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Area Prescribing Group Update March 2014 - 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
http://www.intranet.sheffieldccg.nhs.uk/medicines-prescribing/traffic-light-drug-list.htm
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 as GREEN but remains as AMBER for treatment of DVT / PE.
Apixaban , for prevention of Stroke in patients with atrial fibrillation was classified as GREEN.
Dabigatran, for prevention of Stroke in patients with atrial fibrillation was classified as GREEN.
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 Updates are as follows:
Endocrine Chapter has 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 - has
been reviewed, and now includes advice if CRP is raised and
advice around WBC counts has been changed from <4.0 x109/ l to <3.5 x109/ l.
Management of Epilepsy in Children has 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:
SYCOM Guidelines
Primary Care Guidelines for the Prevention of Stroke and Systemic Embolism in Non valvular
Atrial Fibrillation This is interim guidance, until NICE Guidance in AF is published, which is
expected in June 2014.
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Guidelines on the administration of medicines to patients with dysphagia.
Medical Management of Diabetic Retinopathy This 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.
Common Blood Monitoring This 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 2014 Recommendations 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 warnings on 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
thromboembolism concludes 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 the T34 Syringe Driver Protocol and T34 Syringe Driver Community Nurse
Administered Medication Record Card are 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 http://www.crediblemeds.org/ 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.
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