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.

May 2022

Drug changes and additions
  • Anoro ellipta (combination of umeclidinium bromide and vilanterol (as trifenatate)) dry powder inhaler (DPI) 55micrograms / 22micrograms has been added as a green (first line) option for the maintenance of chronic obstructive pulmonary disease.
  • Pancrex V powder (pancreatin) has been added as an amber (specialist input) option for the treatment of pancreatic exocrine insufficiency in patients requiring enteral feeding.
  • Octasa suppositories (mesalazine 1g) have been added as an amber (specialist input) option for the treatment of acute mild to moderate ulcerative proctitis and the maintenance of remission of ulcerative proctitis.
    • Pentasa suppositories (1g) have been removed from the formulary
    • Click here for the formulary entry
  • Utrogestan vaginal capsule (micronised progesterone 200mg) has been added as an amber (specialist input) option for threatened miscarriage in women with a history of miscarriage in line with NICE NG126 (off-label).
  • Cenobamate tablets (50mg, 100mg, 150mg, 200mg) have been reclassified as amber (specialist input) options for treating focal onset of seizures in epilepsy in line with NICE TA753.
Shared Care / Specialised Medicines Service (SMS) guidelines
  • Riluzole for the treatment of individuals with the amyotrophic lateral sclerosis form of motor neurone disease
    • This Devon-wide guideline updates and replaces previous individual riluzole guidelines for North & East, South, and West Devon
    • The updated Devon-wide prescribing guideline can be found on the NHS Devon CCG Website, or via the riluzole drug entry
  • Azathioprine and mercaptopurine for the treatment of inflammatory bowel disease in adults
    • This Devon-wide guideline updates and replaces previous individual gastroenterology guidelines for North & East, South, and West Devon
    • The updated Devon-wide prescribing guideline can be found on the NHS Devon CCG Website, or via the azathioprine and mercaptopurine drug entries

March 2022

Drug changes and additions
  • Lyumjev (insulin lispro) 100 units per 1ml, 10ml vials, 3ml cartridges, and 3ml KwikPen pre-filled disposable injection devices have been added as an amber (specialist input) option for the treatment of diabetes mellitus in adults
    • Click here for the formulary entry
    • All insulins should be prescribed by brand. Lyumjev is not interchangeable with Humalog.

NHS England is introducing a new initiative for primary care to increase the prescribing of dry powder inhalers (DPIs) and soft mist inhalers (SMIs) where clinically appropriate, as part of the drive to create a more sustainable NHS. This does not apply to salbutamol pressurised metered dose inhalers (pMDIs).

  • The Devon Formulary has historically taken a proactive approach to inhalers, balancing the inclusion of DPI and/or SMI options for each drug class, where available, with the need to ensure that pMDI options are available for children and other patients who may require these.
  • With the exception of salbutamol and ipratropium, pMDIs are generally included as blue (second-line) options, supporting steps to reduce the carbon footprint of inhaler use. It is accepted that pMDIs are required for children and there may be other clinical or dexterity reasons for prescribing a pMDI.
  • The formulary section on the environmental impact of inhalers has been updated with the latest estimates from PrescQIPP on the carbon footprint of individual formulary inhalers. Click here
  • To further support this initiative, additional DPIs have been added to the formulary, see below:
Corticosteroid inhalers
  • Budesonide Easyhaler 100 micrograms/dose, 200 micrograms/dose and 400 micrograms/dose (DPI) has been added alongside Pulmicort Turbohaler (DPI) for the treatment of asthma. Budesonide Easyhaler is licensed from six years of age.
Adrenoreceptor agonist inhalers
  • Formoterol 12 micrograms/dose Easyhaler (DPI) has been added alongside Oxis (formoterol) 12 micrograms/dose Turbohaler (DPI) for the treatment of COPD.
  • Oxis (formoterol) 6 micrograms/dose Turbohaler has been removed from the Devon Formulary, as the daily dose is 12 micrograms twice daily and the 6 micrograms Turbohaler is twice the price per daily dose compared with Oxis 12 micrograms Turbohaler.
Combination long-acting beta2 adrenoreceptor / corticosteroid inhalers
  • Fobumix Easyhalers (budesonide / formoterol) (DPI) have been added alongside Symbicort Turbohaler (budesonide / formoterol) (DPI) for the treatment of asthma in adults and COPD
  • DuoResp Spiromax (budesonide / formoterol) (DPI) has been reclassified from a first-line to a second-line option
  • Fusacomb Easyhaler (fluticasone propionate 250 micrograms / salmeterol 50 micrograms per dose) (DPI) has been added for the treatment of asthma from 12 years of age.
  • Luforbec pMDI (BDP extrafine 100 micrograms / formoterol 6 micrograms per dose) has been added for the treatment of asthma in adults and COPD
  • Fostair pMDI (BDP extrafine 100 micrograms / formoterol 6 micrograms per dose) has been removed from the formulary due to its high acquisition cost in comparison to Luforbec 100/6 pMDI.
    • No new patients should be prescribed Fostair 100/6 pMDI. For existing patients, continued prescribing is accepted until the next review when the patient should be switched to Fostair NEXThaler or Luforbec 100/6 pMDI if clinically appropriate.
    • The text above is included in the formulary. Click here
  • Fostair pMDI (BDP extrafine 200 micrograms / formoterol 6 micrograms per dose) was reclassified to an amber formulary option on 7th March 2022 as high dose corticosteroid inhalers (such as Fostair 200/6 – 2 puffs twice a day) should only be used after referral to secondary care. For further information on high dose corticosteroids, click here
    • If Fostair 200/6 was recommended by a specialist before 7th March 2022 the GP does not need to re-refer the patient and should continue to prescribe Fostair 200/6 in line with the specialist’s recommendation
    • The text above is included in the formulary entry. Click here
  • Fostair NEXThalers (BDP extrafine / formoterol) (DPI) remain unchanged as a first-line option
Triple combination inhalers
  • Trimbow NEXThaler (BDP extrafine / formoterol / glycopyrronium) (DPI) has been added to the formulary.
  • Trimbow pMDI has been reclassified to a second-line option, as pMDIs are generally considered second-line options (supporting steps to reduce the carbon footprint of inhaler use).

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
Last updated: 12-05-2022

 

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