For the latest updates and advice on coronavirus (COVID-19), please visit the
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.
Fixed temporary IT issues with 'Contact Us' forms
The Devon-wide Formulary and Referral Website was experiencing some technical issues with regards to email communications via the contact details pages located on the website, which has resulted in some enquiries not reaching the Formulary and Referral Teams.
This issue has now been resolved; the cause was related to an external NHS system error which incorrectly marked enquiries as spam and deleted them.
We are not sure for how long there was an error and we have been informed that the enquiries sent during this time are not retrievable. If you have contacted us via the website and have not received a response, please accept our apologies. You may wish to resend your enquiry via the website function.
To help us answer or direct your question to the right person, please tell us who you are and where you are emailing from; e.g. GP practice name, locality, or acute trust.
Please provide as much detail as possible to assist us in responding to your query, but
do not include patient identifiable information. We will aim to respond to queries as soon as possible.
If your enquiry is related to a particular prescribing issue and an urgent reply is required, please contact your practice's Medicines Optimisation Pharmacist or the Medicines Optimisation Generic Mailbox:
The issue also affected the
learning pages and if you have completed any multiple choice quizzes and require certificates please email the Formulary Team with; your full name, the completed quiz topic, and the month it was completed, and we will issue you with a certificate.
EMA Safety Review: EMA's safety committee has confirmed that 5mg ulipristal acetate used for the treatment of symptoms of uterine fibroids can cause liver injury, and recommends revoking the licence for ulipristal acetate for uterine fibroids.
- The use of 5-mg ulipristal acetate medicines for uterine fibroids had already been suspended as a precautionary measure while awaiting the outcome of this review.
- This recommendation does not affect the single-dose ulipristal acetate emergency contraceptive and there is no concern about liver injury with these medicines.
Environmental impact of inhalers
- Devon Formulary guidance on the environmental impact of inhalers has been updated to remove reference to the GSK "Complete the Cycle" scheme which is to close at the end of September 2020. Spent inhalers should be returned to a pharmacy for disposal. The pharmacy's pharmaceutical waste bins are incinerated, destroying the greenhouse gases; steel and aluminium may be recovered and recycled at some incinerators. Spacers cannot currently be recycled.
Pelvic Inflammatory Disease (PID)
- Local specialists indicated that Mycoplasma Genitalium (M.Gen) testing for suspected PID was essential, however this test is not currently widely available in Devon in primary care, so patients should attend genitourinary medicine (GUM) clinics for full testing and management. Formulary guidance has therefore been updated to recommend referral of all patients with suspected PID to GUM clinics. Please see the formulary for further information.
Drug changes and additions
- Salamol CFC-free® aerosol inhalation 100 micrograms/ metered inhalation (pMDI) has been added into the formulary as the preferred brand of salbutamol pMDI. Salamol CFC-free® is estimated to have less than half of the carbon footprint of Ventolin Evohaler. Please see the formulary for further guidance.
- Vigabatrin drug entry has been updated to reflect the requirement for visual field testing and visual acuity assessment before treatment and at 6-month intervals for the whole duration of treatment. Please see the formulary for further guidance.
- The routine commissioning of Sativex (cannabidiol and dronabinol) is accepted in Devon for the treatment of spasticity due to multiple sclerosis only when specific criteria are met (see Commissioning Policy for more details). Refer to section 10.2.2 Skeletal muscle relaxants
- The routine commissioning of pitolisant hydrochloride is accepted in Devon only for the treatment of narcolepsy with cataplexy in adults aged 19 years and over who would otherwise be eligible for treatment with sodium oxybate (see Commissioning Policy for more details). Refer to section 4.1.1 Hypnotics
- The routine commissioning of lnvicorp (aviptadil with phentolamine) is accepted in Devon for the management of male erectile dysfunction only when specific criteria are met (see Commissioning Policy for more details). Refer to section 7.4.5 Drugs for erectile dysfunction
Palliative care guidance: diamorphine injection replaced with morphine sulfate injection
- Morphine sulfate injection is the first line opioid for subcutaneous injection in place of diamorphine injection (in line with the alert issued by the DHSC and NHSE, March 2020)
- All palliative care guidance including diamorphine injection has been replaced with guidance for morphine sulfate injection
- Section 16.2 Pain control in palliative care covers the use of morphine sulfate injection in various situations, including administration via a syringe driver (see subsection Subcutaneous opioids). If the volume of medication in a syringe driver is a concern, advice should be sought from the specialist palliative care team. Special considerations apply to patients in the last few days of life who are on a fentanyl patch (see subsection Transdermal opioids).
- Section 16.9 Breathlessness in palliative care covers
use of morphine sulfate injection,
including administration via a syringe driver
- Please note that
guidance for the administration of medicines via syringe driver for pain and
breathlessness is now located under the respective symptom specific sections
16.2 Pain control in palliative care and Section 16.9 Breathlessness in palliative care). Cross references with links
to these sections are included in
Section 16.16 Syringe Drivers.
- Section 16.15 Just In Case Bags: Diamorphine injection was replaced with morphine sulfate injection in the list of medicines for standard Just In Case bags for patients without COVID-19 in April 2020
Non-cystic fibrosis bronchiectasis
- Following an update to the Gonorrhoea guidance from the British Association for Sexual Health and HIV (BASSH) (January 2019); formulary guidance has been reviewed and updated. Please see the formulary for further information.
- Arrange a dual test for both Chlamydia trachomatis and Neisseria gonorrhoeae; samples can be completed using standard swabs. Gonorrhoea must be specifically requested for testing to be completed accurately.
- Ceftriaxone intramuscularly 1g, as a single dose, is recommended as the first line treatment option for uncomplicated anogenital and pharyngeal gonorrhoea infections
- Oral antibiotics have been amended to amber (specialist input) as susceptibility should be known prior to use, and specialist input is to be sought
Deep vein thrombosis (DVT) and pulmonary embolism (PE)
- Following the withdrawal of ingenol mebutate gel by the European Medicines Agency, the formulary indication for fluorouracil 5% cream has been extended to include the treatment of mild to moderate field changes. Please see the formulary for more information.
Drug changes and additions
Last updated: 28-09-2020
- Zemtard XL (diltiazem hydrochloride) modified release capsules 120mg, 180mg, 240mg, 300mg have been added as green (first line) option for mild to moderate hypertension and angina. Click here for more information.
- Slozem (diltiazem hydrochloride) modified release capsules have been removed from the formulary.
- Omeprazole dispersible tablets 10mg, 20mg, and 40mg have been added as blue (second line) option for the treatment of reflux oesophagitis, and symptomatic treatment of heartburn and acid regurgitation in gastro-oesophageal reflux disease in children over 1 year of age and ≥10kg. Click here for more information.
- Omeprazole oral suspension 10mg/5ml sugar free has been added as a blue (second line) option for the treatment of reflux oesophagitis, and symptomatic treatment of heartburn and acid regurgitation in gastro-oesophageal reflux disease in children over 1 month of age, if the prescribed dose cannot be given using the available strength of dispersible tablets (e.g. dose less than 10mg), or administration through enteral feeding tubes is required. Click here for more information.
- Ensure the licensed omeprazole suspension is prescribed and not a special liquid/suspension by selecting omeprazole 10mg/5ml oral suspension sugar free.
- UrgoClean Ag dressings 6cm x 6cm, 10cm x 10cm, 15cm x 20cm have been added as amber (specialist input) options for when infected wound sites require debridement. Click here for more information.
- First line
- Second line