Formulary updates

April 2020

Standard Just In Case Bags for patients without COVID-19: morphine sulfate injection

Due to unpredictability in the supply of diamorphine 5mg and 10mg injection, a national directive was issued by the DHSC and NHSE to move from diamorphine 5mg and 10mg injection to morphine sulfate injection, as the opioid of choice, where clinically appropriate. This is now to be a permanent move. The list of medicines for standard Just In Case bags for patients without COVID-19 has been updated to replace diamorphine 10mg injection for breathlessness and pain with morphine sulfate 10mg/1ml injection. If you have existing standard Just In Case bags containing diamorphine, please continue to use these. This will help to conserve stocks of morphine.

Please note an error was made in an announcement regarding Just In Case bags in the CCG bulletin of Apr 9th. We can confirm that there is no change to the quantities of ampoules which should be included in standard Just In Case bags - this will continue to be 3 ampoules of midazolam and 3 ampoules of an antimuscarinic for respiratory secretions in addition to the other contents which are described in detail here

March 2020

Ulipristal acetate 5mg tablets have been removed from the formulary following suspension of the CCG commissioning policy pending the outcome of the new EMA Safety Review of liver injury risk.

  • Prescribers should not start any new patients on ulipristal acetate for uterine fibroids. Refer to the formulary entry for further information for women who are currently being prescribed ulipristal acetate for uterine fibroids.

Recommendations for ulipristal acteate for emergency contraception are not affected by the EMA Safety Review.

Brand or generic prescribing

The way in which preferred brands are presented in the formulary has changed.

Using approved (generic) names for medicines is generally encouraged for prescribing in both primary and secondary care. There are some circumstances in which continuity of the same brand is important for clinical reasons or patient safety, and occasionally branded prescribing is more cost-effective than generic prescribing. The format of the formulary continues to define when brand prescribe is necessary for clinical or patient safety reasons. For more information and examples refer to "brand or generic prescribing" on the Formulary Information page.

Previously, where a specific brand offered a cost-efficient option to help reduce cost pressures across the NHS, these were listed in the formulary. From March 2020, a list of locally preferred brands is maintained by the NHS Devon CCG Medicines Optimisation (MO) Team and can be found on the NHS Devon CCG Website. These brands are no longer specifically referenced in the Devon Formulary; relevant formulary drug entries have been updated to list the generic name and include a hyperlink to the MO Team preferred brands page.

February 2020

Specialised Medicines Service prescribing guidelines have been agreed for flupentixol decanoate, haloperidol decanoate, and zuclopenthixol decanoate depot injections. The formulary entries have been updated with a link to the guidelines

Liothyronine: GPs who receive a request from a consultant to prescribe liothyronine for a patient who has not previously received liothyronine should contact the CCG Medicines Optimisation team before accepting the request. Click here

January 2020

New European Medicines Agency safety alert issued for ingenol mebutate gel. Healthcare professional letter expected week beginning 27th January 2020.

The routine commissioning of loteprednol is accepted in Devon for the treatment of patients with steroid responsive inflammatory eye conditions who have a known clinically significant rise in intraocular pressure with other steroid eye drops (see Commissioning Policy and formulary entry for more details)

Management of hypertension in pregnancy: Following publication of NICE NG133 Hypertension in pregnancy: diagnosis and management (June 2019), formulary guidance has been reviewed and updated. Please see the formulary for further guidance.

  • The following products have been reclassified as blue (second line) options for hypertension in pregnancy:
    • Labetalol tablets 100mg, 200mg, and 400mg
    • Nifedipine capsules/ tablets 10mg, 20mg, 30mg, and 60mg
    • Methyldopa tablets 125mg, 250mg, and 500mg

Chapter 17. Wound Management Formulary: The chapter has undergone format changes and information has been consolidated to streamline the accessibility of clinically appropriate guidance and treatment options.

  • Draina S wound pouches mini, medium, and large have been added into the formulary as amber (specialist) appliances for the management of wounds and fistulas with significant levels of exudate, where conventional dressings would need to be changed more frequently. Click here for more information.

Thealoz Duo eye drops (sodium hyaluronate 0.15%, trehalose 3%) have been added into the formulary as an amber (specialist) option for patients who cannot tolerate Evolve HA eye drops (sodium hyaluronate 0.2%), or for patients who have been diagnosed with severe dry eye and Evolve HA is not sufficient. Click here for more information.

Acute prostatitis: Following publication of NICE NG110 Prostatitis (acute): antimicrobial prescribing (October 2018). Formulary guidance has been revised and updated. Please see the formulary for further guidance.

Urinary tract infections (lower): Following publication of NICE NG109: Urinary tract infection (lower): antimicrobial prescribing (October 2018) formulary guidance has been revised and updated. Please see the formulary for further guidance.

Community-acquired Pneumonia (CAP) guidance review: Following publication of NICE NG138 Pneumonia (community-acquired): antimicrobial prescribing (September 2019). Formulary guidance has been revised and updated. Please see the formulary for further guidance.

Prescribing medicines in renal impairment:Following publication of an MHRA Safety Update on using the appropriate estimate of renal function to avoid the risk of adverse drug reactions, resource website links, useful information on when to use creatinine clearance, and a link to the calculation have been added to the formulary. Please see the formulary for further guidance.

Teratogenic potential and prescribing in pregnancy and lactation information: Following publication of an MHRA Safety Update, resource website links and useful information on effective contraception and frequency of pregnancy testing when medicines with teratogenic potential are prescribed have been added to the formulary. Please see the formulary for further guidance.

December 2019

Fluphenazine decanoate (Modecate) injections have been removed from the formulary following product discontinuation (due to manufacturing and supply problems not any safety issues). Any remaining patients currently prescribed these products should be referred to specialist services for consideration of alternative therapy (DPT have confirmed that referral should be via the assessment teams as normal).

November 2019

GlucoRx CarePoint Ultra pen needles 4mm/31G have been added to the formulary as green (first line) options. Click here for more information.

Kelhale Aerosol inhalation metered dose inhalers (beclometasone dipropionate [BDP] extrafine) 50micrograms and 100micrograms have been added to the formulary as green (first line) options. BDP inhalers should be prescribed by brand since they are not all interchangeable. Click here for more information.

  • The following products have been reclassified as blue (second line) options:
    • Qvar Aerosol inhalation metered dose inhalers (BDP) 50micrograms and 100micrograms
    • Qvar Autohaler breath-actuated aerosol inhalation metered dose inhalers (BDP) 50micrograms and 100micrograms
    • Qvar Easi-breathe breath-actuated aerosol inhalation metered dose inhalers (BDP) 50micrograms and 100micrograms

Latanoprost / timolol single unit dose eye drops (preservative-free) 50micrograms / 5mg/ml have been added to the formulary as an amber (specialist) option. Click here for more information.

Acute cough guidance review: Following publication of NICE NG120 Cough (acute): antimicrobial prescribing (February 2019), formulary guidance has been revised and updated. Please see the formulary for further guidance.

Chronic Obstructive Pulmonary Disorder (COPD) guidance review: Following publication of updated guidance from both GOLD and NICE in 2019, formulary guidance on the management of COPD has been revised and updated. The review incorporates management of stable COPD and COPD exacerbations and includes new antimicrobial guidance for acute exacerbations. Please see the formulary for further guidance.

The environmental impact of inhalers: New guidance has been produced which highlights the carbon footprint of inhalers, and steps that may be taken to mitigate environmental impact in terms of inhaler device choice, waste and recycling. Please see the formulary for further guidance

Ondansetron in pregnancy: The formulary guidance on ondansetron use for nausea and vomiting in pregnancy has been updated, following a safety recommendation by the European Medicines Agency (EMA). The SPCs for ondansetron products will be updated to indicate that it should not be used during the first trimester of pregnancy, as a review of studies of pregnancy identified a small increase in the risk of orofacial cleft. However, use of ondansetron in pregnancy is still supported by the UK Teratology Information Service and The Royal College of Obstetricians and Gynaecologists. Please see the formulary for further guidance.

Chapter 14. Immunological products and vaccines: The chapter has undergone format changes and information has been consolidated to streamline the accessibility of clinically appropriate guidance and treatment options. Vaccination strengths, doses, and treatment regimens have been removed and replaced with a permanent link to Public Health England's (PHE) 'The Green Book'. Please see the formulary for further guidance.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): The formulary entries for NSAIDs have been reviewed and updated following the recent review of formulary gout guidance and as part of the rolling review programme. Please see the formulary for further guidance.

Partial updates to the following North and East Devon Shared Care guideline have been published:

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

User improvements: *NEW* Search Functionality

Following feedback from the user survey, a new improved search function has been added which allows users to filter search results by Formulary or Referral pages.

Last updated: 24-04-2020

 

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