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.

November 2020

Commissioning Policies

• The routine commissioning of 10mg rivaroxaban is accepted in Devon for the prevention of recurrent deep vein thrombosis and pulmonary embolism (see Commissioning Policy for more details). The formulary entry has been updated to reflect this policy. Click here for more information.

Drug changes and additions

• ActivHeal Alginate® dressings, 5cm x 5cm, 10cm x 10cm, 10cm x 20cm, have been added for moderately to heavily exuding wounds that are granulating or with areas of slough. ActivHeal Alginate may also be used as a haemostat to control minor bleeding in superficial wounds. Click here for more information.
• ActivHeal Alginate® Rope, 2cm x 30cm, has been added for acute and chronic cavity wounds with moderate to heavy exudate. ActivHeal Alginate Rope may also be used as a haemostat to control minor bleeding in superficial wounds. Click here for more information.
• Aquacel Foam® dressings with silicone adhesive border have been added as primary or secondary dressings for low, moderate and high exuding wounds where a hydrocolloid fibrous and a foam dressing in combination is required. Click here for more information.
• Aquacel Foam® dressings without silicone adhesive border have been added as primary or secondary dressings for low, moderate and high exuding wounds where a hydrocolloid fibrous and a foam dressing in combination is required. Click here for more information.
• Vigabatrin tablets 500mg and granules for oral solution 500mg have been reclassified as red (hospital only) drugs, as the prevalence and potential severity of visual effects requires frequent ophthalmological monitoring of a specialist nature. Click here for more information.

August 2020

Commissioning Policies

• The routine commissioning of Sativex (cannabidiol and dronabinol) is accepted in Devon for the treatment of spasticity due to multiple sclerosis only when specific criteria are met (see Commissioning Policy for more details). Refer to section 10.2.2 Skeletal muscle relaxants
• The routine commissioning of pitolisant hydrochloride is accepted in Devon only for the treatment of narcolepsy with cataplexy in adults aged 19 years and over who would otherwise be eligible for treatment with sodium oxybate (see Commissioning Policy for more details). Refer to section 4.1.1 Hypnotics
• The routine commissioning of lnvicorp (aviptadil with phentolamine) is accepted in Devon for the management of male erectile dysfunction only when specific criteria are met (see Commissioning Policy for more details). Refer to section 7.4.5 Drugs for erectile dysfunction

September 2020

EMA Safety Review: EMA's safety committee has confirmed that 5mg ulipristal acetate used for the treatment of symptoms of uterine fibroids can cause liver injury, and recommends revoking the licence for ulipristal acetate for uterine fibroids.

• The use of 5-mg ulipristal acetate medicines for uterine fibroids had already been suspended as a precautionary measure while awaiting the outcome of this review.
• This recommendation does not affect the single-dose ulipristal acetate emergency contraceptive and there is no concern about liver injury with these medicines.

Environmental impact of inhalers

• Devon Formulary guidance on the environmental impact of inhalers has been updated to remove reference to the GSK "Complete the Cycle" scheme which is to close at the end of September 2020. Spent inhalers should be returned to a pharmacy for disposal. The pharmacy's pharmaceutical waste bins are incinerated, destroying the greenhouse gases; steel and aluminium may be recovered and recycled at some incinerators. Spacers cannot currently be recycled.

Pelvic Inflammatory Disease (PID)

• Local specialists indicated that Mycoplasma Genitalium (M.Gen) testing for suspected PID was essential, however this test is not currently widely available in Devon in primary care, so patients should attend genitourinary medicine (GUM) clinics for full testing and management. Formulary guidance has therefore been updated to recommend referral of all patients with suspected PID to GUM clinics. Please see the formulary for further information.

Drug changes and additions

• Salamol CFC-free® aerosol inhalation 100 micrograms/ metered inhalation (pMDI) has been added into the formulary as the preferred brand of salbutamol pMDI. Salamol CFC-free® is estimated to have less than half of the carbon footprint of Ventolin Evohaler. Please see the formulary for further guidance.
• Vigabatrin drug entry has been updated to reflect the requirement for visual field testing and visual acuity assessment before treatment and at 6-month intervals for the whole duration of treatment. Please see the formulary for further guidance.

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