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Joint Formulary Newsletter

Bedfordshire and Luton Joint Formulary Newsletter

July 2021, Number 7

ADDITIONS / DELETIONS to the Joint Formulary agreed by the JPC committee

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
ADDITIONS

  • VisuXL Gel :-  Amber formulary status – Specialist initiation only with GPs to continue.  VisuXL Gel is restricted for use in the following circumstances and can ony be initiated by an Ophthalmologist:-
    • For use in patients with moderate to severe dry eye with corneal staining (long-term prescribing
    • For use post complex corneal surgery  (NB short term prescribing)
  • Ceyesto (Melatonin 3mg immediate release tablets) :- due to be  launched end of August 2021. Amber formulary status.  Ceyesto is an option for  the treatment of insomnia in children and adolscents aged 2-18 years. (NB:This is an off label use- Ceyesto is licensed for short-term treatment of jet lag in adults).

Ceyesto is an additional formulary option for patients:-.

      • who require an immediate release melatonin product
      • who can swallow tablets and are already prescribed an immediate release melatonin product, including those on an unlicensed melatonin liquid preparation or melatonin 1mg/1ml oral solution (Colonis Pharma Ltd)
      • as an option for patients on doses of 3mg, 6mg or 9mg daily

The above recommendations were agreed for new patients, with the switching protocol (which would be individualised rather than a ‘bulk’ switch) to be discussed in more detail with relevant colleagues in primary and secondary care prior to implementation.

DELETIONS

  • Sub-cutaneous (s/c)  infliximab:- Black formulary statuss/c infliximab has been reclassified as Non-Formulary (it was temporarily added to help alleviate pressures during the early stages of the COVID-19 Pandemic but uptake has been minimal). Patients who were already switched to s/c infliximab can continue to receive treatment ; no new patients should be started on s/c infliximab.

 

Hospital Drug and Therapeutic Committee Updates

Drugs and Therapeutics and Prescribing Committees’ decisions are noted for information:

Bedfordshire Hospitals NHS Trust:

  • Ulipristal (Esmya®) – confirmed return to the Formulary as a hospital only drug – restrictions on prescribing added to the Formulary
  • Phenindione – moved to non-Formulary. Only one patient on treatment in Bedfordshire and Luton.
  • Indocyanine green – Formulary addition
  • Mitomycin C for corneal lesions – Indication addition
CCG Prescribing Committees

BLMK Prescribing Committee

No additions or deletions

Wound Care Formulary Group (Ratified by the JPC)
  • No update from the Wound Care Group
Decisions Made By Joint Formulary Group (Ratified by the JPC)

 

  • Hydromol Ointment  Green formulary status – Hydromol Ointment now replaces Epaderm Ointment (Epaderm is now non-Formulary). Hydromol and Epaderm contain the same active ingredients at the same strength and Hydromol is cheaper in both primary and secondary care.
  • Glyceryl Trinitrate Injection Red formulary status- added to Formulary. Has been in widespread use for many years at Bedfordshire Hospitals NHS Trust (BHT site).
  • Nebulised Colistimethate sodium for Non-Cystic Fibrosis Bronchiectasis Amber formulary status – Wording on Formulary has been clarified to reflect JPC approval of use in adults . Specialist initiation and GP continuation
  • Dithrocream – Manufacturer has started a phased discontinuation so the strength required may not be available. To remain on the Formulary at present with information on discontinuation added. To remove from the Formulary when stock exhausted (expected to be around August 2022)

 

NICE Updates

Joint Formulary updates following publication of NICE Technology Appraisal Guidance

CCG Commissioned

The following CCG commissioned items have received positive NICE TA’s and have been added to the Joint formulary as a result:-

  • Bempedoic acid with ezetimibe for treating primary hypercholesterolaemia or mixed dyslipidaemia, [NICE TA694] AMBER formulary status : Specialists initiation and GP continuation.
  • Ezetimibe/bempedoic acid combination preparation has also been added to the Formulary with the same AMBER status
  • Andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban. [NICE TA697] RED formulary status : Specialists use only, no GP prescribing.

NHSE Commissioned

The following NHSE commissioned items have received positive NICE TA’s and have been created as a new drug entry on the Joint formulary as a result:- All of these drugs below have a RED formulary status : To be prescribed in secondary care by a specialist; No GP Prescribing.

  • Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative advanced breast cancer after endocrine therapy [NICE TA 687] (NB: Fulvestrant formulary status has changed from Non-Formulary to Formulary)
  • Acalabrutinib for treating chronic lymphocytic leukaemia, [NICE TA689]
  • Trastuzumab deruxtecan for treating HER2-positive unresectable or metastatic breast cancer after 2 or more anti-HER2 therapies. [NICE TA704]

 

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