Formulary updates

January 2020

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

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.

One-Alpha capsules 250 nanograms, 500 nanograms, and 1 microgram have been added as the formulary preferred brand for alfacalcidol for vitamin D complementation in severe renal impairment. 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.

Community-acquired Pneumonia (CAP) guidance review: Following publication of NICE NG138 Pneumonia (community-acquired): antimicrobial prescribing (September 2019), formulary guidance was discussed and will be updated soon, further details will be circulated at that time.

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.

October 2019

Commissioning Policy: The routine commissioning of glycopyrronium bromide oral solution is accepted in Devon for the symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders (see Commissioning Policy for more details)

Commissioning Policy: The routine commissioning of Continuous Glucose Monitors (CGMs) is accepted in Devon for patients with type 1 diabetes mellitus in line with specific criteria (see Commissioning Policy for more details)

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.

Last updated: 09-12-2019

 

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