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.
Learning: *NEW Multiple-Choice Quizzes*
New 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:
- Upper Respiratory Tract Infections
- The routine commissioning of lisdexamfetamine is accepted in Devon for the treatment of attention deficit hyperactivity disorder (ADHD) in adults who have failed to gain an adequate response to, or tolerate, methylphenidate (see Commissioning Policy for more details)
- The existing commissioning policy for lixisenatide for the treatment of type 2 diabetes has been rescinded. The policy previously recommended the routine commissioning of lixisenatide in Devon for the treatment of adults with type 2 diabetes mellitus in combination with oral glucose-lowering agents and/or basal insulin when these, together with diet and exercise, fail to provide adequate glycaemic control, this policy has now been withdrawn and removed from the Devon Formulary.
- This policy withdrawal is not intended to affect patients currently receiving treatment and they may continue to use it, until their NHS clinician considers it appropriate to stop or change treatment
Drug changes and additions
- Ezetimibe 10mg tablets have been reclassified as a blue (second line) option for the treatment of primary hypercholesterolaemia. Click here for the formulary entry
- Nilemdo® (Bempedoic acid) tablets 180mg and Nustendi® (Bempedoic acid 180mg with ezetimibe 10mg ) tablets have been added as amber (specialist input) options for the treatment of primary hypercholesterolaemia or mixed dyslipidaemia in line with NICE TA694. Click here for the formulary entry
Helicobacter Pylori (H. Pylori) retesting
Following discussions and a consultation period with local gastrointestinal specialists in Devon, formulary guidance for H. pylori retesting in dyspepsia and gastro-oesophageal reflux disease has been updated. A recommendation was made by specialists, and agreed by NHS Devon CCG, to diverge from NICE guidance (which recommends retesting for H. pylori should be via a carbon-13 urea breath test) and opt to use stool antigen tests for repeat testing following H. pylori infection in patients with a defined clinical need. The formulary has been updated to provide clarity on the patient groups who have a strong clinical need for retesting.
Shared Care / Specialised Medicines Service (SMS) guidelines
Three new Specialised Medicines Service prescribing guidelines have been agreed for:
- Atomoxetine for attention deficit hyperactivity disorder in adults
- Lisdexamfetamine for attention deficit hyperactivity disorder in adults
- Methylphenidate for attention deficit hyperactivity disorder in adults
The formulary entries have been updated with links to the guidelines
Drug changes and additions
- Sumatriptan injection 3mg/0.5ml in pre-filled pens has been added as an option for the treatment of migraine only if sumatriptan 6mg injection is effective but not tolerated. Click here for the formulary entry.
- Dulaglutide injection 3mg/0.5ml, 4.5mg/0.5ml in pre-filled pens have been added as blue (second line) options to expand on the current available strengths of dulaglutide injection. These are indicated for type 2 diabetes mellitus in line with current formulary guidance. Click here for the formulary entry.
- Methenamine hippurate tablets 1g have been added as an amber (specialist input) option for the prophylaxis and long-term treatment of chronic or recurrent uncomplicated lower urinary tract infections. Click here for the formulary entry.
- Toujeo DoubleStar (insulin glargine) prefilled disposable injection device 3ml has been added as an amber (specialist input) option for patient with diabetes mellitus.
- SoloStar prefilled pens contain 1.5ml (equivalent to 450 units), 1-80 units per single injection, in steps of 1 unit
- DoubleStar prefilled pens contain 3ml (equivalent to 900 units), 2-160 units per single injection, in steps of 2 units
- Care should be taken to ensure patients and carers are aware that the dose increments are in 2 units of insulin for the Toujeo DoubleStar product
- Educational risk minimisation materials can be found here
- Click here for the formulary entry
Pelvic Inflammatory Disease (PID)
Updated national guidance from the British Association of Sexual Health and HIV (BASSH) recommends that testing for PID is extended to include Mycoplasma genitalium (M. gen) to direct the choice of antibiotic treatment. Testing for M. gen is currently not widely available in Devon and can only be arranged at Genito-Urinary Medicine (GUM) services. Formulary guidance has therefore been updated to recommend that patients with suspected PID should be referred to GUM services for full assessment.
- Where patients are unable to attend GUM services, specialists have agreed an oral-only antibiotic safety net regime that can be administered in primary care. This is not in line with national guidance from BASSH but allows a trial of antibiotics that covers a range of pathogens, and equally should not drive any antibiotic resistance.
- Please see the formulary for further guidance
NICE Technology Appraisals
- Dapagliflozin tablets 5mg and 10mg: Chronic heart failure has been added as an indication in line with NICE TA679. Treatment with dapagliflozin should be started on the advice of a heart failure specialist. Click here for the formulary entry.
Last updated: 05-08-2021
- The routine commissioning of Rybelsus® (oral semaglutide) is accepted in Devon for the treatment of type 2 diabetes who are suitable for treatment with a GLP-1 mimetic, as described in NICE Guideline NG28, but for whom injectable therapy is not suitable (See Commissioning Policy for more information). The formulary entry has been updated to reflect this policy. Click here for more information.
- The Commissioning Policy for FreeStyle Libre, for patients with diabetes mellitus (in line with policy criteria), has been updated to include patients on insulin who are living with a learning disability, as recorded on their GP learning disability register (see Commissioning Policy for more details). The formulary entry has been updated to reflect this policy. Click here for more information.
- Patients meeting these criteria can be referred to specialist services for consideration of FreeStyle Libre/ Libre 2 devices. GPs referring on this basis should highlight that the individual is on the learning disability register, as this information may not be available to specialists. As well as supplying the Libre reader, specialists can provide any necessary training for patients and/ or carers to support its use.
- First line
- Second line