Download Halton CCG

Issue 3, March 2014
Halton CCG ................................................................................................................................................................................. 1
Pan Mersey Area Prescribing Committee ................................................................................................................................... 2
Current Issues............................................................................................................................................................................. 3
Drug Tariff .................................................................................................................................................................................. 4
Safety ......................................................................................................................................................................................... 5
National Institute for Health and Care Excellence (NICE) ............................................................................................................ 7
NICE Medicines and Prescribing Centre ...................................................................................................................................... 7
Halton CCG
NEWS
Supply of medication for patients travelling or moving abroad
The Pan Mersey Guidance recommends that prescribers should not routinely supply treatment durations in excess of
three months. The detailed single page guidance is available at
http://www.panmerseyapc.nhs.uk/guidelines/documents/G4.pdf
Rifaximin in overt hepatic encephalopathy
Halton CCG has recently confirmed the local RED status of Rifaximin and any prescribing should remain within
Secondary Care / Specialist prescribing only.
Rifaximin is marketed to reduce episodes of overt hepatic encephalopathy in adults, where treatment with lactulose
as monotherapy had failed. NICE developed two separate Appraisal Consultation Documents (July 13 and Nov 13)
both of which concluded that whilst the drug was clinically effective it was not cost effective. In the light of this
information Halton CCG originally designated it as a RED drug. It is unlikely that NICE will produce a TA for this
product. The recent Quality Committee accepted the recommendation from the Medicines Management Working
Group that the local RED status should remain long term.
ScriptSwitch
Over the last year the current ScriptSwitch profile has been updated regularly and a significant number of messages
have been added and/or updated, contributing to improved patient safety and cost effective prescribing.
Future Plans
As Halton CCG has renewed their ScriptSwitch contract for another year the Medicines Management Team will be
updating the current ScriptSwitch profile through out 2014/2015 in line with the CCG’s requirements.
Your Input
In order for us to tailor ScriptSwitch to the needs of the CCG we need your input. If you have any suggestions or
feedback around the ScriptSwitch profile can you let your practice Medicines Management Team know?
Pan Mersey Area Prescribing Committee
RECOMMENDATIONS
ALOGLIPTIN film-coated tablets (Vipidia®▼)
The Pan Mersey Area Prescribing Committee (APC) does not currently recommend the prescribing of ALOGLIPTIN
film-coated tablets (Vipidia®▼) for the treatment of Type 2 diabetes mellitus.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS37.pdf
ARIPIPRAZOLE depot injection (Abilify Maintena®▼)
The Pan Mersey APC does not currently recommend the prescribing of ARIPIPRAZOLE depot injection (Abilify
Maintena®▼) for schizophrenia.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS39.pdf
CANAGLIFLOZIN film-coated tablets (Invokana®▼)
The Pan Mersey APC does not currently recommend the prescribing of CANAGLIFLOZIN film-coated tablets
(Invokana®▼) for the treatment of Type 2 diabetes mellitus.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS38.pdf
DEXAMETHASONE intravitreal implant (Ozurdex®▼) in the treatment of non-infectious uveitis
Pan Mersey APC recommends the prescribing of DEXAMETHASONE intravitreal implant (Ozurdex®▼) for the
treatment of posterior non-infectious uveitis as a third-line treatment option after use of topical treatments,
periocular corticosteroid injections, and oral systemic treatments such as corticosteroids or immunosuppressants.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS44.pdf
DOXAZOSIN modified release (M/R) tablets (all brands)
The Pan Mersey APC does not recommend the prescribing of DOXAZOSIN modified release (M/R) tablets (all brands).
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS42.pdf
LUBIPROSTONE Capsules (Amitiza®▼)
The Pan Mersey APC does not currently recommend the prescribing of LUBIPROSTONE Capsules (Amitiza®▼) for the
treatment of constipation.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS41.pdf
MENINGOCOCCAL GROUP B VACCINE (Bexsero®▼)
The Pan Mersey APC does not currently recommend the prescribing of MENINGOCOCCAL GROUP B VACCINE
(Bexsero®▼) for the active immunisation of individuals against invasive meningococcal disease.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS40.pdf
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ROSUVASTATIN tablets (Crestor®)
The Pan Mersey APC does not recommend the routine prescribing of ROSUVASTATIN tablets except in the
circumstances described.
http://www.panmerseyapc.nhs.uk/recommendations/documents/PS43.pdf
GUIDELINES
Prescribing for patients living or travelling abroad or otherwise absent from the UK
Pan Mersey Area Prescribing Committee recommends that prescribers should NOT supply treatment durations in
excess of THREE MONTHS for patients who are going to live or travelling abroad or otherwise absent from the UK.
Patients should make local arrangements in their country of residence for on-going medical care.
http://www.panmerseyapc.nhs.uk/guidelines/documents/G4.pdf
Current Issues
NEWS
EMIS Web searches –missing patients
It has been identified in a few practices that some regular patients are missing from EMIS Web searches run from the
Currently Registered population. Further investigation has revealed that these patients were registered using earlier
versions of EMIS, and registration was never fully completed. As a consequence, these patients will not be picked up
in any QOF searches.
Action: To identify these patients, a search can be run for the 'FP1 submitted', ‘FP4 submitted’ and ‘Patient
Presented’ registration status (in one Practice, the search identified 41 patients and 31 of these required further
action). If you require assistance in running this search, please contact your Medicines Management Pharmacist/
Technician. Where patients are identified, the Practice may need to liaise with Patient Services at the Health
Authority to rectify the issue.
QUERY CORNER
Does it matter if the total recommended daily dose of dabigatran is given as a once-daily dose instead of twice a
day, for patients with non-valvular atrial fibrillation (AF) treated for stroke prevention?
In patients with AF, decisions on the appropriate anticoagulant dose and the dosing regimen are based on achieving
a balance between the risk of bleeding (due to high plasma concentrations) and the risk of thrombosis (due to low
concentrations).
After oral dosing, dabigatran achieves peak plasma concentration within 0.5-2.0 hours and has a terminal half-life of
12-14 hours. Twice daily dosing enables dabigatran plasma concentration to be maintained at levels above the
minimum required to achieve anticoagulation, whilst minimising the risks of bleeding.1
Once-daily administration for this indication is not covered by the marketing authorisation in the UK. Boehringer
Ingelheim cannot recommend its use in this way.
1.Clemens A et al. Twice daily dosing of dabigatran for stroke prevention in atrial fibrillation: a pharmacokinetic justification. Curr Med Res
Opin 2012;28(2):1-7
Acknowledgments go to Boehringer Ingelheim for their assistance with this query.
Drug Tariff
PRICE CHANGES
Top ten monthly price reductions
Drug name, formulation, strength, pack, price, reduction
Rivastigmine 2mg/ml oral solution sugar free [1 x 120] £91.26 (-£4.51)
Fenofibrate micronised 67mg capsules [1 x 90] £19.97 (-£3.33)
Olanzapine 20mg orodispersible tablets sugar free [1 x 28] £21.46 (-£2.47)
Aceclofenac 100mg tablets [1 x 60] £9.63 (-£2.30)
Tolfenamic acid 200mg tablets [1 x 10] £12.75 (-£2.25)
Pramipexole 350microgram tablets [1 x 30] £20.35 (-£2.20)
Olanzapine 15mg orodispersible tablets sugar free [1 x 28] £15.91 (-£1.86)
Diclofenac sodium 75mg modified-release capsules [1 x 56] £9.69 (-£1.71)
Irbesartan 300mg/hydrochlorothiazide 12.5mg tablets [1 x 28] £14.47 (-£1.46)
Irbesartan 300mg/hydrochlorothiazide 25mg tablets [1 x 28] £14.47 (-£1.46)
Top ten monthly price increases
Drug name, formulation, strength, pack, price, increase
Bromocriptine 1mg tablets [1 x 100] £60.10 (+£50.20)
Isradipine 2.5mg tablets [1 x 56] £39.74 (+£13.30)
Diethylstilbestrol 1mg tablets [1 x 28] £102.79 (+£7.69)
Orphenadrine 50mg tablets [1 x 250] £216.72 (+£6.84)
Carbimazole 20mg tablets [1 x 100] £110.38 (+£6.76)
Squill oxymel [1 x 2000ml] £40.63 (+£5.95)
Prednisolone 5mg soluble tablets [1 x 30] £42.78 (+£5.58)
Ammonia solution aromatic [1 x 500ml] £12.26 (+£4.09)
Salbutamol 4mg tablets [1 x 28] £69.83 (+£3.74)
Nortriptyline 25mg tablets [1 x 100] £88.08 (+£3.60)
Top 100 annual price reductions
http://www.panmerseyapc.nhs.uk/home/tariff_watch/partviiia_reductions_201402.pdf
Top 100 annual price increases
http://www.panmerseyapc.nhs.uk/home//tariff_watch/partviiia_increases_201402.pdf
DRUG AVAILABILITY
Medication supply issues
The following generic drugs have supply issues and hence are incurring increased costs; they have been given a
NCSO (no cheaper stock obtainable) status for March 2014. Please consider the costs of the following drugs before
prescribing. Note: gabapentin is still considerably less expensive than pregabalin.
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Amiloride 5mg tablets (28) –£19.55
Co-Amoxiclav 250/125 tablets (21) -6.79 (new)
Co-Amoxiclav 500/125 tablets (21) –£6.93
Gabapentin 100mg capsules (100) – £4.11
Gabapentin 300mg capsules (100) – £7.20
Hydroxocobalamin 1mg/ml solution for injection ampoules (5) – £7.99
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Mebeverine 135mg tablets (100) – £18.00
Naproxen 500mg gastro- resistant tablets (56) – £9.99
Propranolol 10mg tablets (28) – £5.80
Propranolol 40mg tablets (28) – £5.14
Propranolol 80mg tablets (56) – £6.50
Other drugs with long-term supply issues
Description
Due date
Comment
Alendronic acid 70mg tablets
Several suppliers unable to
confirm
A raw material issue is causing a
delay in supply – limited availability
Bactroban Nasal® ointment 3g
Supplier unable to confirm
Ongoing supply issue
Bumetanide 1mg tablets
Supplier unable to confirm
Ongoing supply issue
Caverject® Dual Chamber all
strengths
Early 2016
A manufacturing issue is causing a
disruption in supply
Clomipramine 10mg, 25mg and
50mg capsules
Supplier unable to confirm
Ongoing supply issue
Co-amilofruse 2.5/5 and 5/40
tablets
Mebeverine 135mg tablets
Supplier unable to confirm
MHRA issue (recall)
Supplier unable to confirm
A raw material issue is causing a
delay in supply
Valsartan capsules and tablets –
all strengths
June 2014 (although some limited
stocks available)
A raw material issue is causing a
delay in supply
Note: this list has been compiled using information obtained from AAH Pharmaceuticals and Alliance
Pharmaceuticals. Some generics are manufactured by several different companies, which may mean having to ‘shop
around’ for supplies.
For any further information regarding supply problems, please contact your Practice Pharmacist or Technician, or the
Medicines Management Team.
Discontinued lines
Serevent Diskhaler® and refill disks have been discontinued and will not be available after April 2014.
Cipramil® 10mg and 40mg strengths have been discontinued and will not be available after May 2014. Cipramil®
20mg strength tablets remain available.
Forceval Junior® capsules have been discontinued, but Forceval Junior Soluble® tablets remain available.
Safety
Home oxygen patients advised to avoid electronic cigarettes (e-cigarettes)
The European Industrial Gases Association has recommended that e-cigarettes be avoided by patients receiving
home oxygen therapy. Furthermore, batteries of e-cigarettes shouldn’t be charged near a patient receiving oxygen
therapy, or near the oxygen itself. E-cigarettes include a power source that is charged either by a USB power point or
a separate battery charger. The association believes that, when saturated with oxygen, these items may ignite.
New drug-driving offence on the horizon
According to the MHRA, a new driving offence is expected to come into effect later this year that will make it illegal
to drive under the influence of any one of several drugs. The list of drugs includes morphine, methadone,
methamphetamine and several prescription benzodiazepines. Parliament will debate the regulations this coming
summer. Manufacturers of any prescription medicines affected have been asked to amend their packaging to include
additional warnings.
Risk of fire hazard – paraffin-based emollients and home oxygen therapy/air-filled mattresses.
Patients prescribed paraffin/petroleum emollients, particularly large quantities, should be told to keep away from
fire and flames, and not to smoke when using these preparations (MHRA Safety Update Jan 2008). The risk is even
greater if these patients are also on home oxygen therapy and they should be made aware of the risk of fire. Last
year there were 2 fire fatalities in the North West that involved air filled pressure mattresses: The patients involved
were smoking in bed and either fell asleep or failed to discard the smoking materials properly, causing their bed
clothes to set alight. Sadly they both also had paraffin based creams on their legs which quickly contributed to the
fire. As the mattresses then burnt through, the air rushed over the flames causing a massive burst of fuel to support
the fire. As the air generator was at the foot of the bed and away from the seat of the fire, the air flow continued
unabated. In Warrington, the Home Oxygen Service links in with Cheshire Fire and Rescue to carry out risk
assessments, provide advice and help mitigate these risks.
MHRA DRUG SAFETY UPDATE (MARCH 2014)
Orlistat®: theoretical interaction with antiretroviral HIV medicines
Orlistat® may theoretically reduce the absorption of antiretroviral HIV medicines. Initiate Orlistat® treatment only
after careful consideration of the possible impact on efficacy of antiretroviral HIV medicines.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON392868
St John’s wort: interaction with hormonal contraceptives, including implants—reduced contraceptive effect
St John’s wort interacts with hormonal contraceptives. This interaction reduces the effectiveness of these
contraceptives and increases the risk of unplanned pregnancy.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON392869
Strontium ranelate: cardiovascular risk—restricted indication and new monitoring requirements
The European Medicines Agency considered that strontium ranelate should only be used by people for whom there
are no other treatments for osteoporosis. The cardiovascular risks identified with strontium ranelate may be
sufficiently reduced in this population by restricting its use to people without cardiovascular contraindications and
by monitoring cardiovascular risk regularly.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON392870
Methysergide: serious fibrotic reactions—restricted use and new monitoring requirements
There is a risk of fibrosis associated with methysergide (Deseril®) treatment. Methysergide should only be used for
the prophylactic treatment of severe intractable migraine and episodic and chronic cluster headache in adults, when
treatment with standard medicines has failed.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON392871
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Combined hormonal contraceptives: risk of venous thromboembolism—clarification of advice
Clarification of advice regarding what contraception a woman should use instead of CHCs in the event of: major
surgery; a period of prolonged immobilisation; or if she smokes and is older than 35 years.
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON392873
National Institute for Health and Care Excellence (NICE)
CLINICAL GUIDELINES
Osteoarthritis: care and management in adults
This guidance updates and replaces NICE clinical guideline 59 (published February 2008). It offers evidence-based
advice on the care of adults with osteoarthritis.
http://guidance.nice.org.uk/CG177
Psychosis and schizophrenia in adults: treatment and management
This guideline updates and replaces NICE clinical guideline 82 (published in March 2009). It offers evidence-based
advice on the care of adults with psychosis and schizophrenia.
http://guidance.nice.org.uk/CG178
NICE Medicines and Prescribing Centre
GOOD PRACTICE GUIDANCE
Draft NICE lipid modification guidance clarification
NICE is updating its lipid modification guidance which was originally issued in 2008. In the draft guidance, currently
out for consultation, NICE is recommending that the threshold for starting preventive treatment should be halved
from a 20% risk of developing CVD over 10 years to a 10% risk, along with other changes. Please note these are
provisional recommendations only at present, which may change following the consultation. The final guidance is
due for publication in July 2014.
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=66546
The Halton Medicines Management Team is available from Monday to Friday between 9:00am and 5:00pm on
01928 593 452. The team also have a new generic email address that you can use to communicate with us
[email protected]
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