Area PrescribingGroup UpdateMarch2014 -Second Edition
Here is a brief summary of prescribing advice following the February& March 2014 meetings of the Area Prescribing Group.Click on the hyperlinks to open individual documents on the intranet.
Traffic Light Drugs List Updates
The following amendments to the Traffic Light Classification have been made:
Lixisenatide, for treatment of Type II Diabetes, was classified as AMBER.
Dapoxetine ,for Premature Ejaculation, was classified as AMBER, including a recommendation that this is only to be prescribed when all the criteria specified in the SPC are met and with a maximum supply of 6 tablets per month.
Rivaroxaban, for the prevention of recurrent Deep Vein Thrombosis and Pulmonary Embolism was classified asGREENbutremains as AMBER for treatment of DVT/PE.
Apixaban, for prevention of Stroke in patients with atrial fibrillationwas classified asGREEN.
Dabigatran,for prevention of Stroke in patients with atrial fibrillationwas classified asGREEN.
Teriflunomide▼, for treatment of Multiple Sclerosis was classified as RED.
Aripiprazole for treatment of moderate to severe manic episodes in adolescents with Bipolar Disorder was classified as AMBER.
New Formulary Updatesare as follows:
Endocrine Chapterhas been updated to include – linagliptin, a DPP-4 inhibitor, in addition to sitagliptin. Linagliptin is the only DPP-4 inhibitor that doesn’t require a dose reduction for any degree of renal impairment, as opposed to sitagliptin, where three different doses are recommended for various degrees of renal impairment.
Shared Care Protocols
Sodium Aurothiomalate -hasbeen reviewed, and now includes advice if CRP is raised and advice around WBC counts has been changedfrom <4.0 x109/l to <3.5 x109/l.
Management of Epilepsy in Childrenhas been revised to incorporate CHM advice regarding the continuity of supply, added in perampanel and changed buccal midazolam preparations from Epistatus to Buccolam.
Guidelines
The following guidelines have been revised and approved:
SYCOMGuidelines
Primary Care Guidelines for the Prevention of Stroke and Systemic Embolism in Non valvular Atrial FibrillationThis is interim guidance, until NICE Guidance in AF is published, which is expected in June 2014.
Guidelineson the administration of medicines to patients with dysphagia.
Medical Management of Diabetic RetinopathyThis describes the recommended medical management of diabetic retinopathy. The cornerstone of management is, as ever, good control of blood sugars, BP and lipids. The document describes the potential role of fenofibrate in patients with retinopathy and offers details on licensing issues, cautions, dosing and potential side effects.
CommonBlood MonitoringThis updated document has been aligned with all current Sheffield Shared Care Policies and Clinical Guidelines. A number of new monographs have also been added to the document e.g. acamprosate, denosumab, fenofibrate, new oral anticoagulants and ticagrelor.
NICE Guidance
NICE BITES February 2014Recommendations apply to men referred to secondary care with suspected or diagnosed prostate cancer, including follow-up in primary care once diagnosed.
MHRA Drug Safety Update
There are strengthened warningson neuropsychiatric side effects associated with mefloquine.
Drug Safety Update February 2014 (including correction)
A recent review of the association between combined oral contraceptives and the risk of venous thromboembolismconcludes that the benefits of treatment far outweigh the risk of serious side effects but recommends that prescribers and women using COCs should be aware of the major risk factors for thromboembolism and remain vigilant for the key signs and symptoms.The advice includes checklists which may be helpful.
Other
A reminder that theT34 Syringe DriverProtocolandT34 SyringeDriver Community Nurse Administered Medication Record Cardare available under Prescribing Guidelines on the CCG intranet.
Drug induced QT Prolongation
Recently there have been warnings relating to drug-induced QT prolongation for three commonly used drugs – citalopram, domperidone and ondansetron. This Medicines Q+A discusses the issues to be considered when assessing the risk of drug induced QT prolongation in individual patients.The American website has regularly updated lists of medicines which cause prolongation of the QT interval.
Electronic Prescription Service& Care Home Residents
It was suggested that all stakeholders; including GP practices, community pharmacists and care home staff, should agree their role in the process and who is to generate the “token” as it is good practice for prescriptions to be checked by the care home prior to dispensing by the pharmacy.
Branding of Anti-epileptics
The MHRA has advised that switching between different manufacturers antiepileptic drugs (AEDs) should be avoided for some specified drugs (category 1). For other AEDs, the decision lies with the individual prescriber dependent on patient factors. The MHRA advises that where it is desirable for a patient to be maintained on a specific manufacturer’s product, this should be prescribed either by brand name or by using the generic name and name of manufacturer. Thus, it is the professional responsibility of prescribers and dispensers to maintain, wherever possible, consistency of supply for the products listed in category 1 and any drugs in category 2 and 3 where patient factors determine a specific need.
For further information on the above, or if you have issues that may need to be addressed by the APG, please contact Sharron Kebell or Gary Barnfield on 0114 3051331. Visit the APG section on the intranet for full details of our prescribing advice and guidelines.
1