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Joint Formulary Newsletter

Bedfordshire and Luton Joint Formulary Newsletter

January 2020, Number 2

Incorporates Key Recommendations from The Bedfordshire and Luton Joint Prescribing Committee (JPC) 4th December 2019

FORMULARY UPDATE

The Bedfordshire and Luton Joint Formulary (a combined medicines formulary for use by BCCG, LCCG, Bedford Hospital and the Luton and Dunstable University Hospital) is now ‘live’. It can be accessed here

Unless otherwise stated decisions made apply to all organisations in the Joint Formulary Group.

FORMULARY TRAFFIC LIGHT STATUS INFORMATION
RED RED - Hospital Only - to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment
AMBER Amber medicines are considered suitable for GP prescribing following specialist initiation
GREEN These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations
SCG Shared Care - These medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place, status reverts to RED.
BLACK A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. DO NOT PRESCRIBE
The following ADDITIONS to the Joint Formulary were agreed at the JPC Committee Meeting

Environmental considerations and inhaler choice (joint formulary chapter 3: respiratory)

Following the publication of the NICE Asthma patient decision aid, a paper was prepared for consideration which outlined cost-effective, low carbon inhaler choices.

As a result, the JPC approved the following additions to the Primary Care Respiratory Guidelines:-

  • Addition of Salbutamol Easyhaler®, as a low carbon option, for COPD and Asthma
  • Addition of Pulmicort Turbohaler® (budesonide), as a low carbon option, for Asthma
  • Addition of Beclometasone Easyhaler®, as a low carbon option, for Asthma

It was agreed that there would be a low carbon inhaler formulary option available for each stage in the treatment pathway, should patients request it.

Primary Care Management of Adult Female Urinary Incontinence (joint formulary chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders)

Following an update to NICE guidelines, the following urinary incontinence treatments were added to formulary:

  • Oxybutynin patches (for patients with swallowing difficulties only)
  • Trospium as 3rd line treatment option.

Bedfordshire and Luton Prescribing Guideline for Dry Eye Management in Adults (joint formulary chapter 11: Eye)

The aim of the guideline is to provide information to Primary Care Prescribers around the treatment steps for dry eye and review the most cost effective brands (branded prescribing recommended in Primary Care).

CCGs will use Scriptswitch/Optimise to support primary care on which brand to prescribe. To facilitate this, secondary care teams will recommend generic products. The following eye drops were added onto the formulary:

  • Sodium hyaluronate 0.4% eye drops
  • Sodium hyaluronate 0.15% with trehalose 3% eye drops (Thealoz Duo®)

N.B: self care is recommended for mild to moderate dry eyes in line with national guidance (Conditions for which over the counter items should not routinely be prescribed in primary care).

Aviptadil/phentolamine intracavernosal injection (Invicorp®) for erectile dysfunction (joint formulary chapter 7: Obstetrics, Gynaecology, and urinary-tract disorders)

  • Invicorp® was added to the formulary as a second line option if PDE5-inhibitors are ineffective, GPs may prescribe after specialist initiation providing patient meets SLS

Rasagiline for Parkinson’s Disease (joint formulary chapter 4: Central Nervous System)

  • Rasagiline was added to the joint formulary. It is included in the Patient Pathway for the Treatment of Motor Features of Parkinson’s disease (Bulletin 262: Opicapone for Parkinson’s Disease) Its use is established locally and may be prescribed in primary care after specialist

Slenyto® brand of melatonin for ADHD

Slenyto® remains a ‘red drug’ – for specialist initation and continuation as per licensed indication pending a business case to accurately determine patient numbers.

Hospital Drug and Therapeutic Committee Updates

The following additions to the Joint Formulary were ratified at Bedford Hospital DTC:-

  • Taurolodine and Citrate 4% (TauroLock®) (approved for use at Bedford Hospital in accordance with Trust Guideline when recommended for use by Vascular Access )
  • Mannitol Challenge Test (Osmohale®) (Restricted to use by Bedford Hospital Respiratory Physiology department)

The following additions to the Joint Formulary were ratified at the Luton & Dunstable Hospital DTC:-

  • Levonorgestrel 20mcg/24hours IUD (Levosert ®)
  • Buprenorphine orodispersible tablets 2mg , 8mg (Espranor®) For use in existing patients only, initiation by specialist dependency services only.This addition is to facilitate continuity of supply for existing patients who have been admitted to the hospital (this specific preparation is now the first line choice recommended by ‘Change Grow Live’, a charity specialising in substance abuse).
  • Pivmecillinam –where sensitivities known and not be used 1st-line
  • Neomycin sulfate 500mg tablets for bowel decolonisation prior to colorectal surgery (hospital only)
  • Ferinject (ferric carboxymaltose injection) for use in obstetric patients
  • Cefepime – Hospital only- for last-line use only where sensitivities are known in severe uncomplicated pyelonephritis caused by ESBL-producing enterobacteracaea or respiratory tract infections where an alternative antipseudomonal beta-lactam is needed.
  • Selegiline orodispersible – for patients with swallowing difficulties. (amber)
  • Tretinoin 10mg capsules – hospital only- restricted to prescribing by Consultant Haematologist for APL (NHSE commissioned) .
CCG Prescribing Committees

BCCG Prescribing Committee

  • Oxypro® – preferred brand of oxycontin prolonged release, promoted via Scriptswitch
  • Nacsys® – First line mucolytic, promoted via Scriptswitch

LCCG prescribing committee

Palmdoc blood glucose test strips

Wound Care Formulary Group (Ratified by the JPC)

UrgoTul SSD has been discontinued in the UK due to new licensing. The replacement product is UrgoTul Silver.

Decisions Made By Joint Formulary Group (Ratified by the JPC)
  • Selegeline formulary status changed to amber
  • Linezolid formulary status changed to amber with following note: – GPs can prescribe linezolid under the specialist direction of a Consultant Microbiologist only, in order to prevent a hospital admission. For all hospital initiated treatment it should be considered ‘hospital only’ and the full course should be prescribed in secondary care and not transferred to
  • Prednisolone E/C –status changed to non-formulary (error during formulary development)–
  • Omeprazole suspension is currently being used at Bedford Hospital in neonates and those with fine gauge tubes whilst ranitidine liquid is unavailable.
  • All depot antipsychotic injections included in the Joint Formulary are listed red – for specialist initiation and continuation only.
NICE Updates

Cannabis based products

  • NICE guideline [NG144] Published date: November 2019, https://www.nice.org.uk/guidance/ng144
  • This guideline covers prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant
  • JPC comment: Sativex is now recommended by NICE as an option for treating spasticity. The JPC has previously endorsed an EoEPAC negative position on this treatment in line with previous NICE Guidance. The Committee confirmed that there should be no prescribing (primary or secondary care) until the drug has been reviewed via EoEPAC and/or local processes (scheduled for February 2020 consideration). Nabilone is recommended for chemotherapy induced nausea and vomiting – no GP prescribing is recommended.

Post JPC the following NICE technology appraisals were published:

Joint Formulary updates following publication of NICE Technology Appraisal Guidance CCG Commissioned

Dapagliflozin with insulin for treating type 1 diabetes, Technology appraisal guidance [TA597] – Joint Formulary updated to reflect TA, for specialist initiation and GP continuation.

 

NHSE Commissioned- New drugs added

(Recommended via Cancer Drugs Fund) – TA link added to formulary website

(Recommended via Cancer Drugs Fund) – added to the Formulary

Neratinib for extended adjuvant treatment of hormone receptor-positive, HER2-positive early stage breast cancer after adjuvant trastuzumab,Technology appraisal guidance [TA612], – added to the Formulary

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