Formulary updates

October 2019

Partial updates to the following North and East Devon Shared Care / Specialised Medicines Service (SMS) guidelines have been published:

Updated information includes:

  • Monitoring requirements (including a reduction in routine monitoring frequency to 3 monthly in most cases)
  • Specialist contact details
  • Additional clinical information added to GP responsibilities and supporting information

Shared Care / SMS guidelines are available on the NHS Devon CCG website ( www.devonccg.nhs.uk) or via the above hyperlinks. Hyperlinks are also available from the relevant drug entries in the Devon Formulary

September 2019

Learning: *NEW Multiple Choice Quizzes for 2019*

New and updated 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 or have been updated:

  • Asthma (NEW)
  • Epilepsy (UPDATED)
  • Pain and analgesia (NEW)
  • Parkinson's Disease (NEW)
  • Gynest intravaginal cream 0.01% and Ovestin intravaginal cream 0.1% have been removed from the formulary in favour of generic estriol intravaginal cream 0.1%. Click here for more information.
  • In line with guidance from NHS England (see below), the following changes have been made to formulary recommended needles for pre-filled and re-usable insulin pens:
    • GlucoRx CarePoint pen needles 4mm/31G, 5mm/31G, and 6mm/31G have been added to the formulary as green (first line) options
    • BD Viva pen needles 4mm/32G and 5mm/31G have been reclassified to blue (second line); the 6mm/31G size have also been added to the formulary
    • GlucoRx Finepoint 4mm/31G, 5mm/31G, and 6mm/31G have been reclassified as blue (second line) options
    • Omnican Fine pen needles 5mm/32G have been added to the formulary as a blue (second line) option.
    • Omnican Fine 4mm/31G and 6mm/31G have been removed from the formulary
    • Microdot droplet 4mm/32G and 6mm/31G have been removed from the formulary
  • The following changes have been made to formulary recommendations on bisphosphonates:
    • Ibandronic acid tablets 150mg have been reclassified as a blue (second line) option for the treatment of postmenopausal osteoporosis.
    • Risedronate sodium tablets 5mg, 30mg, and weekly tablets 35mg have been reclassified as a blue (second line) option for the treatment of osteoporosis
  • Following ongoing long-term supply issues and discontinuation of some branded nifedipine, the formulary entry has been updated to provide prescribers with supporting information. Click here for more information.
  • Colistimethate sodium 1 million unit and 2 million unit powder for solution for injection vials have been reclassified as an amber (specialised input) option for nebulised use in non-cystic fibrosis bronchiectasis patients (unlicensed). Click here for more information.
    • Promixin 1 million unit powder for nebuliser solution remains as a red (hospital only) option for cystic fibrosis treatment
    • Colobreathe 1,662,500 unit dry powder for inhalation remains as a red (hospital only) option for cystic fibrosis treatment, in line with NICE TA276
  • Sodium aurothiomalate (Myocrisin) injections have been removed from the formulary due to product discontinuation by the manufacturer. Patients currently prescribed these products should be referred to specialist services for consideration of suitable therapeutic alternatives.

Chlamydia trachomatis: Following an update to the Chlamydia trachomatis guideline from the British Association for Sexual Health and HIV (BASHH). Formulary guidance has been reviewed and updated. Please see the formulary for further information.

  • Doxycycline is recommended as a first line treatment option for all chlamydial sites
  • Azithromycin is recommended as a second line treatment for all chlamydial sites
  • There are separate recommendations for use in pregnancy

Psoriasis management: Following updates to NICE Guideline CG153 Psoriasis: assessment and management (September 2017) and British Association of Dermatologists (BAD) Clinical Guideline: Psoriasis (October 2018). Formulary guidance has been revised, expanded and updated. Please see the formulary for further guidance.

Gender dysphoria and transgender prescribing: A summary of the prescribing responsibilities described by NHS England, alongside advice from NHS England for GPs regarding requests by private online medical service providers has been added to the formulary. Please see the formulary for further information.

Following public consultation; NHS England (NHSE) and NHS Clinical Commissioners (NHSCC) published guidance for CCGs on items which should not be routinely prescribed in primary care. Click here for more information. The following items have new guidance attached in the formulary:

Following public consultation; NHS England (NHSE) and NHS Clinical Commissioners (NHSCC) published guidance for CCGs, on conditions for which over the counter (OTC) items should not routinely be prescribed in primary care. Click here for more information.

July 2019

  • Following agreement of the Dapsone Specialised Medicines Service prescribing guideline in North and East Devon; the formulary entry has been updated with a link to the guideline.

June 2019

  • Kliniderm Superabsorbent dressings (10cm x 10cm, 10cm x 15cm, 20cm x 20cm, 20cm x 30cm, 20cm x 40cm) have been added as green (first line) options for patients with moderate to heavy exudating wounds that require a superabsorbent dressing. Click here for more information.
    • Eclypse dressings (10cm x 10cm, 15cm x 15cm, 20cm x 30cm, 60cm x 40cm) have been removed from the formulary
  • Cilique (ethinylestradiol 35micrograms/ norgestimate 250micrograms) tablets have been added to the formulary as a green (first line) option for hormonal contraception. Click here for more information.
  • Prontosan Debridement Pad has been added to the formulary as a green (first line) option for the soft mechanical debridement of wounds. Click here for more information.
    • DebriSoft Pad (10cm x 10cm) and DebriSoft Lolly (23.5cm x 10cm) have been removed from the formulary
  • Desmopressin oral lyophilisates 25 micrograms & 50 micrograms have been added to the formulary as an amber (specialist) option for primary idiopathic nocturnal polyuria in adults. Click here for more information.
  • Flexitol 25% Urea Heel Balm has been added to the formulary as an amber (specialist) option for the treatment of callused, anhidrotic, fissured, and hard foot skin conditions. Click here for more information.
  • Liothyronine drug entry has been revised and updated to ensure consistency with local protocols for initiation and review of existing patients. Click here for more information.

International Dysphagia Diet Standardisation Initiative (IDDSI): A new way of describing texture modified foods and thickened liquids was introduced across the UK from April 2018 to April 2019. The new categorisation is called IDDSI and consists of a banding of eight levels (0 – 7) with consistency descriptors. The formulary has been updated to reflect this change. Please see the formulary for further guidance.

Neural tube defects (prevention in pregnancy): Guidance has been added for the prevention of neural tube defects in pregnancy and a link to guidance has been added to the folic acid drug entry. Please see the formulary for further guidance.

 

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