line with NICE TA924.

• See here for the tirzepatide formulary entry for type 2 diabetes and formulary guidance for type 2 diabetes.

Commissioning Policies

The routine commissioning of ferric maltol is accepted in Devon for the treatment of IDA in patients with IBD in whom two standard oral iron preparations have been ineffective or not tolerated (see Commissioning Policy for more details).

See here for the formulary entry.

The routine commissioning of fluticasone propionate and azelastine combination nasal spray is accepted in Devon for the treatment of allergic rhinitis when allergy specialists have optimised treatment with standard combination therapies (see Commissioning Policy for more details).

See here for the formulary entry.

January 2025

Drug changes and additions

Sulfasalazine tablets, gastro-resistant tablets, and oral suspension are now recommended Devon-wide as amber (specialist input) options for use in line with relevant “Shared Care” / SMS guidelines.

See here for the formulary entry.

Penicillamine tablets are now classified as a red (hospital only) option Devon-wide.

See here for the formulary entry.

Commissioning policies

The formulary entry for opicapone has been updated to reflect the updated Commissioning Policy for opicapone for the treatment of patients with Parkinson's disease (see Commissioning Policy for more details).

• The updated policy was agreed by NHS Devon following discussion and recommendation by the Clinical Policy Recommendation Committee and supports the use of opicapone as an option, alongside entacapone, for the management of end of dose motor fluctuations in Parkinson’s disease.

See here for the formulary entry.

Revised formulary guidance

Management of seborrhoeic dermatitis

Updates include:

• Advice on treatment for those aged from birth to 18 years
• Updates to treatment options, including:
  • the addition of topical calcineurin inhibitors as amber (specialist input) options
  • the removal of combination steroid and antimicrobial product recommendations
• Supporting information on treatment durations and licensed age ranges
• Advice on reassessment and referral, including links to local Clinical Referral Guidelines (CRGs).

See here for the formulary guidance.

NICE Technology Appraisals

NICE TA1009: Latanoprost / netarsudil 50 microgram/ml / 200 microgram/ml eye drops have been added to the Devon Formulary as an amber (specialist input) option for reducing intraocular pressure (IOP) in adults with primary open-angle glaucoma or ocular hypertension in line with the technology appraisal guidance.

See here for the formulary entry.

NICE TA1010: Danicopan 50mg and 100mg tablets have been added to the Devon Formulary as a red (hospital only) option for treating paroxysmal nocturnal haemoglobinuria alongside ravulizumab or eculizumab.

See here for the formulary entry.

NICE TA1012: Avapritinib 25mg, 50mg, 100mg, and 200mg tablets have been added to the Devon Formulary as a red (hospital only) option for treating advanced systemic mastocytosis.

See here for the formulary entry.

NICE TA1013: Quizartinib 17.7mg and 26.5mg tablets have been added to the Devon Formulary as a red (hospital only) option for induction, consolidation, and maintenance treatment of newly diagnosed FLT3-ITD-positive acute myeloid leukaemia.

See here for the formulary entry.

"Shared Care" / Specialised Medicines Service (SMS) guidelines

Sulfasalazine (gastroenterology) shared care guideline (North & East Devon) has been amended to remove reference to prescribing by brand.

See here for the formulary entry.

Penicillamine (rheumatology) shared care guideline (North & East Devon) has been withdrawn.

• Penicillamine is no longer routinely used as a DMARD in contemporary practice, it has therefore been reclassified to hospital only.
• There should be no new requests for shared care.
• Existing rheumatology patients may continue to receive treatment in primary care under historic shared care agreements.

See here for the formulary entry.