Formulary updates

July 2020

Palliative care guidance: diamorphine injection replaced with morphine sulfate injection

April 2020

Standard Just In Case Bags for patients without COVID-19: morphine sulfate injection

Due to unpredictability in the supply of diamorphine 5mg and 10mg injection, a national directive was issued by the DHSC and NHSE to move from diamorphine 5mg and 10mg injection to morphine sulfate injection, as the opioid of choice, where clinically appropriate. This is now to be a permanent move. The list of medicines for standard Just In Case bags for patients without COVID-19 has been updated to replace diamorphine 10mg injection for breathlessness and pain with morphine sulfate 10mg/1ml injection. If you have existing standard Just In Case bags containing diamorphine, please continue to use these. This will help to conserve stocks of morphine.

Please note an error was made in an announcement regarding Just In Case bags in the CCG bulletin of Apr 9th. We can confirm that there is no change to the quantities of ampoules which should be included in standard Just In Case bags - this will continue to be 3 ampoules of midazolam and 3 ampoules of an antimuscarinic for respiratory secretions in addition to the other contents which are described in detail here.

March 2020

Ulipristal acetate 5mg tablets have been removed from the formulary following suspension of the CCG commissioning policy pending the outcome of the new EMA Safety Review of liver injury risk.

  • Prescribers should not start any new patients on ulipristal acetate for uterine fibroids. Refer to the formulary entry for further information for women who are currently being prescribed ulipristal acetate for uterine fibroids.

Recommendations for ulipristal acteate for emergency contraception are not affected by the EMA Safety Review.

Brand or generic prescribing

The way in which preferred brands are presented in the formulary has changed.

Using approved (generic) names for medicines is generally encouraged for prescribing in both primary and secondary care. There are some circumstances in which continuity of the same brand is important for clinical reasons or patient safety, and occasionally branded prescribing is more cost-effective than generic prescribing. The format of the formulary continues to define when brand prescribe is necessary for clinical or patient safety reasons. For more information and examples refer to "brand or generic prescribing" on the Formulary Information page.

Previously, where a specific brand offered a cost-efficient option to help reduce cost pressures across the NHS, these were listed in the formulary. From March 2020, a list of locally preferred brands is maintained by the NHS Devon CCG Medicines Optimisation (MO) Team and can be found on the NHS Devon CCG Website. These brands are no longer specifically referenced in the Devon Formulary; relevant formulary drug entries have been updated to list the generic name and include a hyperlink to the MO Team preferred brands page.

February 2020

Specialised Medicines Service prescribing guidelines have been agreed for flupentixol decanoate, haloperidol decanoate, and zuclopenthixol decanoate depot injections. The formulary entries have been updated with a link to the guidelines

Liothyronine: GPs who receive a request from a consultant to prescribe liothyronine for a patient who has not previously received liothyronine should contact the CCG Medicines Optimisation team before accepting the request. Click here

Last updated: 27-07-2020


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