Formulary updates

COVID-19 updates

For the latest updates and advice on coronavirus (COVID-19), please visit the NHS website.

For a summary of Formulary updates specific to the COVID-19 pandemic, please click here.

For Clinical Referral Guideline (CRG) updates specific to the COVID-19 pandemic, please click here. The NHS Devon CCG Medicines Optimisation Team have produced a COVID-19 Information and Guidance page, which features a frequently asked questions section, please click here.

January 2022

Drug changes and additions
  • Emerade 300 microgram and 500 microgram adrenaline auto-injector
    • 300 microgram and 500 microgram: Following satisfactory implementation of corrective actions, the MHRA has agreed that the 300 microgram and 500 microgram strengths of Emerade adrenaline auto-injectors can be re-supplied to the market
    • 150 microgram: Emerade 150 microgram auto-injectors will not be returning to market at this time, further details of re-supply will be provided at a later date
    • Click here for the formulary entry
  • Inclisiran 284mg injection
    • A link has been added to the statement on inclisiran issued by the Royal College of General Practitioners and the British Medical Association on 3rd December 2021 which includes recommendations for the prescribing of inclisiran by GPs
    • Click here for the formulary entry
  • Inhixa (enoxaparin) pre-filled syringe 20mg, 40mg, 60mg, 80mg, 100mg, 120mg, 150mg have been added as amber (specialist input) options for prophylaxis of venous thromboembolic disease and the treatment of DVT and PE.
    • Inhixa is also licensed for acute coronary syndrome and the prevention of clotting in extracorporeal circuits; these indications are red (hospital only)
    • Click here for the formulary entry
  • The following anal irrigation systems have been added to the formulary (see "Anal irrigation systems" below for formulary link):
    • Aquaflush Compact+ mini system
    • Aquaflush Self Retaining Cone (SRC) cone system
    • Qufora IrriSedo Klick balloon system
    • Peristeen Plus TAI (balloon) System
    • Aquaflush Quick cone system has been removed
    • Peristeen balloon system has been removed
    • IryPump S electronic pump system has been removed
  • Alirocumab solution for injection 300mg/2ml pre-filled pen has been added as a red (hospital only) option for treating primary hypercholesterolaemia and mixed dyslipidaemia
  • Tinidazole tablets 500mg have been reclassified as a red (hospital only) antibiotic for use in secondary care, as it has been discontinued from the UK market
    • Although tinidazole is not available in the UK, stock may be obtained by the acute trusts through an ‘unlicensed specials and import route’
    • Click here for the formulary entry
Anal irrigation systems
Foods for special diets
  • The gluten-free guidance section has been updated to include additional information on the prescribing of gluten-free foods in primary care from NHS England Guidance. Recommended personal units of gluten-free foods per month has been added in simple tables for ease of reading
  • Please see the formulary for further information
Shared Care / Specialised Medicines Service (SMS) guidelines

Denosumab for osteoporosis (North, East and West Devon only)

  • Following publication of an MHRA Drug Safety Update in 2020, which highlighted an increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment with denosumab 60mg (Prolia) for osteoporosis, the SMS guideline for denosumab has been reviewed with local specialists. The following changes have been agreed:
    • Clarification that specialist advice should be sought if the GP considers treatment with denosumab is no longer appropriate or the patient wishes to discontinue treatment
    • Advice on duration of treatment has been updated to reflect the increased risk of multiple vertebral fractures reported within 18 months of stopping or delaying treatment, and to highlight that denosumab should not be stopped without considering alternative treatment to prevent rapid bone mineral density loss and a potential rebound in vertebral fracture risk.
  • The updated SMS guideline can be found on the NHS Devon CCG Website, or via the denosumab drug entry

December 2021

Commissioning Policies
  • The routine commissioning of fidaxomicin is accepted in Devon for the treatment of Clostridioides difficile infection (see Commissioning Policy for more details). The formulary has been updated, click here for more information
  • The routine commissioning of ulipristal acetate 5mg tablets (Esmya) is accepted in Devon for up to 4 courses of intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women who have not reached menopause when uterine fibroid embolisation and/or surgical treatment options are not suitable or have failed.
    • This is in line with the revised licence indication which was reinstated by the MHRA in February 2021
    • The policy is published on the CCG website here
NICE Technology Appraisals
  • NICE have withdrawn NICE TA597: Dapagliflozin with insulin for treating type 1 diabetes. Dapagliflozin (Forxiga) with insulin is no longer licensed for treating type 1 diabetes mellitus.
Drug changes and additions
  • The following blood glucose meters, test strips, and lancets/lancing devices have been added to the formulary:
    • GlucoMen Glucofix Tech meter
    • Accu-Chek Instant meter
    • GlucoRX HCT meter
    • GlucoMen Glucofix Tech Sensor test strips
    • Accu-Chek Instant test strips
    • GlucoRx Lancets 0.2mm/33G
  • AgaMatrix WaveSense JAZZ blood glucose meters, AgaMatrix WaveSense JAZZ DUO test strips, and AgaMatrix Ultra-Thin Lancets 0.2mm/33G have been reclassified to blue (second line) products
  • Fidaxomicin tablets 200mg have been added as an amber (specialist input) option for the treatment of Clostridioides difficile infection in line with the Commissioning Policy
  • Olaparib (Lynparza) tablets 100mg and 150mg have been added as red (hospital only) options in place of the 50mg capsules
  • Risankizumab (Skyrizi) 150mg/1ml solution for injection in a pre-filled syringe have been added as a red (hospital only) option in place of the 75mg/0.83ml solution for injection in a pre-filled syringe
  • Ventolin Nebules 2.5mg and 5mg (salbutamol) have been discontinued. Remaining stock is expected to be exhausted early December for 2.5mg strength, and late December for the 5mg strength.
    • It is recommended to prescribe as generic salbutamol nebuliser liquid.
    • Click here for the formulary entry
Clostridioides difficile (c.difficile) infection
Diagnostic and monitoring devices for diabetes mellitus
  • Following a comprehensive review involving Diabetes Nurse Specialists this section has been updated with regards to recommendations on blood glucose meters, blood ketones meters, testing strips, and lancets.
  • Please see the formulary for further information

October 2021

NICE Technology Appraisals
  • Inclisiran solution for injection in pre-filled syringe 284mg/1.5ml has been added as a blue (second line) option for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults in line with NICE TA733.
    • Lipid specialists in Devon are developing guidance to incorporate inclisiran. In the meantime, they have suggested GPs seek advice if they are uncertain whether treatment with inclisiran is appropriate for a patient
    • Click here for the formulary entry and current guidance
  • Budesonide orodispersible tablets 1mg have been added as a red (hospital only) option for induction of remission in eosinophilic oesophagitis in line with NICE TA708. Click here for the formulary entry
Drug changes and additions
  • Chloramphenicol preservative-free single dose eye drops 0.5% have been reclassified as a green (first line) anti-bacterial eye drop option for patients with a known allergy to the preservative. Click here for the formulary entry
  • Shingrix powder and suspension for injection shingles (herpes zoster) vaccine (recombinant, adjuvanted) has been added to formulary following inclusion in the Green Book of immunisation. Click here for the formulary entry
    • Shingrix should be offered to all immunocompromised people for whom Zostavax is contraindicated, but who are eligible for vaccination under the current programme
Hepatitis B vaccination (CKD patients)
  • Commissioning responsibility and associated funding for Hepatitis B vaccination for patients with chronic kidney disease has transferred from Primary Care Commissioning to Specialised Commissioning. Following the changes in responsibility the following two vaccines have been reclassified as red (hospital only). Click here for the formulary entry:
    • Fendrix suspension for injection pre-filled syringes (Hepatitis B, rDNA) vaccine (adjuvanted, adsorbed)
    • HBvaxPRO40 suspension for injection (Hepatitis B, rDNA) vaccine
    • Engerix B suspension for injection in pre-filled syringes (Hepatitis B, rDNA) vaccine (adsorbed), only when used in renal insufficiency is also hospital only
Conjunctivitis

Formulary guidance for conjunctivitis has been updated, amendments include the following:

  • A revision to neonatal conjunctivitis to clarify that all neonates with severe conjunctivitis should be referred urgently to secondary care
  • Chloramphenicol eye drops dosing regimen and duration of treatment aligned with the drug entries
  • Action to be taken if treatment with chloramphenicol ophthalmic products fails
  • Please see the formulary for further information
Oral nutritional supplements (ONS)

Following consultation with local dietitian specialists in Devon, the formulary ONS options have been reviewed. The options selected are chosen on the basis of palatability, range of flavours, and cost efficiency. Supporting information to inform appropriate selection has been added to each section and the nutritional content of products is displayed in a tabular format

Prescribing for Alzheimer’s disease

This formulary section includes new guidance on the initiation of memantine in combination with an acetylcholinesterase inhibitor in patients with established Alzheimer’s disease, based on NICE guidance for dementia NG97.

Behavioural and psychological symptoms of dementia (BPSD)

This formulary section provides support for non-specialists, and refers to the Devon Partnership NHS Trust (DPT) prescribing guideline for severe BPSD (PG14) for detailed information for individual drugs and types of dementia, as well as incorporating elements from the NICE guidance for dementia NG97.

Learning: *NEW Multiple-Choice Quizzes*

New multiple-choice quizzes (MCQs) have been added to the formulary. The quizzes are designed to highlight key areas of formulary guidance and to help keep up to date with national and local guidance. Click here for more information.

The following quizzes are new:

  • Constipation
  • Upper Respiratory Tract Infections
Last updated: 10-01-2022

 

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