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.

Formulary Interface Group updates

In February 2021, the North & East Devon and South & West Devon Formulary Interface Groups (FIGs) merged to form a single Devon-wide FIG. The resulting multi-stakeholder group includes representatives from NHS Devon CCG and primary and secondary care providers.

• Terms of Reference (ToR) for the Devon FIG are available here; they build on the ToRs of the predecessor FIGs and were produced with reference to the ToR of the Devon Clinical Policy Committee and guidance from NICE and PrescQIPP.

April 2021

Drug changes and additions

• FreeStyle Libre 2 interstitial glucose sensor has been added as an amber (specialist input) option for patients with diabetes mellitus in line with specific criteria (see Commissioning Policy for more details).
  • All patients who are using a Libre in keeping with formulary guidance can now be moved on to Libre 2, the updated sensor
  • To prevent wastage, switching to the Libre 2 sensor should be undertaken when the patient’s existing supply of Libre sensors runs out
  • Local specialists have produced a patient information leaflet to support patients upgrading to the FreeStyle Libre 2 sensor. The leaflet is available here (under the header “Supporting you”)
  • Click here for the formulary entry

Environmental impact of inhalers

Informative tables have been added to the guidance which give the indicative carbon footprint (as CO₂eq) per puff of each inhaler as well as estimates of annual CO₂eq and equivalent car miles for the recommended regimens.

• It is intended to highlight the environmental impact of inhaler devices containing hydrofluorocarbon (HFC) propellants compared to dry powder / soft mist inhalers.
• Please see the formulary for further guidance

March 2021

Drug changes and additions

• Hydrogen peroxide 1% cream, 25g and 40g, has been added for use in the management of localised non-bullous impetigo. Click here for more information.
• Espranor® (buprenorphine) 2mg, 8mg oral lyophilisate has been added as an option for substitution treatment for opioid drug dependence. Click here for more information.
• Rivastigmine 4.6mg, 9.5mg, 13.3mg (24 hours) patches have been added as a formulation for mild to moderate dementia in Alzheimer’s disease. Click here for more information.

Impetigo

Formulary guidance has been reviewed and updated. The guidance provides recommendations on advice to reduce the spread of impetigo, initial treatment, reassessment and further treatment, referral and seeking specialist advice, and appropriate choice of antimicrobial. Please see the formulary for further information.

Urinary tract infections (UTI)

Formulary guidance for recurrent UTI and catheter-associated UTI has been revised and updated. Please see the formulary for further guidance.

Acute Pyelonephritis

Formulary guidance has been reviewed and updated. Please see the formulary for further guidance.

Specialised Medicines Service (SMS)

The following Specialised Medicines Service (SMS) prescribing guidelines have been partially updated to provide clarity in respect of prescribing and monitoring responsibilities at initiation of treatment (specialists will prescribe and monitor during the first 28 days, GPs to continue prescribing and monitoring thereafter):

• Azathioprine for the treatment of rheumatological conditions*
• Ciclosporin (Neoral) for rheumatological disease*
• Leflunomide for the treatment of rheumatoid arthritis and psoriatic arthritis*
• Sulfasalazine enteric coated for the treatment of rheumatological conditions*

* Please note, these changes were agreed at the March 2020 meeting of the N&E Devon FIG, the delay in publication was due to resources being diverted to support the NHS response to the COVID-19 pandemic.

The following Specialised Medicines Service (SMS) prescribing guidelines have been partially updated to include advice from the recent MHRA Drug Safety Update “Methotrexate once weekly for autoimmune diseases: new measures to reduce risk of fatal overdose due to inadvertent daily instead of weekly doses” (September 2020). The new recommendations strengthen existing advice highlighting the once weekly dosing of methotrexate for autoimmune disease but are unlikely to represent a significant change in practice.

• Weekly oral and subcutaneous methotrexate for the treatment of rheumatological and autoimmune diseases
• Weekly oral and subcutaneous methotrexate for the treatment of dermatological conditions
• Weekly oral and subcutaneous methotrexate for the treatment of inflammatory bowel disease

January 2021

Commissioning Policies

• The routine commissioning of rosuvastatin is accepted in Devon for the prevention of cardiovascular disease in patients who are intolerant of other appropriate statins (see Commissioning Policy for more details). The formulary entry has been updated to reflect this policy. Click here for more information.

Last updated: 09-04-2021

 

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